HbA_1c targets in type 2 diabetes: guidelines and evidence

• Aims of treatment for type-2 diabetes include minimising long-term complications (eg, cardiovascular disease, blindness, chronic kidney disease, premature mortality) and avoiding the unwanted effects of treatment (eg, severe hypoglycaemia, weight gain).

• Publication of the UK Prospective Diabetes Study (UKPDS) 33 in 1998 suggested that ‘intensive blood glucose control’ to lower the glycated haemoglobin (HbA1c) in people with type 2 diabetes reduced microvascular disease but not macrovascular complications.

• The UKPDS 34 study in overweight patients found that metformin produced less of a reduction in HbA1c but reduced cardiovascular complications and death. Recently, further trials have examined the impact of intensive glycaemic control and have produced conflicting results.

• In this article we examine the evidence and guideline recommendations for HbA1c targets; glycaemic control for acutely unwell patients and targets in pregnancy will not be covered (DTB;51:42–5).

What place for racecadotril?

In this article, we review the evidence for racecadotril and its place in the management of acute diarrhoea (DTB 2013;51:54–7).

Glycopyrronium for COPD

In this article, we review the evidence for glycopyrronium and assess its place in the management of chronic obstructive pulmonary disease (DTB 2013;51:66–8).

Prevention of recurrent urinary tract infections in women

• Recurrent urinary tract infections (UTIs; usually defined as three episodes in the last 12 months or two episodes in the last 6 months) can have a considerable impact …