Diabetes care today: not everyone should have intensive multipharmacological treatment.

The uncritical promotion of intensive multipharmacological treatment for type 2 diabetic patients is an example of simplistic communication of research results. The effect, practicability and safety of pharmacological treatment is greater for high than for low levels of blood glucose and other risk factors. The large number of poorly controlled diabetic patients is a further argument for concentrating the treatment effort on those patients at highest risk. A pragmatic risk balance sheet can be used to decide when to start treatment even at relatively low levels of risk factors. We need such a framework in which we can individualise goal-setting and treatment.