Australian Family Physician
Australian Family Physician


Volume 38, Issue 1, January-February 2009

Controversies in type 2 diabetes An update

Bu B Yeap
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Controversy has emerged concerning the risks associated with glitazone therapy in type 2 diabetes, specifically bone fracture and myocardial infarction. Results from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study have stimulated debate about appropriate glycated haemoglobin (HbA1c) targets.
This article examines the context for glitazone therapy in patients with type 2 diabetes, the risks associated with pioglitazone and rosiglitazone, and arguments for targeting HbA1c at the threshold of 7%.
Pioglitazone and rosiglitazone can be employed as oral therapy in patients with type 2 diabetes and preserved endogenous insulin secretion. Potential benefits and risks of each agent should be considered. An acceptable initial target for HbA1c is 7%. Lowering HbA1c to 6.5% did not reduce macrovascular complications in patients with type 2 diabetes, but did reduce new or worsening nephropathy. Aggressive therapy aiming to lower HbA1c to <6% in patients with type 2 diabetes at especially high risk of cardiovascular disease may lead to a higher risk of mortality.

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Australian Family Physician RACGP

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