It is interesting how the American
Diabetes Association dodges the classifications for diabetes. So
there is no doubt, I will quote what they have in print.
“The
classification of diabetes includes four clinical classes:
1. Type 1 diabetes (results from β-cell
destruction, usually leading to absolute insulin deficiency)
2. Type 2 diabetes (results from a
progressive insulin secretory defect on the background of insulin
resistance)
3. Other specific types of diabetes due to
other causes, e.g., genetic defects in β-cell function, genetic
defects in insulin action, diseases of the exocrine pancreas (such as
cystic fibrosis), and drug- or chemical-induced (such as in the
treatment of HIV/AIDS or after organ transplantation)
4. Gestational diabetes mellitus (GDM)
(diabetes diagnosed during pregnancy that is not clearly overt
diabetes)”
At least for two years is a row they
have been consistent, if that counts for anything. I do find it
absurd that they lump genetic defects together with other diseases of
the pancreas and drug- or chemical-induced diabetes. Yet again,
prediabetes is only listed as a risk for diabetes. It is no wonder
physicians do not take prediabetes seriously and in general ignore
it. With research showing that diabetes can be stopped during this
stage and full diabetes prevented, one would think this should
receive more attention – maybe even rating it as diabetes so that
insurance would cover treatment as a preventive measure since it has
been proven that prediabetes intervention does help in the prevention
of full onset of diabetes.
This means that the ADA only looks to
something they can diagnose as a disease and treat as being
important. Again, there is no incentive to diagnosis and treat
prediabetes because without ADA making this a classification, medical
insurance will have no incentive to reimburse for treatment or
medications to stop diabetes. Even with the Centers for Medicare and
Medicaid Services (CMS) expanding into many prevention services, the
ADA does not see this as a value. Their mantra seems to be: “let
them get diabetes and then we will treat them.”
Even if they did not change anything
from last year in their statement after the classifications. They
continue to give doctors a blanket to hide under when a patient is
incorrectly diagnosed. They have stated, “Some
patients cannot be clearly classified as type 1 or type 2 diabetic.
Clinical presentation and disease progression vary considerably in
both types of diabetes. Occasionally, patients who otherwise have
type 2 diabetes may present with ketoacidosis. Similarly, patients
with type 1 diabetes may have a late onset and slow (but relentless)
progression of disease despite having features of autoimmune disease.
Such difficulties in diagnosis may occur in children, adolescents,
and adults. The true diagnosis may become more obvious over time.”
Then in the diagnosis area, they also
repeat the information from 2012. In one short paragraph, they throw
out the oral glucose tolerance test (OGTT) and then bring it back
later – at their convenience. They cite costs and later use the
OGTT when it suits their needs. They recognize that African
Americans may have higher rates of glycation and then dismiss this as
controversial. They cite epidemiological studies for their dismissal
and then leave out other studies that show that Asians may also have
higher glycation rates.
It seems that the people in charge do
what suits them and ignore what they don't want to consider. With
the increase of Americans from other countries, more consideration
needs to be paid to their ethnic heritage and variances from the
European and Scandinavian heritage of most of them.
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