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French practice guidelines for drug treatment of type 2 diabetes: best ignored

In these guidelines, the French drug regulatory agency AFSSAPS and the main health authority, the Haute autorité de santé (HAS), set unacceptable levels and treatment aims and give equal weight to first-line drugs and drugs with an unfavourable benefit-risk balance.

France’s National Authority for Health, the Haute autorité de santé (HAS), produces a large number of publications, including "clinical practice guidelines" to assist doctors. Apart from a few points, the way that the clinical practice guidelines for drug treatments of type 2 diabetes have been drawn up is unsatisfactory: there are numerous omissions, errors and approximations in the text and in the recommendations; there is no indication of contributors' potential conflicts of interest; general practitioners are under-represented, despite their key role in treating these patients; and no diabetic patient groups are represented.

In these guidelines, some of the suggested levels for commencing treatment are not backed up by clinical trial results. Metformin is naturally suggested as an initial treatment, since it has proved effective in reducing mortality. But the guidelines place it on a par with other oral antidiabetic drugs such as glitazones, whose effect on morbidity and mortality is unknown, or even harmful.

In short, it is better not to follow these clinical practice guidelines.

©Prescrire May 2007

Source: "Trier les publications de la HAS pour se concentrer sur les guides de qualité" Rev Prescrire 2007 ; 27 (283) : 388. "Traitement médicamenteux du diabète de type 2 : l’AFSSAPS et la HAS font la part belle aux médicaments en vogue, sans tenir compte des réalités cliniques" Rev Prescrire 2007 ; 27 (283) : 389.

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