Recent trials and meta-analyses have raised questions about choice of therapy and use of strict glycaemic targets
In August 2006, representatives of the American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD) published a consensus algorithm for glycaemic management of type 2 diabetes.1 The algorithm provoked debate, but the authors defended their recommendations,2 including the introduction of metformin at diagnosis and the addition of insulin, sulfonylureas or glitazones as second-line therapy if satisfactory glycaemic control is not achieved. The glycaemic target at this and later stages of therapeutic intensification was a glycated haemoglobin (HbA1c) level less than 7.0%. However, based on epidemiological data from studies suggesting no threshold for microvascular or macrovascular benefit, including pooled results from the United Kingdom Prospective Diabetes Study (UKPDS),3 organisations such as the ADA suggested more stringent goals — including a normal HbA1c level (< 6.0%) — if the clinical situation allowed this.4
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