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• W2017691885 abstract "To the Editor: The past decade has witnessed the introduction of numerous novel therapeutic agents for type 2 diabetes, from thiazolidinediones to engineered insulins, not to mention the incretin-based therapeutics that are on the verge of entering the market. Confronted with so many options, many physicians could feel confused and unsure regarding the choice of therapeutic agent. It may therefore be understandable that the American Diabetes Association and the European Association for the Study of Diabetes have judged it necessary to generate a consensus statement on the subject, presented simultaneously in Diabetologia and Diabetes Care by Nathan et al. [1, 2]. Nevertheless, I regret that these two societies, which together exert the strongest influence on world diabetes opinion, decided to publish a consensus algorithm, because I believe that diabetes treatment is too complex to be reduced to a useful algorithm. The heterogeneity of type 2 diabetes is textbook knowledge; diabetic patients are extremely variable regarding their phenotype, disease course, response to treatment, etc., even within homogeneous populations, and different cultures and ethnic backgrounds compound variability. Unfortunately, no single therapeutic agent has the ability to normalise metabolism in type 2 diabetes. With all due respect to the outstanding science behind the development of the thiazolidinediones, they have not even matched the efficacy of age-old drugs such as metformin and sulfonylurea. Therefore, type 2 diabetes therapy continues to very much rely on the experience of the physician, which mainly translates into his ability to identify the right combination of drugs, diet and lifestyle for the individual patient, and his persuasive capacity to have patients adhere to recommendations over the years. To whom does the consensus statement address itself? Certainly not to the diabetes specialist. The authors state that ‘the algorithm that we propose is likely to engender debate,’ and that ‘there was no strong consensus regarding the second medication added after metformin.’ I am convinced there will be even less consensus outside the restricted group of specialists who formulated this ‘consensus’ (sic) statement. Is it for the general practitioner? The decision tree in Fig. 2 suggests the addition of basal insulin, sulfonylurea or glitazone ad libitum if lifestyle modification plus metformin is not sufficient. This is a big help indeed to the non-diabetes specialist! Not to mention the recommendation of intensified insulin treatment—not many of the general practitioners I know would like to assume this responsibility without first consulting a diabetes specialist. I am all for transferring much of the responsibility of diabetes care to general practitioners, provided it is done under the guidance of, and involves continuous interaction with, diabetes specialists. I am strongly against distributing a printed list of recommendations and hoping for the best. Diabetologia (2007) 50:693–694 DOI 10.1007/s00125-006-0573-0" @default.
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• W2017691885 date "2006-12-23" @default.
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• W2017691885 title "Comment on: Nathan DM, Buse JB, Davidson MB et al (2006) Management of hyperglycaemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy. A consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia 49:1711–1721" @default.
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• W2017691885 doi "https://doi.org/10.1007/s00125-006-0573-0" @default.
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