Type 2 diabetes is a complex disorder generally affecting older people who are often overweight and likely to suffer other medical problems as well. Its management presents considerable challenges to medical and nursing staff, whose care must be directed at the sum of the problems of the individual patient. Management now requires not only attention to blood glucose control, but also to the treatment of hypertension and hyperlipidaemia, as well as introducing the necessary measures for reducing cardiovascular risk factors.
Optimal treatment of Type 2 diabetic patients, especially those who are symptom-free, overweight and have in addition several cardiovascular risk factors, exercises our clinical skills and judgments to the limit. There needs to be a sense of reality within the consultation, bearing in mind the potential dangers of unacceptable polypharmacy accompanied by low adherence to prescribed treatment as well as a sense of guilt experienced by those who fail to achieve ideal targets set by physicians. Awareness of the priorities and intentions of individual patients needs to be given consideration, and patients need to agree on the objectives for treatment. Recommendations for treatment must be clinically relevant for the individual patient, who should be involved in choosing which of the many therapeutic options to select after explanation of advantages and risks. The difficulties of controlling Type 2 diabetes tend to increase with the passage of time as the disease progresses. Management is often difficult and needs to be pragmatic: the late Professor John Malins when asked how this should be done used to quote the advice given by Chekhov to his actors—that it should be "done as well as possible".
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