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Mr AS – 42 year old

Explore the benefits and considerations of intensive glucose lowering treatment in type 2 diabetes. Learn about the impact on mortality and morbidity, the importance of lifestyle factors, and the role of medications like metformin, aspirin, and statins.

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Mr AS – 42 year old

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  1. Mr AS – 42 year old “I’ve lost some weight recently, been thirsty and my brother in law has diabetes. My blood glucose was 24” Intensive glucose lowering treatment in type 2 diabetes. Preiss et Ray BMJ 2011;343:doi:10.1136/bmj.d4243 (Published 26 July 2011) MeReC Bulletin Volume 21 Number 5 June 2011

  2. What do I do, why do I do it? • Type 2 – prevalence now over 4.1% (inc 0.8% in 4 years from 2004-8) • Huge burdens on NHS, £450m to £650m • Huge personal burdens • My patient will die 6 years earlier • Most commonly of CVD (and some cancers ) • Microvascular burden

  3. “Aggressive therapy of each aspect of care may not be appropriate or feasible for every individual patient” Smoking Lifestyle Control blood pressure Education Control blood glucose Metformin “There are no arguments in favour of poor glucose control. Poor glucose control is associated with increased mortality and morbidity. “ Aspirin Statin

  4. Benefits of variety of surrogate points -5 yr

  5. Estimated effects from 0.9% reduction in HbA1c, on a variety of “end points”

  6. Mortality against HbA1c - from “Survival in people with type 2 diabetes as a function of HbA1c” – Lancet 2010 A=oral B=insulins

  7. What will you do, why will you do it?

  8. “Aggressive therapy of each aspect of care may not be appropriate or feasible for every individual patient” Smoking Lifestyle Control blood pressure Education Control blood glucose Metformin “There are no arguments in favour of poor glucose control. Poor glucose control is associated with increased mortality and morbidity. “ Aspirin Statin

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