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Because sugar was historically the defining feature of diabetes mellitus (meaning “excess urination of honey”), treatment focused primarily on lowering blood glucose levels until recently. However, based on high-quality evidence from meta-analyses, glucose control should no longer be the main focus of treatment. A new approach to the care of adults with type 2 diabetes emphasizes proven interventions that improve duration and quality of life.
Bolstering data from the University Group Diabetes Program published in 1970,1 four more recent studies have shown that intensive treatment aimed at lowering blood glucose levels neither affects mortality nor decreases complications of type 2 diabetes.2-5 In contrast, interventions that are especially effective at extending life in these patients include smoking cessation,6 blood pressure control, and reduction of lipid levels.5 The United Kingdom Prospective Diabetes Study also showed that treatment with metformin (Glucophage) decreases mortality, regardless of its effect on blood glucose or A1C levels.7 These findings are reflected in new guidelines from the American Diabetes Association and the European Association for the Study of Diabetes.8
An easy way to illustrate this new approach to patients is by “lending a hand” (Figure 1).4,5,7,9-14 From thumb to little finger, each digit on an open hand portrays one intervention in decreasing order of benefit: smoking cessation (thumb), blood pressure control (index finger), metformin therapy (middle finger), lipid reduction (ring finger), and glycemic control (little finger).5,7,14-16
Step 1 (Thumb): Smoking Cessation
Smoking poses a greater...