Oral hypoglycaemic agents

The UK Prospective Diabetes Study (UKPDS) demonstrated that tight glycaemic control in type 2 diabetes reduces the risk of long-term complications of diabetes.1 For every one per cent reduction in HbA1c, there is a 37% reduction in risk of microvascular events and 14% reduction in myocardial infarction. The study also confirmed that type 2 diabetes is a progressive disease, with pancreatic beta-cell secretion declining with time and insulin resistance increasing. Thus one important aspect of managing type 2 diabetes is to achieve as low an HbA1c as possible, without hypoglycaemia and preferably at the same time achieving or maintaining ideal body weight. With increasing duration of diabetes, it is likely that more and more therapy will be required to achieve these goals. This is an important message to discuss with patients at diagnosis, so that they do not feel ‘failures’ if oral therapy or insulin is required.