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Diabetes Drugs Given ‘Too Soon’?

Posted: Tuesday, March 17, 2009

One in three people with Type 2 diabetes are given medication too soon, instead of being urged to eat better and do more exercise, a UK study suggests.

A study of 650 people in south west England found 36% were put on tablets within a month of being diagnosed, a Diabetes UK conference heard, but guidelines recommend first trying lifestyle changes to control diabetes.

A Department of Health spokeswoman said medication helps people to "manage their condition.” The Royal College of GPs agreed diet and exercise should come first.

Dr. Rob Andrew, a senior lecturer at the University of Bristol, said that, “When people are diagnosed, they're ready to make a lot of changes but if you give them a tablet, you're saying it is not their lifestyle that is the problem.”

In the latest study, researchers found that in many patients, lifestyle management was not given a chance, despite being widely recognized as being the initial first "treatment.” Metformin is the first drug of choice, but more drugs can be added if that is not doing enough to control blood sugar levels.

The researchers found that 13% of participants were actually on two types of tablets within the first few weeks of being diagnosed with Type 2 diabetes.

"There is quite clear guidance that says when you're first diagnosed, you should have the opportunity to concentrate on lifestyle, then if that doesn't work the next stage is metformin.”

He added that incentive payments to encourage GPs to reduce blood glucose levels in patients with diabetes, a lack of NHS resources for lifestyle support and a cultural attitude that people will not make the necessary changes are probably all to blame.

Simon O'Neill, from Diabetes UK, said they were concerned that in some cases medication seemed to be the first port of call.

"A healthy, balanced diet and doing physical activity should always be the foundation of good diabetes management. "Type 2 diabetes is a progressive condition - the longer a person has diabetes, the more likely they are to need tablets, and eventually insulin. Even if people are on tablets, medication should not simply replace diet and physical activity." Professor Steve Field, chairman of the Royal College of GPs, said this was probably a case of jumping in too quickly with pills.

"It is a reminder for GPs and nurses managing newly diagnosed diabetes that lifestyle advice is the most important component."

He added that in some areas of the country there was a lack of resources for supporting behavioural changes.

"As the NICE guidelines recommend, people with Type 2 diabetes should be encouraged to make lifestyle changes, such as healthy eating and increased physical activity, before starting medication," she said.