Comment on: Nathan DM, Buse JB, Davidson MB et al. (2006) Management of hyperglycaemia in type 2 diabetes:a consensus algorithm for the initiation and adjustmentof therapy. A consensus statement from the American Diabetes Association and the European Associationfor the Study of Diabetes. Diabetologia 49:1711–1721

Excerpt

To the Editor: The American Diabetes Association and European Association for the Study of Diabetes consensus document on the management of hyperglycaemia in type 2 diabetes [1, 2] states that while ‘a lifestyle intervention programme to promote weight loss and increase activity levels should ... be included as part of diabetes management’, ‘the beneficial effects of such programmes are usually seen rapidly, within weeks to months, and often before there has been substantial weight loss’, a statement supported by a 40-year-old reference. The whole section on lifestyle interventions dismisses them as desirable in principle but hardly worth a try because of their ‘limited long-term success ... to maintain glycaemic goals in patients with type 2 diabetes’. There are even suggestions that increased physical activity may lead to ‘potential problems associated with neuropathy, such as foot trauma and ulcers’, a notion unsupported by systematically collected evidence, indeed by no reference at all. They also suggest that ‘the most convincing long-term data that weight loss effectively lowers glycaemia have been generated in the follow-up of type 2 diabetic patients who have had bariatric surgery’, hardly a model of lifestyle intervention in the average person with type 2 diabetes. Hence, the recommendation to start newly diagnosed patients straight on ‘lifestyle intervention + metformin’. …