April 27, 2012

Friday Tidbits 04-27-12

Even if I want to praise this study, I cannot. That is why I have included it in Friday Tidbits. There are too many unknowns and even the authors admit more studies are urgently needed because of the lack of evidence. I do not know if this was intentional, but the article even failed to identify where the study was published, right in the first paragraph. For an editor's choice, that is very poor.

The title says what I want it to say, Insulin Usually Better Than Oral Drugs For Type 2 Diabetes.” Then the confusion starts about where it was published and even to the point of what the real reason is for comparing oral medications, specifically metformin to insulin. Those that follow my blogs know I am not one in favor of insulin being the medication of last resort for type 2 diabetes. All I can say about this study it that it is there and read it for yourself.

The second tidbit is about a different subject, but still should be interesting in many ways. While the stated purpose is to keep older drivers on the road, I can see many other possibilities, some good and some not so beneficial. It is a one-of-a-kind research auto that can monitor our concentration, stress levels, and driving habits while behind the wheel. The stated purpose is to develop new technologies to support older drivers.

The Intelligent Transport team at Newcastle University, UK have converted an electric car into a mobile laboratory. Named 'DriveLAB', the car is outfitted with tracking systems, eye trackers and bio-monitors in an effort to understand the challenges faced by older drivers and to identify where the key stress points are.

Research shows that giving up driving is one of the key factors responsible for a fall in health and well-being among older people, leading to them becoming more isolated and inactive.

The negatives I can see if this makes its way to the USA is many enforcement agencies and especially auto insurance companies will use this information to restrict drivers and raise auto insurance costs. In some areas of the country, this may indeed be a good thing. In the largely rural parts, this may be a help for drivers and if auto insurance companies are not allowed at the data, this could be a benefit to older drivers when other means of transportation are unavailable.

The last tidbit is an area that more people are learning about, but the doctors as a whole will not acknowledge or accept in most cases. It is interesting that the naturopathic and medical doctors did work together in this study. How well they did is an unanswered question and the only fault I can find that really bothers me about the study. From that, I may misinterpret some things, chiefly that they do not want to be identified by their medical professional organizations.

The other part of this is a blog by a type 1 blogger and her discussion about some of the trials and discoveries in treating her diabetes. This is well worth the time to read from her perspective.

Yes, some medical doctors will work with naturopathic, holistic, and complementary medicine doctors very well. I will not object to any doctor working with another doctor in a different type of medicine. There are many holistic, naturopathic, and complementary medicine doctors that will not work with other doctors of any type as they can also become so full of their own importance that they think they are the only answer. These are the personalities in any type of medicine that all of us can do without as they do more harm that good in the long-term.

April 26, 2012

CDE Certification – Does It Have Value?

This is a valid question for everyone and should include diabetes patients as well. The other question in this article is perhaps the question educators are asking is, “what’s in it for me?” What is the value and what's in it for me are two questions that make a patient stop and think, do I really need these services if that is the attitude fostered by people that are supposed to be professionals.

Sure, I admit that I have taken one completely out of context, but the question does need clarity and definition, which really begs for another question. If a member of the National Certification Board for Diabetes Educators can state such a question, then maybe, just maybe, we have something to be concerned about and wonder if the test people need to pass to be certified as a diabetes educator is really the correct test for certification? And, another question – are they really qualified and do they understand diabetes to be able to relate to the patients?

And what about the hours they need to have working in their profession? Is really what is needed to make these professionals caring and understanding about patients with diabetes. It seems to me that this is lost on many patients when the attitude is one of mantras and you must follow the American Diabetes Association's guidelines or risk losing your certification.

This “one-size-fits-all” mantra is an indication that the CDEs are out of touch and unwilling to work with the patient as an individual. This to me as a patient, says I may not need the services of a CDE when I do not follow the guidelines of either the ADA or AADE. I have been fortunate to find what works for me and with fine-tuning it from time to time should be able to maintain reasonably good health. That is providing something besides diabetes does not complicate the issues.

I do have several friends that are CDEs, mostly from the registered nurse (RN) profession. When I am told that they are speaking as a RN or their primary training, I will listen and I have received some excellent advice. They know from experience that if they are speaking as a CDE, my eyes will probably glaze over and I have probably tuned them out. How do they know this? Because we have talked about the different topics encompassing the CDE profession and they have learned that if they are advocating the ADA way, I will be contradicting in nature and quoting from some of the ADA areas that are newly published that they are not up to date on.

With the medical field changing daily, it is not easy for them to stay up-to-date and I do try to reeducate them. I will send them URLs for the latest information and direct them to the latest information that disagrees with what they have learned. Since they are friends, I try to be polite, but occasionally they know that even they cannot follow some of it as the AADE has not approved the change.

None of my CDE friends are overly happy that several of us have an informal group (more along the lines of a peer-to-peer group) and work with each other at the level of the individual. We follow the idea (mantra if you will) that as long as something works for you, and if your A1c shows that it is working, don't change. As individuals, we seldom find something that works identically for each of us. A few of us have friends or relatives that have the credentials as a CDE, but we do not invite them to our get-togethers. Almost all of us refuse to have meetings with the CDEs that work with our doctors or endocrinologists.

We do need to be clear as patients what the definition for a CDE is and says. To quote from this article, “A CDE is a medical professional who possesses comprehensive knowledge of and experience in diabetes management, prediabetes, and diabetes prevention. The CDE plays a unique and essential role for people affected by diabetes.

The CDE is a recognized and highly respected credential in the industry. Diabetes self management education from a CDE can lead to better control and can also decrease short and long-term complications that strain the healthcare system and cause unnecessary pain and suffering to patients.

The reality of diabetes is that it touches many different aspects of a patient’s life. Certified educators therefore come from a variety of backgrounds ranging from nurses and dietitians to exercise physiologists and podiatrists. They are required to have knowledge across multiple disciplines.

All diabetes educators need to be aware of new technology and therapies and how to incorporate them into the unique management plan they design for patients.”

The above is quite a statement. I wish it was as comprehensive as it appears on the surface. Diabetes self-management education (DSME) is played up in articles such as this and in reality is seldom taught. It has been replaced too often with mantras of “do this and do that” without the education. There are some excellent education programs available, but not promoted by or used by CDEs.

One such program is BGAT (blood glucose awareness training). Most (there are a few exceptions) CDEs do not even understand what this is and since the AADE does not support it, few will learn about it. The few that do use it are with progressive endocrinology practices like the Joslin Diabetes Center, and the Diabetes Behavioral Institute.

Another area that CDEs want to ignore is peer-to-peer groups. It is most unfortunate that a study has not been done comparing peer-to-peer groups with CDE trained groups. Most studies use usual care (meaning nurses and others) with peer-to-peer groups always doing better in helping lower A1c's – often by a significant amount. Read my blog here about some of the studies.

April 25, 2012

Neglect of the Basic Sciences in Medicine

Ever since reading this blog by Tom Ross, I have been looking for something to either confirm or refute this. All correspondence with my sources has confirmed what he states in his blog. Most articles that I have found seem to confirm what he stated as well. This article in the Lancet also confirms the basics in his blog. It approaches the topic from a different perspective, but is damaging in its statements.

What is unsaid is as important as the statements made. I may not be right, but I perceive the shortage of funding being the result of the type of studies Tom blogs about and people disbursing these funds of being more careful to not support research that yields fake or falsified results. In a way, these unscrupulous researchers are penalizing good researchers.

An example of this is described in this article and happened when an untimely article on Alzheimer's disease was published and later came under question. This happens, but since our own government-sanctioned research, (the National Institutes of Health (NIH) has no appeals process, her research request was denied and done. This systematically erosion of the basic medical sciences means that they are being neglected and this marginalization will have damaging effects on clinical care in the decades to come.

These studies that never prove out and cannot be duplicated by other researchers is turning the screws down tighter on the basic medical sciences and will make researchers leave the field for more lucrative opportunities elsewhere. This in turn will make drug development more expensive or prohibitive for the pharmaceutical industry.
Even big industries cannot continue to fund research when they cannot duplicate fabricated research results.

I will dare to say that researchers that present these falsified results need to face severe criminal consequences and be made to repay the grants used under false pretenses. Something needs to happen to restore the faith in our medical (and even food and nutrition) research.

There are many faults in our current system of medical research, but the scoundrels are creating other problems because both government and other research charities are determined to concentrate their funding in larger organizations where accountability is managed and false research is stopped sooner or may even be prevented. This will deplete research funding at many university medical research centers and thus curtail even commercial development by these universities.

This is a sad state of affairs for all basic medical research and creates future problems for retaining new medical researchers in the field.

April 24, 2012

Colorectal Cancer Screening – Is More Options Better?

Speaking from a patient viewpoint, yes, I can agree that some people may need more options with colorectal cancer screening. What this study is showing is that among minorities, adherence to colorectal cancer screening is poor or not done because they do not want to go the colonoscopy route.

I consider myself lucky that I went the colonoscopy route 14 years ago. I did not have any family history of colon cancer, but I had lost both parents to cancer and was just doing the colonoscopy on the spur of the moment. How fortunate I was as the oncologist declared that one of the polyps removed was about six months precancerous. I have had several colonoscopies since and except for one time have had polyps removed.

I can understand why many people resist having a colonoscopy as it is not something I enjoy either – it is invasive. However, with my personal history of polyps, I will continue to have them as often as my doctor orders them. I do not want to use the fecal occult blood testing (FOBT) as this means that the cancer already exists when the test is positive.

Not only do you have cancer when the FOBT comes back positive, if not caught early enough, the cancer may metastasize (spread to other parts of the body). I would rather be uncomfortable for a day or two and have the colonoscopy than go through the operation (very invasive) of having part of my colon removed or having chemotherapy and radiation.

For those interested, you may read about colon cancer here. There are several parts to the discussion and you may use the next button at the bottom of the printed material and read all the pages. If you feel better after reading all the material, you should have a better understanding of the different tests and laboratory tests and the pros and cons of each. You may want to consider bookmarking the page and be able to refer back to it later.

If you have a history of colon cancer in your family, please consider the colonoscopy as your prevention of colon cancer. If you have a history in your family, consider age 40 as time to start having colonoscopies. Otherwise, age 50 is the recommended age for checking out your colon.

April 23, 2012

Diabetes Does Cause Hearing Loss

This is another diabetes complication that often is ignored. It is ignored because people do not consider hearing loss as being a complication. Consider how many of our organs may are affected by diabetes. If you have diabetes, you may figure that you are at twice the risk of having hearing loss.

One way to avoid this and most diabetes complication is to manage your diabetes by maintaining careful management of your blood glucose levels. Keeping these as close to normal or at normal is good for keeping complications away. This applies to all complications. Let your blood glucose levels take off for the stratosphere and your odds of developing the complications go up with them.

With hearing, it is the small blood vessels and nerves in your inner ear that become damaged by high blood glucose over a period of time. Autopsy studies of diabetes patients have shown the evidence of this damage.

The study researchers discovered the high rate of hearing loss with diabetes after analyzing the results of a nationally representative sample of U.S. Adults. The hearing tests measured the participants' ability to hear low, middle, and high frequency sounds in both ears. The researchers discovered the link between diabetes and hearing problems and that it was evident across all hearing frequencies, but was more pronounced in the high frequency range.

Comparisons between those without diabetes and those with diabetes were this. At the low to mid-frequency sounds for people without diabetes at nine percent to people with diabetes of 21 percent. The high frequency hearing loss was 32 percent (without diabetes) to 54 percent (with diabetes).
The alarming fact for me was for people with prediabetes. Just because they do not have diabetes, does not exempt them from hearing loss. They exhibited a 30 percent higher rate of hearing loss than those with normal blood glucose.

This is just another reason for preventive action for people with prediabetes and strict blood glucose management for all people with diabetes. If you think you are immune to hearing loss, you are in for a shock if you let your blood glucose management have an extended holiday.