Type 2-diabetes - Sundhedsstyrelsen

considerations dictate that the existing educational programmes should
not be expanded.
H Resources should instead be canalised to the development and testing of
new concepts for attaining results in the long term.
Smoking cessation
Smoking cessation is normally considered a cost-effective treatment. As the
cost-effectiveness of smoking cessation in Type 2 diabetes patients is unknown,
no real health economic calculation has been made. It is plausible, though,
that smoking cessation among patients with Type 2 diabetes comprises a costeffective
treatment strategy.
The Project Group’s recommendations concerning non-pharmacological
treatment of Type 2 diabetes
General recommendations
Recommendations concerning non-pharmacological treatment of Type 2 diabetes
are difficult to make because although Type 2 diabetes is considered a
lifestyle disease, the evidence for the permanent value of lifestyle changes (dietary
changes, weight loss, physical activity, smoking cessation), education and
home measurement of blood glucose is sparse. There is thus less certainty
about the effects of non-pharmacological intervention than of pharmacological
treatment with regard to cardiovascular disease, diabetic nephropathy, diabetic
retinopathy and mortality. It should be noted, though, that the pharmacological
intervention studies available are based on concomitant non-pharmacological
treatment. Conversely, for ethical reasons it cannot be expected that scientific
studies of the value of non-pharmacological treatment can be initiated
without pharmacological intervention also being permitted.
H It is thus recommended that low-fat diet, weight loss, regular physical
activity and smoking cessation should comprise the foundation of all treatment
of Type 2 diabetes, and that home measurement of blood glucose
should be integrated with the remaining non-pharmacological self-care
behaviour (A).
H The expected long-term value of education, including education in diabetes
schools, has not been documented, but is on the other hand the
foundation for the non-pharmacological treatment, which in itself is the
foundation for the pharmacological treatment. It is therefore recommended
that education should be offered to all patients with Type 2 diabetes.
Before considering changing the current educational practices
(which are poorly described), for example through the establishment of
more diabetes schools, experience with the activities at the existing diabetes
schools should be carefully evaluated (D).
Specific recommendations
H A hypocaloric, low-fat diet is recommended for obese Type 2 diabetes
patients (A).
Type 2-diabetes. Medicinsk teknologivurdering af screening, diagnostik og behandling 75