April 30, 2013

AAFP and Their Professional Website – Part 2

Part 2 of 2 parts

When I started reading this I had some very mixed thoughts. In rereading the site, I do think there is much information missing, but some of it may be intentional because they have so few patients needing this information. I do strongly disagree with some statements. The first statement is this one here. The statement sets a tone that I dislike when they say, “Your A1C goal will be determined by your doctor, but it is generally less than 7%.” The doctor is not the person to set the goal; it is the responsibility of you, the patient. Yes, your doctor should help and maybe guide you, but it is not for the doctor to be dictating this goal. The doctor does not live with you 24/7 to help you reach the goal, unless you are married to one.

And why would a doctor recommend an A1c goal above 7%? At this level, the risk of complications is already elevated and complications become very likely. Even a A1c goal of 6.5% is increasing the risk of complications. In rare cases where the person with diabetes is in extremely poor health and consequently unlikely to be able to manage their diabetes, if they are near the end of life, a goal above 7% may be advisable. Still, this is doing harm which goes against doctors not doing any harm. The caregiver may be able to maintain an A1c level below 7%, but many do not consider this possible.

I am reading more and more about how when doctors set goals for patients; this is destructive to the incentive of the patient for working for better diabetes management. This is also what some doctors will do to set you up for failure. By setting your goal, then the doctor can tell you that you are not following directions and that if you continue to fail, the doctor will threaten you with insulin. I will walk away from a doctor doing this and not think twice about it.

If you set a reasonable goal and the doctor does not like it, he should be able to tell you why it is unreasonable and maybe suggest a different goal. To dictate a goal is unethical in my opinion. I also think nothing is wrong, if you have just been diagnosed, of not setting any goals until you have had time to learn, and maybe, talk to others with diabetes. This will give you time to do some reading and find information with which to set good and reasonable goals. A doctor that is not educating you or setting up education classes for you should be happy that you are not setting goals until the second appointment.

Now if you are willing to let the doctor set your goal, then you have only yourself to blame when the doctor chews you out for not making the goal. A good doctor should know better than to set goals for patients and should be willing to guide the patient with a little education to assist the patient arriving at realistic and reasonable goals.

The following discussion from the causes and risk factors is not well thought out and needs more discussion.

Weight and Risk Here is one place I feel simplicity needs to take a back seat. There is no discussion of ideal weight for a particular type of body frame size. This often invalidates much of this discussion. An example should highlight the need for additional discussion. I urge you to consider opening this blog in one tab, the AAFP page is another tab, and the ideal body weight calculator in a third tab.

Using the woman's chart, I chose a 5' 4” women and the 157 pounds from their chart.
For a small frame - the ideal weight is 120 to 132 lbs – or 25 lbs over weight.
For a medium frame – the ideal weight is 130 to 143 lbs – or 14 lbs over weight.
For a large frame – the ideal weight is 140 to 154 lbs – or 3 lbs over weight.
The one factor that I have not found a calculator for is mixing the age into the calculations. I don't know if it would make this great a difference, but it is a variable.

Using the men's, I chose a 5' 10” man and the weight of 186 pounds from the chart.
A small frame – the ideal weight is 156 to 171.6 lbs – or 14.4 lbs over weight.
A medium frame – the ideal weight is 166 to 182.6 lbs – or 3.4 lbs over weight.
A large frame – the ideal weight is 176 to 193.6 lbs – ideal weight.
Again, the one variable is the man's age.

This shows how different charts can mislead people and create false goals and realities. There may be different weight to height charts for the different body frame sizes, but it comes fairly close from memory with what my doctor discussed. Another variable that needs consideration is ethnic background.

Everyday there seems to be studies about diabetes. Many articles do their best to highlight something. The American Academy of Family Physicians (AAFP) decided to start the diagnosis and tests section with some of the complications caused by diabetes. If they want readers to read this, they would not be interested in the bad things first. They would likely want to know how diabetes is diagnosed which is what the topic heading suggests. The diagnosis and tests area is a poor place to discuss the diabetes complications. This discussion should have been left for the diabetes complication area where they are again discussed.

One indication of how much their information needs updating comes when they discuss how they diagnose diabetes. Granted, the three discussed tests are very valid, but the American Diabetes Association (ADA) had declared the A1c as a valid test also, but this is not given any consideration by the AAFP. I know some groups do not accept the ADA and what they designate, but I had not thought the A1c test would be rejected by the AAFP.

The fasting blood glucose test (FGT), the oral glucose tolerance test (OGTT), and random blood glucose test are just three of the tests. To this you also need to add the plasma blood glucose test (PGT) and the A1c test. Then there are several additional tests to assist in the determination of the type of diabetes including several of the symptoms which might help in the determination.

No comments: