March 2, 2014

Which Hand Is Correct in Diabetes Treatment?

I admit I was horrified when I read this press release. My first thought was what will these people think of next. Nothing about diabetes can be this cut and dried. When I arrived at the image of the hand that the topics assigned to each part, I really was at a loss for understanding.

This image shows the "lend a hand" illustration: an open palm facing out. The five major forms of diabetes interventions are arranged in descending order of importance from thumb to pinky. The order is smoking cessation, blood pressure control, metformin therapy, lipid reduction, and glucose control, respectively.
Image credit: Modified by Heather White, Tufts University

To accomplish each in the order as described, what are they going to do when they have a patient that has never smoked a cigarette? Will they have to have the patient learn to smoke just to have the patient cease smoking? What will they do for the patient that does not have hypertension? Are they going to insist that a person take metformin when the person may be able to manage diabetes with nutrition and exercise? Are they going to force people with normal lipid panels to take statins? Then we arrive at what they consider the least important intervention – glycemic management.

Now granted, the majority of people newly diagnosed with type 2 diabetes will have some of the requirements needing intervention, but why would they not do all at once. I would have hated for them to have done one at a time on me. This does seem to be the recommendation that they suggesting – treating each in the order they have identified until it is under management and then moving to the next digit of the hand. This has me wondering about the conflicts of interest and how much influence this has on their decision.

The senior author lamely admits, "Some degree of glycemic control is necessary to prevent symptoms." "It's just that the return on investment is low when we try to push patients with diabetes to get their blood glucose as close as possible to normal."

It seems to me that the authors are too tied up with return on investment to care about the overall health of the patient. To these authors, I would remind them that health care is not this cut and dried and not every patient will present with the same needs. Yet they seem to be of the opinion that every patient should be treated the same and left no room for adapting their model to fit the patient. Until the medical community stops practicing a “one-size-fits-all” regimen, we as patients need to stay alert to be sure we receive the treatment we need and the explanation of why we need the treatment.

You should read another interpretation of this by Tom Ross when he discusses also using the other hand. I found his blog very interesting.

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