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Survey
Exposes Inconsistencies Between Long-Term Ambition and Current Clinical
Practice in the Management of Type 2 Diabetes
93 per cent of GPs
feel that the increase of Type 2 diabetes-related complications will
exert a significant pressure on their practice, according to a new
survey 1. To address this, 86 per cent identify prevention of
long-term diabetes-related complications as the most important factor
when treating their patients 1. However, indicators of
current clinical practice 2 show GPs are still focusing on
short-term intervention rather than tackling long-term needs of
patients.
Metformin
is the first line therapy for glycaemic control, but when metformin
therapy is not enough, GPs are still adding in a sulphonylurea 2.
Sulphonylureas rapidly address symptoms of diabetes and glycaemic
control in the short-term, but the landmark UKPDS study has demonstrated
that over the longer-term, initial improvements in glycaemic control are
lost 3. In addition, this treatment approach does little to
address the root cause of the disease, insulin resistance.
The
current approach of the majority of GPs appears all the more surprising,
when 79 per cent of the GPs surveyed ranked short-term glycaemic control
as the least important issue when introducing a second line treatment
for Type 2 diabetes 1. Furthermore, 68 per cent recognised
insulin resistance as an important risk factor to manage 1.
Research by Saydah et al shows
that 63 per cent of patients are unable to achieve target HbA1c levels
of 7 per cent 4 , which further suggests that traditional
approaches are not delivering long-term glycaemic control in the
majority.
Commenting
on the results of the survey, Dr. Eugene Hughes, Isle of Wight GP with a
special interest in Diabetes said: “It is extremely encouraging
to see that the intent to address the underlying cause of Type 2
diabetes is high on the GPs’ list of priorities. However, if we
are going to try and turn our beliefs into a reality we must ensure we
adopt effective options to have a positive impact on the long term
pressures we all recognise.”
The
association between insulin resistance and cardiovascular disease is as
strong as that seen for smoking 5, and it is the cause of
death for almost three quarters of those with Type 2 diabetes 6.
Agents that address insulin resistance (insulin sensitisers) demonstrate
both long term glycaemic control 7 and positive effects on a
range of cardiovascular risk factors 8, and are the logical
early addition to metformin monotherapy, or as combination.
Dr Hughes added:
“These new results clearly illustrate the need to challenge current
practice and consider an approach which fundamentally addresses insulin
resistance as well as providing lasting glycaemic control.”
The survey was conducted in July amongst 200
GPs
About
Type 2 diabetes
1.
Type 2 diabetes is an inability
to process glucose properly due to a combination of genetic and
environmental factors, particularly obesity. This leads to insulin
resistance and ultimately a failure to produce enough insulin for the
body’s needs.
2.
Type 2 diabetes is a
progressive illness that can lead to serious long-term complications,
such as heart disease, stroke, blindness and kidney failure.
About
rosiglitazone plus metformin
1. A
combination of rosiglitazone and metformin, Avandamet™ (rosiglitazone
/ metformin HCl), is indicated for the treatment of Type 2 diabetes,
particularly in overweight patients, unable to achieve sufficient
glycaemic control at their maximal tolerated dose of metformin alone.
2. Rosiglitazone
is also indicated as oral monotherapy for the treatment of Type 2
diabetes, particularly in overweight patients, inadequately controlled
by diet and exercise for whom metformin is inappropriate because of
contraindications or intolerance.
3.
TNS GP Internet Omnibus, July
2004
1.
2. Bonora E, Formentini
G, Calcaterra F. HOMA-estimated insulin resistance is an independent
predictor of acrdiovascualr disease in type 2 diabeteic subjects.
Diabetes Care 2002; 25 (7) 1135-1141
2.
Jariwala S, Mather R, Walker L.
Diabetic Medicine 2003; 20 (suppl 2) 105
3.
Budd S et al. The
incidence of non insulin dependent diabetes mellitus in the community:
extrapolation to the
UK
suggests over 95,000 new cases per year.
Diabet Med 1998; Suppl 2: S11, Abs 30
4.
10.
American Diabetes
Association, Implications of the United Kingdom Prospective Diabetes
Study. Diabetes Care 1998; 21 (12) 2180-2184
5.
12.
Hallsten K et al.
Rosiglitazone but not metformin enhances insulin and exercise stimulated
skeletal muscle glucose up date in patients with T2D. Diabetes 2002; 51:
3479-3485
(21/8/04) |
