Intensiveret behandling af type 2-diabetes mellitus: Er polyfarmaci nødvendig og berettiget?

Newly published randomised controlled trials with pharmacological intervention against hyperglycaemia, hypertension and dyslipidaemia have challenged the traditional empiric treatment of type 2-diabetes. This review focuses on the results of these trials as well as randomised trials with pharmacological therapy of microalbuminuria, primary prevention with acetylsalicylic acid and angiotensin converting enzyme (ACE) inhibitors. The overall results from these trials are clinically relevant reductions in the risk of late diabetic complications. Taken together, the new clinical knowledge does not mean that all patients with type 2-diabetes besides relevant changes in lifestyle will benefit from a comprehensive polypharmacy. It means, however, that based upon the individual risk profile the medical professionals have to motivate the patient for an evidence based "therapeutic package" which is likely to improve the longterm outcome.