TY - JOUR T1 - Evidently... JF - Evidence Based Medicine JO - Evid Based Med SP - 105 LP - 105 DO - 10.1136/ebm.10.4.105 VL - 10 IS - 4 AU - Richard Lehman Y1 - 2005/08/01 UR - http://ebm.bmj.com/content/10/4/105.abstract N2 - 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 Ann Intern Med2005;142:323–32OpenUrlCrossRefPubMedWeb of Science: 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 (Heart2005;91:44OpenUrlAbstract/FREE Full Text–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 … ER -