ABC of Diabetes, Sixth Edition by Tim Holt, Sudhesh Kumar

By Tim Holt, Sudhesh Kumar

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On commencing statins, patients should be advised to report unexplained myalgia or muscle weakness. Statin-induced myositis is not common but can be a serious problem if the drug is not withdrawn. However, mild muscle aches without evidence of myositis are much commoner and are not necessarily an indication for statin withdrawal. Fibrates are appropriate drugs for those intolerant of statins, but can also cause myopathy. 3 mmol/l despite statin therapy. In patients with previous myocardial infarction, omega-3 fatty acids have been shown to reduce CVD and all-cause mortality.

Very few well-designed studies on multifactorial interventions have been published to date. A seminal study in this regard was Steno-2, which provided evidence of the 1 2 3 4 5 6 7 Intensive therapy Conventional therapy 8 9 10 11 12 13 Years of Follow-up No. 6 Cumulative incidence of cardiovascular events (a), and of death (b) in the Steno-2 study. Reproduced with permission from Gaede P. N Engl J Med 2003;348:383–93. 6). One-hundred and sixty type 2 patients with microalbuminuria were randomised to receive conventional treatment in accordance to national Danish guidelines or to an intensive treatment arm.

E. less than 3 months) are legally obliged to inform the Driver and Vehicle Licensing Agency (DVLA). Advice to inform the DVLA should be recorded in the notes. DVLA regulations are revised from time to time and the latest guidance should be consulted. 3 Proportion of patients attaining treatment goals in UKPDS. diet 3 years 6 years 9 years diet 10 0 3 years 6 years 9 years Prepared from data reported in: United Kingdom Prospective Diabetes (UKPDS) Group (49). JAMA 1999; 281: 2005–2012. 30 ABC of Diabetes Difficulties in achieving targets Despite concerns about over-treatment, the reality is that too few patients manage to achieve their target HbA1c.

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