June 28, 2013

Should Type 2's Not On Insulin Use Glucose Meters?

Experts versus those that live with diabetes, how I dislike saying this, but it is down to this and this is the shame. Our so-called “experts” at the American Diabetes Association (ADA), the American Association of Clinical Endocrinologists (AACE), and supporting organizations and prestigious diabetes clinics all believe that patients with type 2 diabetes and not on insulin do not need to self-monitor blood glucose levels that frequently or not at all. Many feel that a quarterly A1c test should be sufficient.

To the above, add primary care physicians and other doctors that do not stay current with the latest information about diabetes, and it is the patients who are left without any guidance, or education on managing their diabetes. Yet, these “experts” could care less and discourage us from learning about self-monitoring of blood glucose because they don't think this would help us. Therefore, is was with great surprise and then appreciation that Amy Tenderich (Founder and Editor, plus a person with type 1 diabetes) of DiabetesMine was able to have a study printed in Diabetes Spectrum of the ADA website. I would strongly urge every person with type 2 diabetes to read the PDF version of her study which can be downloaded by clicking on this link, Use of Self Glucose Monitors Among Type 2 PWDs: Patient Perspectives . I repeat, the study is worth your time reading it and it may give you the boost to consider how you use your meter.

I was even more surprised that a CDE had asked her to do the study. Then the ADA published it as an editorial rather than a study or report. I can only guess that those in power did not appreciate learning what they found in the study. The ADA is not patient friendly.

The important part of Amy's work is that it reflects what the patients think and know compared to what the researchers normally look for and exclude from studies. This blog of mine shows how researchers set up a study to reflect the answer they desire. This is another reason to believe Dr. William Polonsky from the Diabetes Behavioral Institute in his presentation to the ADA that I discuss in my blog link above.  It has a link to a PDF file and his points to the ADA.

I do not know who titled her work, but they use the wrong term. Normally those who know better use the term meter because very few people with type 2 diabetes use a continuous glucose monitor (CGM) which is generally considered a type 1 instrument or tool for them. There is a great difference in cost as well. Some doctors and diabetes clinics give out meters and some receive a prescription for them which insurance will reimburse. People with type 2 diabetes are seldom able to obtain a CGM as their insurance will not cover it. Those that have the big dollars can purchase them, but even then, many find the meter easier to use.

Education is clearly the key to success with how to use the meter, when to test, and how to compensate when a reading is high or too low. Many were self-taught by reading and research on the internet, often on diabetes forums or other social media. I remember having a class on using the meter, but not when to test and how to interpret the readings. I was fortunate to find the series of blogs by Alan Shanley which can be found here. Then down the right side is a search box and type in the word “test.” This will bring up many blogs worth reading.

I am a member of the site where the survey was taken, but because I am very inactive there, I did not see the survey or questions. I am a person with type 2 diabetes, but I am on insulin. I have had questions about why I advocate for testing supplies and I can only say that I believe that testing is the only way correctly to manage diabetes. Understanding how foods affect your body and other variables that come into play will really assist you in preventing the onset of complications.

Diabetes does not need to be a progressive disease and self-monitoring of blood glucose (SMBG) is the only way I know of to manage diabetes and prevent progression to complications. Education is the key and learning what the readings on your meter mean to you when comparing them to your food log and health log is the only way to know what the food you have consumed is doing to your body.

Three schools of thought about the value of home glucose testing among type 2s on page 2 of the PDF have two people from the Joslin Diabetes Center at polar opposites. Dr. Richard Jackson, senior endocrinologist and researcher at Joslin Diabetes Center in Boston feels that an A1C value every three months can provide sufficiently useful information. Nora Saul, certified diabetes educator and 20-year licensed dietitian at Joslin Diabetes Center in Boston agrees that SMBG is under-utilized for gathering information about how patient’s blood glucose responds to different types and amounts of food – especially for judging the effects of high-carb food choices/ diets. Not only is Nora Saul making good statements, she is not following the line of the Academy for Nutrition and Dietetics, which discourages testing to learn what food does to the patient's body, but I wonder how she gets along with Dr. Jackson.

Amy did get three good views about SMBG, and Nora Saul and David Mendosa are both saying things I can agree with. Dr. Anne Peters and Dr. William Polonsky are agreeing that education is a missing factor of knowing what the meter readings mean and they are not being motivated. Apparently, the motivation to prevent the progression to the diabetes complications is sadly missing. With the exception of Dr. Richard Jackson, who must be on some medication that addles his brain, the rest understand the importance of SMBG.

No comments: