Complications of type II diabetes is the topic covered by the latest Effective Health Care Bulletin from the NHS Centre for Reviews and Dissemination. The main emphasis of the bulletin is on renal disease and self-management. The bulletin recommends that patients' urine be tested at least annually for proteinuria. If the result is negative, microalbuminuria and treatment of hypertension should be offered if a patient's blood pressure consistently exceeds 140/90mmHg.
In a review of trials involving diabetic patients receiving angiotensin converting enzyme (ACE) inhibitors, the bulletin states that this class of drugs is particularly beneficial for patients with diabetic renal disease or microalbuminuria, even if they do not have hypertension. However, patients with high blood pressure but no sign of renal disease are likely to benefit as much from other antihypertensive drugs, it adds. The bulletin reports that "more intensive" control of blood glucose appears to delay the development of renal disease but that this should be balanced by an acceptable quality of life for the patient. There is no conclusive evidence that lipid lowering drugs affect renal function, it states. The bulletin emphasises that, while medical interventions are important, long-term outcomes depend on choices that patients make about their diet, physical activity and other health-related behaviour. Health care professionals have a role to play in ensuring that patients play an active and informed role in the management of their diabetes, it says.
Dr Gillian Hawksworth (chairman of the Diabetes Task Force) commented on March 29 that the recommendations are in line with Royal Pharmaceutical Society guidance for community pharmacists caring for patients with diabetes. This guidance was intended for use with local guidelines to help community pharmacists with the monitoring of patients in line with evidence-based practice. "We would support pharmacists using evidence-based practice, which would include appropriate use of ACE inhibitors," she said.