Glucose control in diabetes - how low should you go?

Unexpected and conflicting findings of recent diabetes studies raise the question of how aggressively doctors should manage glucose control in people with type 2 diabetes.

In the latest edition of Australian Prescriber, Dr Kris Park, Head of Diabetes and Endocrinology at Nepean Hospital, cautions that aggressive therapy is not the best approach for all patients.

Dr Park's editorial summarises results of the ACCORD (Action to Control Cardiovascular Risk in Diabetes) and ADVANCE (Action in Diabetes and Vascular Disease) studies.

"In patients with a long duration of diabetes and established vascular disease, tight glycaemic control may not improve the cardiovascular outcomes. Rapid correction of hyperglycaemia and excessively tight glycaemic control appears harmful and should be avoided," Dr Park warns.

Recommended blood glucose levels are given for high-risk individuals, and Dr Park notes the target can be adjusted for each patient with regular assessment for severe hypoglycaemic episodes and hypoglycaemia unawareness.

"The findings from the ACCORD and ADVANCE studies are important but they do not change the treatment goal for most patients with type 2 diabetes," Dr Park writes.

"Optimal therapy for people with diabetes includes addressing not only glycaemic control, but also other coexisting vascular risk factors such as hypertension, lipid abnormalities and platelet dysfunction," Dr Park concludes.

Also covered in this edition of Australian Prescriber is 'Prescribing in liver disease'. Dr Andrew Sloss and Dr Paul Kubler of the Royal Brisbane Hospital discuss the need for the careful choice of drug and dose when prescribing for patients with hepatic impairment.

(Source: National Prescribing Services Limited: Australian Prescriber: April 2009)

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