Management of type 2 diabetes: a challenge for patient and physician

Type 2 diabetes mellitus is a chronic disease, associated with serious comp lications and co-morbidity and considerable costs. The number of people wit h diabetes mellitus is expected to increase with 40% in the next decade, du e to prolonged life expectancy, the ageing of the population and developmen ts in the health care sector, including more active screening strategies. T he majority (40-60%) of type 2 diabetes patients in routine GP practice hav e a poor metabolic control (HbAlc > 8% or fasting blood glucose > 11 mmol/l ). In this paper the obstacles in routine clinical practice for optimal typ e 2 diabetes care are discussed. Long-term complications are the major caus e of morbidity and mortality in type 2 diabetes patients. Therefore, the pr imary aim of type 2 diabetes management is the prevention of complications, by lowering blood glucose levels and reducing the cardiovascular risk prof ile. An important component of type 2 diabetes management is an active role of the patient: diet, smoking habits, physical exercise and self-care beha vior often need to change. In addition, the patient has to adhere to life l ong medical therapy. Motivating the patient for this active role is the cha llenge for health care providers. A complicating factor is that changes in lifestyle do not give immediate benefit for the patient, as the effects are seen in the reduction of the development of long-term complications. The c ornerstones of health care to support active patient participation are: to guarantee the continuity of care, to integrate education in health care and to encourage the patient's attendance. It is the challenge for physicians to give type 2 diabetes patients the tools for active participation in the management of the disease. (C) 2000 Elsevier Science Ireland Ltd. All right s reserved.