Type 2 diabetes is a frequent disease, with severe clinical consequences, especially in the long term: cardiovascular events, damage to or even loss of vision, amputations, severe renal failure. For diabetic patients, the main aim of reducing excess blood sugar (hyperglycaemia) is to prevent or delay these complications. Controlling blood glucose levels is generally monitored by the amount of glycated haemoglobin or HbA1c.

The long-term results of a trial known as the Ukpds trial, which monitored diabetic patients for 17 years, show that keeping HbA1c levels at around 7% during the ten years after diagnosis reduces mortality.

The principles for treating patients with type 2 diabetes are as follows: the initial treatment for hyperglycaemia is based on diet and physical exercise. When these measures are not sufficient to maintain the HbA1c level below 7%, an oral antidiabetic monotherapy should be offered if there are no contra-indications: glibenclamide for diabetic patients who are not overweight, and metformin for those who are overweight.

Insulin is one of the options for patients suffering from type 2 diabetes who do not respond to oral monotherapy.

©Prescrire August 2009

Source: "Diabète de type 2 : viser une HbA1c autour de 7 %" Rev Prescrire 2009; 29 (305): 207.
"Type 2 diabetes: target HbA1c of about 7%", Prescrire Int 2009; 18 (102): 178.

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