Diet-only diabetes strategy not ideal

British doctors could do a lot better in their efforts to manage patients with type 2 diabetes, say the authors of a report in The Lancet.

Their study of 7870 diabetics from 42 general practices showed that 31 percent were being managed with diet only. These patients had less rigorous monitoring than those taking drugs and had more problems, such as poor sugar control and high blood pressure.

The findings suggest the management strategy of using diet only in type 2 diabetes is still very common, Drs. Julia Hippisley-Cox and Mike Pringle, from the University of Nottingham, note.

"We weren't expecting to find such big differences between patients who are on medication and those on diet-only treatment. I think we were expecting to find the overall monitoring in those two groups to be similar," Hippisley-Cox told Reuters Health.

People with type 2 diabetes might be effectively managed with diet only, but there needs to be better routine monitoring and more intensive therapy if sugar control, blood pressure, or cholesterol are not optimum, the authors point out.

The researchers found a four-fold variation between practices in the proportion of patients treated with diet only - ranging from 15 to 74 percent of patients.

The implications are all the more serious since many people with diabetes on "diet only" do not take their diet seriously, they continue. Conservative estimates suggest that 1 percent of Britons have diabetes controlled by diet alone.

"There is clearly considerable scope for improving the care received by these patients," the authors write.

Clinical trials in recent years have shown the benefits of drug treatment for patients with type 2 diabetes, but sometimes the results of trials "take time to filter through" to clinical practice, Hippisley-Cox said.

She hopes this report will "encourage (doctors) to look at patients on diet-only treatment" and reconsider how these patients are being managed. In the long run, more monitoring of these patients is needed to prevent complications.

SOURCE: The Lancet, July 31, 2004.