April 20, 2012

A Few More Friday Tidbits

If you are a person that follows herbal and Chinese medicine, you may be interested in reading this article. I say great for the Australian researchers for uncovering some problems with “traditional” Chinese medicines. The new DNA sequencing technology developed by researchers at Murdoch University in Perth, Australia exposed some potentially toxic plant ingredients, allergens, and traces of endangered animals.

This was just the tip of the iceberg for these researchers as they also discovered animal impurities in some products and some cow DNA that in some countries may violate religious and cultural practices. Not only will this new procedure assist customs agents around the world, but should also help curb trafficking in endangered wildlife species.

The second tidbit comes from ADA and how they are patting themselves on the back for laws passed in Georgia and Alaska to protect school children with diabetes. I am not quite ready to give the American Diabetes Association full credit for these victories although this is what they want you to think. How much lobbying was done the ADA has not been reported by either state yet and the one small article I found in an Alaskan newspaper says the law was an effort by several individuals and no mention of ADA was given. I may have more in the future if I can find solid information.

The third tidbit also comes from the ADA and the European Association for the Study of Diabetes (EASD) because they have issued a joint position statement emphasizing patient-specific treatment of hyperglycemia in persons with type 2 diabetes. The new guidelines are reported concurrently in the April 19 online edition of Diabetes Care and in Diabetologia.

The last guidelines specific to management of hyperglycemia were published about 4 to 5 years ago, and developments that are more recent have now been incorporated into the new guidelines. Why the wait is a question I must ask, as it would seem with the developments that are coming at an ever increasing rate would demand new guidelines on a more frequent basis.

In the Medscape article, I do not understand why the ACCORD study has to be held up as a benchmark. Vivian Fonseca, MD, ADA president of medicine and science states, “On the basis of findings from ACCORD (Action to Control Cardiovascular Risk in Diabetes study) and other studies, the ADA has set the HbA1c goal at 7% in general, but with some individualization.” Hopefully, we are seeing a move away from the “one-size-fits-all” mantra, but while this statement is made, I am willing to say that the rank and file will continue in their old ways for several years.

"For patients with advanced cardiovascular disease, reduced life expectancy, and multiple medical problems, for example, the goal may be higher," Dr. Fonseca said. "For patients who are newly diagnosed and very motivated, the goal may be lower."

Another recent change underlying the new guidelines is the recognition that many people with diabetes will need multiple agents. Yes, that is the problem of the ACCORD study and why it was stopped early, too many problems developed with people dying from multiple agents and the aggressive nature of them being pushed on patients to manage blood glucose levels. When is the medical community going to understand that this will not always work and insulin may be the better route when multiple agents are required? This is more evidence that insulin should not be the medication of last resort.

I will be working on more about the new guidelines, but when I will have it ready is unknown. In the meantime, here is the full text PDF files for the ADA and for theEASD.

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