August 8, 2012

Not A Game Plan for Type 2 Diabetes

While not really a game plan at all, there are some features that this site may bring to peoples attention. Probably the only reason I found this site is an article in Medscape. After researching on the American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE) websites, I did not find a link to Is this intentional? Maybe. Both websites do little to promote what they hype in articles or interviews, so it is small wonder that little is accomplished in bringing visitors to their sites.

Even my own endocrinologists do not promote this during office visits or include information about it in handouts. Why am I writing about this? Someone needs to promote what the professionals are seemingly incapable of doing. I think the person that made this commentquote - “Unfortunately, like the AAFP, the AMA and ACC have also let us down. The societies today exist for their own purposes and not for the benefit of members. The AMA owns the CPT code system and makes more money from this behemoth than from member dues. The ACC is enthusiastically offering "products" (read $$$) to "help" doctors meet their performance goals.

It is beyond time for new professional societies to emerge that actually advocate for physicians involved directly in patient care. Perhaps one big "Society for Patient Care Physicians" that could involve everyone who actually sees patients every day, rather than the academic guideline and rule-writing "doctors" who dominate societies today.” - Unquote.

I think the comment is on target and needs to be done so that doctors that care for and about patients could have a format to get information to patients in terms they understand and this could be promoted for patients. With the Internet of today, what could be of value to patients is often lost in the dogma of the medical organizations. Most could have on their home page a link to patient information and then links on the patient page for more pages of valuable information. This information could then be reliable information that can be used for the benefit of patients and used by patients.

Even the website for approved Internet websites on the AACE website no longer has a direct link to it on the home page. Plus, they are not adding anymore approved sites. They have fulfilled their promise so-to-speak, and now want to leave it alone. For the two sites of the AACE and ACE, there is so much information that could be included as part of their websites. However, at most, the information is limited for patients and not really informative for new patients that may be searching these sites for reliable information.

On the same site is a tab named “The ABCs of Diabetes Management.” This did not surprise me as they are A1c, blood pressure, and cholesterol. Surprise, no mention is made about statins. Blood pressure goals are different than recommended by the American Heart Association, but not significantly higher. From the way the material is presented, the emphasis seems very much on the HbA1c as the measurement for how well the goals are being accomplished not any individual blood glucose tests. At least the A1c goal is 6.5%, but then they say that maybe the goal will need to be higher. No mention is made about individuals that want to strive for lower A1cs or if they will even allow for this.

Then they use four topics to help in achieving the ABCs. They include healthy eating, getting more active, taking your medication, and tracking your ABC goals. I was totally surprised at the healthy eating. They rightly say to limit refined foods and eat vegetable and some fruits. Maybe a little heavy on the fruits, but no mention of whole grains. The limited discussion on getting more active was not bad, but the discussion missed a lot of physical activity. Taking your medication(s) did not discuss any particular medication(s), but the suggestion is there. The concern for hypoglycemia is present and that is a plus. Tracking your ABC goals missed more than it covered. It talks about tracking your blood glucose levels, but does not give any meaning to why track and what to be looking for in meaning. To me, it sounds more like the reason is for the doctor than looking for reasons to the daily numbers.

In the medscape interview, Farhad Zangeneh, MD, FACP, FACE did a good thing in answer to a question about why not use the more effective treatment of bariatric surgery for all obese type 2 patients than have them struggle with lifestyle changes to achieve treatment goals. I will quote his answer - “Not all patients with type 2 diabetes are candidates for bariatric or metabolic surgery, and no matter how much weight is initially lost, there is always weight rebound. There are no easy answers and no shortcuts in the management of diabetes. Even if patients are candidates for bariatric surgery, their psychology — mindset and eating behavior — has to change before their anatomy. There is also growing evidence that patients who undergo gastric bypass surgery are prone to hypoglycemia. For the majority of patients with diabetes, management still boils down to healthy eating, physical activity, and pharmacological medical management.”

As for the goals of “The Game Plan,” most of the information is on a need to be done basis and not education about diabetes and the reasons for doing what is all but demanded that patients do. Some information is there and for some patients that function in this manner, it may be of value.

What I think is that few people are going to find this site without a direct link to it from the AACE main page or even a link from the ACE page. Few patients with type 2 diabetes ever read the articles from the medscape dot com site and I have not seen any other mention of the site elsewhere. Granted I do not read every website, but I think Merck was sold an idea with no solid intention of promoting the website by AACE. Some people will find the website from search engine use, but that will be a small number. Great idea, but no support of the site by AACE.

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