TY - JOUR T1 - In pursuit of normoglycaemia: the overtreatment of type 2 diabetes in general practice JF - British Journal of General Practice JO - Br J Gen Pract SP - 334 LP - 335 DO - 10.3399/bjgp15X685525 VL - 65 IS - 636 AU - Jonathan D Sleath Y1 - 2015/07/01 UR - http://bjgp.org/content/65/636/334.abstract N2 - The prevalence of type 2 diabetes is rising each year,1 with the World Health Organization warning of an emerging global epidemic. The number of people with diabetes at my practice has increased by 36% in the past 5 years. More than 1 in 20 of the practice population now have a diagnosis of diabetes, and about 75% are aged ≥60 years. The cost of treating these extra patients is rising too. In 2013–2014 in England we spent over £800 million on items prescribed to lower and monitor blood glucose,2 and in addition there are the costs associated with extra consultations in primary and secondary care. It would be good to know that this was money well spent.Raised blood glucose is just one component of a complex assortment of metabolic abnormalities in this thing we call type 2 diabetes, and with the laboratory standardisation of HbA1c, this surrogate has proved a convenient tool for easy diagnosis and the monitoring of blood glucose levels. Most people I see with a new diagnosis of type 2 diabetes have no symptoms. They will have had a simple blood sample taken for HbA1c, usually as a consequence of ad hoc screening, instead of the palaver of a glucose tolerance test to see where they lie along the continuum of glucose metabolism. If they pass an arbitrary threshold they turn overnight into a patient with a diagnosis. What has really happened is that a risk factor has been identified. The UK Prospective Diabetes Study (UKPDS) observational study showed that poor levels of diabetic control, as measured by … ER -