TY - JOUR T1 - Tailoring treatment to risk in type 2 diabetes JF - British Journal of General Practice JO - Br J Gen Pract SP - 158 LP - 160 DO - 10.3399/bjgp10X483463 VL - 60 IS - 572 AU - Jonathan Graffy Y1 - 2010/03/01 UR - http://bjgp.org/content/60/572/158.abstract N2 - Detecting and managing type 2 diabetes forms an increasing part of everyday practice, with prevalence estimates suggesting that 3.5–5% of the UK population are affected.1 Although care has improved in recent years, partly because the Quality and Outcomes Framework (QOF) has encouraged systematic approaches to reducing metabolic risk, this success has prompted important questions about how aggressive therapy should be.Managing hyperglycaemia is only part of diabetes care, but it seems to generate much of the controversy, with uncertainty about both the safety and affordability of new QOF targets2 and medications.3 On top of this, changes to the way that glycated hemoglobin (HbA1c) is reported will mean that clinicians need to spend time explaining the revised values to patients.4In a sense, the paper from a Dutch group in this issue of the BJGP5 confirms what we know from other observational studies: that there is a near linear relationship between glycaemic control and death rates in people with type 2 diabetes.6,7 Although in their interpretation the authors focus on the non-significance of the small excess mortality in those with only moderately raised HbA1c levels, the trend appears clear. There are other reasons not to read too much into the detail of their findings: this … ER -