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  1. Richard Lehman, MRCGP, MA
  1. Department of Primary Care, Oxford University, Oxford, UK

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    Eat less and take more exercise: ancient wisdom, seldom heeded by the rich, or even by those giving it. But it’s one way to prevent diabetes, as the Diabetes Prevention Program showed; the other way is to take metformin. The costs and benefits of the 2 approaches are modelled in

    : lifestyle modification is definitely the better bet. Once the diabetic threshold has been crossed, the risk of cardiac death is markedly increased, and the best marker seems to be QT interval abnormality rather than ambulatory blood pressure or ankle/brachial pressure index (–50). There has been a lot debate about the value of self monitoring of blood glucose in type 2 diabetes treated without insulin, and the Cochrane Review CD005060 provides a welcome analysis—some evidence of benefit, though we still need a large prospective study to decide the issue. Crossing the insulin threshold brings further problems—many people are needle-phobic to start with, so it’s tempting to offer a once daily regime, such as insulin glargine; but the …

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