April 16, 2013

More Americans Are Managing Diabetes, Oh Really?

The introduction to this article is not a good indicator of what is happening and it should not garner the readership it is receiving. It should not make people with diabetes feel confident either. The title is very misleading as it only mentions diabetes when it should also mention the three measures or health issues they were discussing. They are talking about blood glucose, blood pressure, and cholesterol levels.

All three of the sources I found actually mislabeled the article. Two said diabetes and the third source – Medscape – listed it as diabetes risk factor. I fail to see how diabetes risk factor is involved when a person already has diabetes. Granted using the term diabetes probably brings more readers like it did me, but this is promoting the wrong assumption about the article and they don't mention the three issues until the second paragraph.

Yes, we all need to be concerned about the three issues as they are interrelated and one can affect the other two to a point. However, what bothers me is that they don't give this interrelation, but they say that two decades, yes, two decades ago, the rate of people with any type to diabetes meeting or exceeding the three measures of good diabetes management was only two percent. Now 20 years later the number has risen to only 19 percent. Shame on the ADA and the rest of the medical establishment for this lack of progress.

They then claim this is a huge improvement and don't even give the numbers of people with diabetes in 1988 and the number of people in 2010. The begs the question of how are they relating the numbers to claim this is a huge improvement. Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City, not participating in the study expresses my feelings. He says that with the increased awareness of diabetes and many newer medications, it is disappointing that only 19 percent meet all three measures.

Zonszein also states something that is upsetting for many - 100 percent of people with diabetes should be on statins - because only 50 percent were on statins. He also said that the 50 percent of the people not having the recommended levels of blood pressure should be on drugs for that. That is right – he wants to shove pills at people rather than see if other means might help first – typical medical response.

Then as if rubbing salt into the wound the article states that is it important to keep these measures as close to the “recommended” goals as possible. The article says this will avoid serious complications like heart disease, kidney failure, and vision problems. They quote of the ADA recommendation for A1c as being 7.0 percent as if this will prevent complications. I'm sorry to say that this may only slow the rate complications and allow diabetes to progress, but this is not a goal. We want to stop complications and prevent progression. Even though the recommendation by the American Association of Clinical Endocrinologists (AACE) of 6.5 percent is not ideal, but much better even for the elderly.

Even though Zonszein is abrupt and seems to lack compassion in his statements, he does raise a few good points. He states that young people developing type 2 diabetes seem to have a particularly aggressive form of the disease. They seem to respond less to insulin and are more insulin resistant. He does state that education is the key for all people with diabetes. Where he gets this is a puzzle. He says that presently people often don't get education until late in the disease. This may have been partially true two decades ago, but today with the internet; more people are getting education earlier. Whether they apply the education is the question.

Fortunately, with the internet, his next point is where many people draw the line. He says that people need the education to know what is going on so that you will take the medications. He claims that when you are not feeling sick, it is difficult to take the pills. He may be partially correct, but young people of today use the internet to look up the different “pills” and find the side effects and purpose of medications.

I agree with Zonszein that this paper is an alarm, but only because our medical community is doing so little to educate people and bring diabetes under better management.

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