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Time to Ditch Diet-Only Diabetes Treatment?

Diet-Only Care for Type 2 Diabetes Failing Patients, U.K. Study Suggests
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WebMD Health News

July 29, 2004 -- Type 2 diabetes patients getting diet-only treatment may not be getting the best medical care, a British study shows.

Most patients with type 2 diabetes get blood sugar-lowering drugs. That's because clinical trials suggest that such patients do better when they keep their blood sugar under tight control.

But some type 2 diabetes patients' doctors simply tell them to keep a careful eye on what and how much they eat. Whether they do this or not, such patients are said to be getting "diet-only treatment." In a study of 7,870 diabetes patients in British general practices, nearly a third were getting diet-only treatment, report Julia Hippisley-Cox, MD, and Mike Pringle, MD, of the University of Nottingham. Their study appears in the July 31 issue of The Lancet.

"Patients with diabetes on diet only are receiving less intensive review of their condition and fewer referrals to, for example, dieticians," the researchers write. "They also have a high rate of complications."

The problem stems from the tendency of some patients -- and some doctors -- to believe in "mild diabetes," Hippisley-Cox and Pringle suggest. Doctors may consider such patients to be at lower risk of complications than other patients with type 2 diabetes.

To some extent, this is true. The researchers found that four out of five patients being treated with blood-sugar-lowering drugs had at least one diabetes complication. The rate was lower in those being treated with diet only. Two out of three had at least one complication.

By any standard, that's a high rate of complications.

"The fact that 60% of those treated by diet only have vascular complications, 20% have diabetes-related eye disorders, 9% have neuropathy, and 9% have [kidney] complications is worrying," Hippisley-Cox and Pringle write.

And type 2 diabetes patients getting diet-only treatment aren't watched as closely by their doctors, the researchers found. They're less likely to get referrals to other specialists. They are less likely to have their cholesterol checked; and when it is checked, they're less likely to get cholesterol-lowering drugs. They are more likely to have high blood pressure, yet less likely to be getting blood pressure-lowering drugs.

The researchers suggest that if doctors feel diet-only treatment is best for a patient -- and for some patients, it may well be -- they should monitor them much more carefully.

SOURCE: Hippisley-Cox, J. and Pringle, M. The Lancet, July 31, 2004; vol 364: pp 423-428.

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