The NHS treatment of blood glucose in Type 2 diabetes may be
illustrated by means of a flowchart of embedded tests of HbA1c tests
and appropriate prescription of oral medications and (if necessary) insulin.
Examples of such flowcharts are given by:
and
Two issues arise with oral medications: effectiveness and safety.
A recent paper addressing these issues is “Comparative Effectiveness and Safety of Medications for Type 2 Diabetes:
An Update Including New Drugs and 2-Drug Combinations” and available from:
Effectiveness
1.
Most 1-drug
medications decreased the HbA1C by about 1 percentage point.
2.
Most 2-drug
medications decreased the HbA1C by about a further 1 percentage
point.
3.
Metformin
decreased low-density lipoprotein cholesterol levels compared with
pioglitazone, sulfonylureas, and DPP-4 inhibitors.
Safety
1.
Sulfonylureas
had a 4-fold higher risk for mild or moderate hypoglycaemia than metformin
alone and, in combination with metformin, had more than a 5-fold increased risk
compared with metformin plus thiazolidinediones.
2.
Thiazolidinediones
increased risk for congestive heart failure compared with sulfonylureas.
3.
Thiazolidinediones
increased risk for bone fractures compared with metformin.
Further
discussion on the safety of oral medication (and usefully expressed in layman terms
is given by:
Like Eddie and Graham I was diagnosed almost 75 months ago
and needing to achieve a greater HbA1C decrease than 2% and also not
wishing to suffer hypoglycaemia or other adverse side effects I implemented a
low carb lifestyle. The results: 75 months with HbA1C averaging 5.4%
with lowest 5.1% and highest 5.7% (Christmas and Chinese New Year).
John
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