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Still, the results indicated that "the best thing to be done is to follow current guidelines," McMahon said. That means "using long-acting drugs and adding insulin either once, twice or three times a day," he said, depending on each patient's particular needs.

What the new data "suggests to the doctor is that if you are serious about controlling diabetes, you should be willing to use the more complex method," added Dr. Larry Deeb, clinical professor of pediatrics at the University of Florida and immediate past president of the American Diabetes Association.

Diabetes control "is hard work for doctor and patient," Deeb said, and "family doctors have got to learn to give insulin the way we endocrinologists do." Deeb is located in Tallahassee, Fla., where the ratio of endocrinologists is 1 to 75,000 inhabitants, he noted.

Family doctors can handle type 2 diabetes, McMahon said, but it is best if they do not work alone. "An endocrinologist, nutritionist and nurse-educator should cooperate," he said.

Because type 2 diabetes is a major risk factor for heart disease, attention should be paid not only to blood sugar levels but also to other coronary risk factors, such as blood pressure and cholesterol levels, McMahon said.

What lies ahead for the British study is uncertain, McMahon said. "They are going to next look at what happens when the first steps fail," he said.

More information

For more on type 2 diabetes, consult the American Diabetes Association.

SOURCES: Graham T. McMahon, M.D., assistent professor, medicine, Brigham and Women's Hospital, Boston; Larry Deeb, M.D., clinical professo
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