HbA1c targets in type 2 diabetes: guidelines and evidence
Aims of treatment for type-2 diabetes include minimising long-term complications (eg, cardiovascular disease, blindness, chronic kidney disease, premature mortality) and avoiding the unwanted effects of treatment (eg, severe hypoglycaemia, weight gain).
Publication of the UK Prospective Diabetes Study (UKPDS) 33 in 1998 suggested that ‘intensive blood glucose control’ to lower the glycated haemoglobin (HbA1c) in people with type 2 diabetes reduced microvascular disease but not macrovascular complications.
The UKPDS 34 study in overweight patients found that metformin produced less of a reduction in HbA1c but reduced cardiovascular complications and death. Recently, further trials have examined the impact of intensive glycaemic control and have produced conflicting results.
In this article we examine the evidence and guideline recommendations for HbA1c targets; glycaemic control for acutely unwell patients and targets in pregnancy will not be covered (DTB;51:42–5).
What place for racecadotril?
In this article, we review the evidence for racecadotril and its place in the management of acute diarrhoea (DTB 2013;51:54–7).
Glycopyrronium for COPD
In this article, we review the evidence for glycopyrronium and assess its place in the management of chronic obstructive pulmonary disease (DTB 2013;51:66–8).
Prevention of recurrent urinary tract infections in women
Recurrent urinary tract infections (UTIs; usually defined as three episodes in the last 12 months or two episodes in the last 6 months) can have a considerable impact …