November 4, 2011

The Type 2 Diabetes Sourcebook

The Type 2 Diabetes Sourcebook by David Drum and Terry Zierenberg, R.N., CDE copyright 2006 is a book I purchased recently. I have just finished reading it and may donate it to my local library if I decide I want to give a very poor book to them. I think not.

When I purchased this book, I was in a rush and while I did look at the table of contents and especially a couple of chapters, I missed something because when reading it, I realized how little valuable information was presented. Many areas are completely lacking in detailed information and explanation of aids for improvements for patients to have tools to guide them. If you are looking for information about ADA norms or AACE norms, this book has them. If you are looking for tools to assist you in managing diabetes to prevent complications, you will need to look elsewhere.

Also lacking was definitive information about why the guidelines are established where they are. Many of the guidelines are presented as fact and no further information of value is given. Since I do not follow the American Diabetes Association guidelines or the American Association of Clinical Endocrinologists guidelines, this book was a real disappointment. There were no suggestions of how to accomplish goals for diabetes health to improve on the guidelines.

Very disappointing was the discussion on the tests needed by people with diabetes. Why should people with a diagnosis of diabetes need another oral glucose tolerance test (OGTT)? Even this was presented for what normal people achieve and not about making a diagnosis. A discussion of OGTT for diagnosis would have been good.

Then when discussing hyperglycemia and hypoglycemia, the authors stated something I find reckless and almost criminal. This statement is “The two immediate problems associated with blood sugar are unusually high and unusually low blood sugar. Although neither is fatal, both are serious.” We know better, as both can be fatal if the patient is not hypoglycemically or hyperglycemically aware of what is happening.

As books about diabetes go, this is one I will not keep in my library, nor is it one I can recommend to anyone. In a real pinch, it might make expensive TP.

November 3, 2011

COI for Clinical Practice Guidelines Rampant

Yes, conflicts of interest (COI) are influencing our clinical practice guidelines. It is not surprising that the American Diabetes Association is one of the offenders as is the American Heart Association. Now they may have the actual numbers by organization, but we are only given a total – 52 percent or a majority had either open conflict of interest or hidden conflict of interest.

Blogger Tom Ross thinks one thing and expresses his opinion very vividly. I can agree in part with him especially for the committee heads that denied any conflict of interest while in fact having conflicts. These people are committing fraud and deserve to be thrown to the wolves. But let us look to the bigger picture. The American Diabetes Association and the American Heart Association made their selections without due diligence, therefore some people within the associations on the selecting committee must already be associated with Big Pharma.

Does not say much for the integrity of the associations when Big Pharma already has their minions in place to give them an advantage. Another black eye, yes, but with all the other bruises from misdeeds, what is one more. It is no wonder that people mistrust the ADA so vehemently. Besides being so behind the times, now we need to be concerned about the additional harm that may be foisted on patients. It is no wonder that the American Heart Association is pushing statins so earnestly.

The study also found that panelists on government-sponsored guidelines committees--such as those organized by the Veterans Administration or the US Preventive Services Task Force--were less likely to have conflicts of interest than panelists on non-government guidelines panels (15/92 [16%] vs 135/196 [69%]; p<0.001). However, the researchers point out that the government-sponsored guidelines committees were less likely to have rigorous COI transparency policies.”

In an accompanying editorial, Dr Edwin Gale from the United Kingdom tries to make humor of the situation. He states “guideline committees should include only experts with no conflicts of interest has "a charming sense of unreality,".” Then he gets testy when he says "Money from drug companies is the oxygen on which the academic medical world depends.” He then makes other statements basically stating how the professional organizations are beholden to the companies in various ways and won't be changed until we have a change in the culture.

I am happy to see this exposure and putting the professional organizations' feet to the fire.

Read some of the various press releases: No. 1, No. 2, No. 3, and No. 4.

November 2, 2011

Parents Now Have Web Site to Test Amblyopia

This is not about diabetes, but I felt that parents of young children should know about this free test to assess their children for amblyopia. What is amblyopia you ask? The definition in Merriam-Webster's Medical Dictionary says “Function: n: dimness of sight especially in one eye without apparent change in the eye structures called also lazy eye, lazy-eye blindness.”

The test was designed by David P. Taylor while he was a graduate student in the Department of Medical Informatics at the University of Utah, Salt Lake City. Researchers, led by Shaival Shah, MD, from the Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City presented the test at the American Academy of Ophthalmology 2011 Annual Meeting.

This free and widely available Web-based test will allow parents to test their own children for amblyopia. assesses visual acuity, which has proven to be more reliable than other sensory tests. The online test comprises a series of 6 graphically rich, jargon-free, plain-language screens describing the test and how to interpret the findings. Typically, the test takes less than 15 minutes to complete.”

One warning to parents – follow directions carefully. The most common error was the parent putting the patch over the incorrect eye. The next most common error was measuring the distance from the screen.

Refinements of the screen instructions might lead to fewer misinterpretations of the instructions and decrease the error rate,” according to Richard Olson, MD, also from the University of Iowa, who was head of the research team.

Please read the press release here.

November 1, 2011

Diabetes Self-Education – An Important Tool

Self-education is one of the best tools for managing diabetes. The doctors do not have the time necessary and some do not have certified diabetes educators (CDEs) available even for referral. Often the doctors do not even have a registered dietitian available that specializes in diabetes. Many, but not all of us, have had less than favorable experiences with CDEs and others, so do be careful.

Self-education is key for people to manage diabetes effectively and studies are showing that this works. My blog here with its link shows that education does work in reducing A1c's. This is just one of several studies that is receiving little attention or publication because writers cannot make it sexy enough to draw attention to it.

My second blog here is about foot care and why it is so important. However, without education, many people continue to ignore the consequences of unmanaged diabetes. Amputation is becoming a thriving money maker for many surgeons and the patients have only themselves to blame in many cases.

Another tool in the education arsenal is peer-to-peer groups. It has been shown that there is a need for these groups. The results they accomplish in reducing A1c's are positive. David Mendosa has an excellent blog about this as part of his reports from the Medicine 2.0 conference at Stanford University in Palo Alto, CA.

There are several of us with type 2 diabetes that occasional get together and exchange ideas and discuss what we have been reading. No, not a support group, but a few of us that do research and study about diabetes. We exchange emails and compare notes about different articles, press releases, and technologies to aid in our management of diabetes. An informal peer-to-peer group at best, but it has helped us in managing our diabetes more effectively.

That is also the reason for discussing the types of patients in previous blogs, here and here. This makes people more aware of what education can do to make us. Education make us more knowledgeable and assists us in making good decisions to manage our diabetes. With this now being diabetes awareness month, keep focused on education. The more education, the easier advocacy becomes and for some even activism.

October 31, 2011

Prediabetes and Its Dangers

So you think there is no danger associated with prediabetes? An acquaintance of mine in this small town told me he was not going to worry about the prediabetes diagnosis as there were no dangers associated with it and either you had diabetes or you did not. So sure was he that he constantly reminded the group of us that had type 2 diabetes that he was going to be okay.

Why we continued to accept him and his taunts still bothers me, but we did. I guess we knew that eventually he would change his tune and start asking questions, serious questions. Well that day finally arrived, but not the way we had expected. When he was not present for our get together (now over a month ago), one of the others called his wife and got a shock. He was in the hospital and was in a high blood glucose coma. We do not know how high it was, but we guessed he now had full-blown type 2 diabetes.

We asked if he could have visitors and his wife said the doctor had asked not for that day or the next for other than family. Well, we never did get to see him. Whether we will every know the full story is doubtful, but that night he passed. His wife said that their two children had arrived after work so she was on her way home to clean up and return. On her way home, their son called and said Dad was gone.

We know a little more, his heart had failed and they had been told that his kidneys were in poor condition. I have been researching and yes, cardiovascular disease does dramatically increase with prediabetes, retinopathy can develop, and kidney health can be impaired. Many with prediabetes can develop diabetic neuropathy or peripheral neuropathy. Not quite what I had expected for prediabetes. Again, this is a reminder that everyone can be affected differently when it comes to prediabetes and type 2 diabetes.

Which leads me to the question – why not treat it as diabetes. I'm sure the American Diabetes Association will not have an answer.

We have also learned that our friend had high blood pressure and had stopped taking his medications. Could we have done more for him? We have talked about this and have decided that for him we had done all we could have under the circumstances, as he would not have listened to us. How will we treat future people that come to the fringes of our group? We will invited them in if they have a diagnosis and work to get them past denial if they are in denial. Will we be successful – remains to be seen. We just know that we will make every attempt.

We have checked the books on diabetes at our local library and they will be acquiring two more books at our request to supplement the ones they have. We are investigating other activities like making our informal group a little more known and possibly working with doctors in nearby towns if they are open to this.

This WebMD article is available as a reference on prediabetes.