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This site contains information, news and advice for healthcare professionals.You have informed us that you are not a healthcare professional and therefore we are unable to provide you with access to this site. The new recommendations advise adapting treatment to each patient’s situation, including history, wishes, and willingness to make lifestyle changes.
Actual treatment targets which are now emphasised are patient-oriented outcomes, in general related to micro- and macrovascular events (e.g. The first and most widely used medical treatment is metformin, a biguanide whose mechanism of action predominately involves reducing hepatic glucose production. If the HbA1c target is not achieved after ?3 months, there are five drug choices including a second oral agent (sulfonylurea, TZD, or DPP-4 inhibitor), a GLP-1 receptor agonist, or basal insulin (see general algorithm).
Because there has been no good quality study comparing all available treatment strategies, there is no clear-cut decision tree as there was in the previous hyperglycaemia guidelines, and shared decision making with the patient is important to help in the selection of therapeutic option. On average, any second agent is typically associated with a further reduction in HbA1c of approximately 1%. Evidence suggests that there is some advantage in adding a third noninsulin agent to a two-drug combination not achieving the glycaemic target. In using triple combinations the essential consideration is obviously to use agents with complementary mechanisms of action.
Diet, exercise, and education remain the foundation of all type 2 diabetes treatment programmes. After metformin, though data are more limited, it is reasonable to consider combination therapy with an additional 1-2 oral or injectable agents with the objective of minimising side effects where possible. For many patients insulin therapy alone or in combination with other agents will ultimately be required to maintain glucose control.

All treatment decisions, where possible, should take into account the patient’s preferences, needs, and values.
Reference: [adapted] Position Statement of the American Diabetes Association and the European Association for the Study of Diabetes. Do you agree that private hospitals should be paid via the NTPF to cut public hospital waiting lists? People with type 1 diabetes have shorter lives than those without the condition, a study by researchers at Dundee University and the Scottish Diabetes Research Network has shown.The study, published in the Journal of the American Medical Association, found that in 24,692 patients aged 20 or above in Scotland, the average loss of life expectancy was 11 years for women and 13 years for men. Stay social with Independent Nurse by following us on Twitter, liking us on Facebook or connecting on LinkedIn.
The American Beverage Association (ABA) is suing the city of San Francisco, claiming legislation passed early June violates the First Amendment.
As reported in B&T, San Francisco supervisors unanimously passed legislation requiring health warnings on sugar-sweetened drinks and prohibiting any outdoor advertisements within the city. The ABA alleges that the ban, “discriminates against speech based on the identity of the speaker, in violation of the First Amendment, by expressly prohibiting speech that includes the name of any sugar-sweetened beverage produce. Other consumer groups joining the ABA include the California State Outdoor Advertising Association and the California Retailers Association.
These much-anticipated new treatment guidelines rely on a more individualised approach, and not as much on a strict glycated haemoglobin (HbA1c) target.
The choice is based on patient and drug characteristics – including willingness to self-inject or need for weight loss – with the over-riding goal of improving glycaemic control while minimising side effects.
Reconsider the approach promptly if it proves to be unsuccessful, as months of uncontrolled hyperglycaemia should specifically be avoided. Since diabetes is associated with progressive ?-cell loss, many patients, especially those with long-standing disease, will ultimately need to be transitioned to insulin.

Your general web browsing experience will be much improved if you upgrade for free to Internet Explorer 9 or Google Chrome. HbA1c) generally reflect changes in the probability of developing microvascular disease but not necessarily macrovascular complications. On the basis of findings from ACCORD  and other studies, the guidelines set the HbA1c goal at 7% in general, but with some individualisation (e.g. It lowers blood sugar levels and may help reduce cardiovascular risk without increased risk of hypoglycaemia and weight gain. The downside of using aggressive treatment to decrease HbA1c is the risk for complications associated with hypoglycaemia, as patients with hypoglycaemia have higher risks for almost all outcomes, including micro- and macrovascular outcomes. However, metformin is associated with initial GI side effects, and caution is also advised to avoid its use in patients at risk for lactic acidosis (e.g. The study also found that 76 per cent of men and 83 per cent of women without type 1 survived to age 70 years compared with 47 per cent of men and 55 percent of women with type 1 diabetes.The study's authors suggested that life expectancy for diabetics has improved in recent years.
They cited an American study which reported that the loss in life expectancy with type 1 diabetes was 27 years in 10,538 patients between 1951 and 1971, as well as an estimate of 20 years on the Diabetes UK website. However, they said that a true comparison of life expectancy could not be made because no historical data existed for a similar cohort.

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