The reality of type 2 diabetes treatment today

The 5-year targets set by the St Vincent Declaration for cardiovascular events and other diabetes outcomes have still not been met, despite concerted efforts to treat cardiovascular risk factors in this population. Since St. Vincent we have seen a new focus on the care of Type 2 diabetes towards multiple risk factor reduction, including blood pressure, lipids, smoking and glycaemic control. The other new concept is that insulin resistance is a key abnormality in the pathogenesis of Type 2 diabetes. The thiazolidinediones are a new class of drug that ameliorate insulin resistance, and we await to see if their use is associated with improved diabetes outcomes. The third key issue is that modern day diabetes care requires polypharmacy. However, adding several drugs to the list of medications taken by many patients with Type 2 diabetes may bring problems of compliance. A typical patient might be taking several tablets for diabetes, plus medications to address cardiovascular risk factors/disease and typical co-morbidities of an ageing population. There is evidence that adherence to therapy is a major issue in diabetes care. More research is needed to define ways of improving adherence [corrected].