Earlier treatment urged for type 2 diabetes; new guidelines focus on lowering glucose

Lifestyle changes and metformin use are recommended as first-line therapies for patients with this disease.

By Susan J. Landers, AMNews staff. Sept. 4, 2006.

Washington -- Inspiring a sea change in the way physicians approach type 2 diabetes is the intent of a new consensus document by the American Diabetes Assn. and its European counterpart. Specifically, this user-friendly algorithm was developed to motivate primary care doctors to treat high blood glucose levels aggressively.

Its message is clear: No longer should A1c levels of 7% or higher be tolerated. Treatment should begin immediately, and there should be an on-going and persistent focus on lowering that number.

The directive, which was published in the August Diabetes Care, also focuses on this treatment style as a way to free physicians from what many people see as the clinical inertia that is blocking appropriate care for patients with diabetes.

There is no doubt that type 2 diabetes constitutes a huge health concern. The Centers for Disease Control and Prevention estimates that more than 20 million people age 20 and older in the United States already have the disease. Growing levels of obesity promise that more will soon follow.

Many studies have found that the risk it poses to nearly all parts of the body is lowered when blood glucose levels are brought as close to the nondiabetic range as possible. But findings also show that it's sometimes two or three years before this control is reached, said John Buse, MD, PhD, director of the University of North Carolina's Diabetes Care Center in Chapel Hill. He was one of several authors of the algorithm.