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Friday 29 August 2014

Effectiveness and Safety of the NHS treatment of blood glucose in Type 2 diabetes

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:


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:

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.

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).


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