title: Management of type 2 diabetes: the current situation and key opportunities to improve care in the UK.
abstract: In common with global trends, the number of individuals with type 2 diabetes in the UK is rising, driven largely by obesity. The increasing prevalence of younger individuals with type 2 diabetes is of particular concern because of the accelerated course of diabetes-related complications that is observed in this population. The importance of good glycaemic control in the prevention of microvascular complications of diabetes is widely accepted, and there is a growing body of evidence to support a benefit in the reduction of cardiovascular events in the long term. Despite the importance of maintaining a healthy weight for the prevention of type 2 diabetes, the results from trials of lifestyle intervention strategies to reduce body weight have been disappointing. New glucose-lowering agents offer some promise in this regard, offering an opportunity to combat the dual burden of hyperglycaemia and obesity simultaneously. The timing and appropriate choice of glucose-lowering therapy has never been more complex as a result of rising prevalence of obesity in the young, concomitant obesity in some 90% of adults with type 2 diabetes and an ever-increasing range of therapeutic options. The present review evaluates performance measures specific to weight and glycaemic control in type 2 diabetes in the UK using data from the Quality and Outcomes Framework in England and Wales, and the Scottish Diabetes Survey. Potential barriers to improvement in standards of care for people with type 2 diabetes are considered, including patient factors, clinical inertia and the difficulties in translating therapeutic guidelines into everyday clinical practice.
authors: Institute of Life Sciences, University of Swansea, Swansea, UK.
authors: S C
authors: SC
authors: Bain
authors: Beta Cell Diabetes Centre, Chelsea and Westminster Hospital, London, UK.
authors: M
authors: M
authors: Feher
authors: Diabetes and Research, Centre for Endocrinology, Royal Surrey County Hospital, Guildford, UK.|Diabetes and Metabolic Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
authors: D
authors: D
authors: Russell-Jones
authors: Diabetes Research Centre, University of Leicester, Leicester, UK.
authors: K
authors: K
authors: Khunti
mesh_terms: D001786:Blood Glucose; D048909:Diabetes Complications / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D019468:Disease Management; D004739:England; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D009765:Obesity / Q000150:complications / Q000378:metabolism / Q000628:therapy*; D058996:Quality Improvement; D006113:United Kingdom; D061217:Weight Reduction Programs
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents
keywords: cost-effectiveness; diabetes complications; glycaemic control; type 2 diabetes