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Dr. David Matthews, chairman of the Oxford Center for Diabetes, Endocrinology and Metabolism, says beta-cell deterioration is "virtually inevitable" in persons with type 2 diabetes. He urges doctors who treat type 2s to refrain from telling them that they only have "mild diabetes," and instead tell them that they are still at considerable risk for diabetic complications.
According to Doctor's Guide to the Internet, Matthew's observations were expressed this past September at the annual meeting of the European Association for the Study of Diabetes in Brussels, Belgium. According to Matthews, who was also a member of the United Kingdom Prospective Diabetes Study group, physicians do a disservice to their patients by minimizing the risks associated with type 2 diabetes.
"What we have to recognize in treating type 2 diabetes is that there is an insidious failure of beta cells, and by recognizing that we can fix in our minds that the patients are going to have to be seen again and again and again," says Matthews.
Matthews says that even under the most favorable circumstances, patients with type 2 diabetes can expect a loss of blood sugar control over the years, as well as a beta cell deterioration of about four percent per year.
"This is part of the underlying pathological process that is diabetes," he says.
Matthews points out that patients with HbA1cs less than 6.6% will have slower loss of beta cell function than those whose HbA1cs are greater than 8.1%. Patients whose fasting blood sugar levels are greater than 180 mg/dl will fail faster than those whose fasting blood sugars are less than 140 mg/dl.
Matthews urges doctors to begin aggressive treatment as soon as beta cell deterioration becomes noticeable.
"If you tell them they've got a mild disease and all they need to do is take a tablet, the next time they come to see you, and their blood sugar is higher, they will think it is their fault," he says. "And, of course they haven't failed. What has failed is their beta cells."
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