Why Are Elderly with Diabetes Discriminated Against?

When one of our support group members told me about his being cut loose by his doctor because of his age and A1c, I was going to vent and write a non-complementary blog about doctors. Now that I have had a few days to cool down and read a couple of other blogs, I know what needs to be said.

Allen had an A1c result of 5.0% and being on insulin, his doctor went ballistic and said he was no longer a patient. That A1c converts to an average blood glucose reading of 97 mg/dl. Allen showed me that he only had two readings below 70 mg/dl, one of 68 and one of 66 mg/dl. He had many readings for the last three months between 80 and 115 mg/dl, but only one reading at 129 mg/dl. Allen is on a low carb – high fat meal plan and has medium protein as part of the meal plan. He does eat a lot of self-caught fish and he does eat other purchased fish.

His doctor did not believe his meter readings and asked where his second meter was to be able to download that. Allen has a very good attitude and replied, “What you have is what you get, there ain't no more. If Dr. Bernstein can do this as a type 1, why can't I as a type 2?” For someone that was interested at one time on going back to oral medications, I don't think we could convince him to stop insulin now. He has even stated this to us, and said when he has problems or memory lapses, he will consider it then.

He is about five pounds under weight and says this is where he feels best and exercise is what he does to keep it there. We are all hoping he can find another doctor, but he does not seem concerned at this time. He says if he needs to rely on his VA doctor, so be it. He has mentioned Dr. Tom, but seems in no hurry.

This is an overt discrimination of the elderly to my way of thinking. Even I am considering a change now as my doctor has been asking me to raise my A1c to above 7.0%. We know what the doctors are afraid of and that is hypoglycemia. Never mind that we are managing our diabetes. I have a long way to improve mine to be at the level Allen is maintaining. In addition, I have more medications and other health problems of high blood pressure and cholesterol which are managed by medications.

Many of our group are concerned now and wondering why doctors have a difficult time assessing us properly and treating us accordingly. I won't use the person's name, but one of our members said that it may be because we are elderly and no longer contributing to society that they don't like us to be concerned about our health. He continued, they wish we would quietly die.

A Reason for Early Insulin Use

I hope many of my readers have already read this post by David Mendosa. It is very timely and appropriate.

I will not go further as David does an excellent job and while I have written similar, but different blogs, I would encourage you to read his blog.

Some COIs Are Not the Same

The American Association of Diabetes Educators (AADE) wants to play with words. Normally I associate COI as meaning conflict of interest which means that what is said or published requires investigation because of monies received by (in this case) Big Pharma. For conflict of interest for AADE just go to Industry Allies Council page from the pop-up window in the About Us.

In the AADE blog for April 22, the writer, Karen Kemmis covers some of name change history. The Specialty Practice Groups (SPGs) have now become Communities of Interest (COIs). Why the AADE chose this when it can be confused with the acronym in the first paragraph is somewhat confusing. There is much discussion about a few of the areas in the COIs, but this is for members only.

I have no problem with this being for members and the discussion is interesting. What is objectionable to me is the COI use. I asked a CDE recently about COIs and had a great discussion about this. I did wait until near the end of the discussion to ask about conflict of interest and did I get told off. How dare I say that she as a CDE have a conflict of interest.

I simply stated the AADE had conflicts of interest and by labeling communities of interest as COIs, that opened quite a can of worms for themselves. Of course the CDE did not see it this way. She continued to lecture me and said that she did not have COIs. I finally agreed that maybe she did not, but her professional group sure did. She asked how I arrive at that conclusion.

Since she had her computer open, I asked her to open the AADE website and then to open the Industry Allies Council page. Then I asked her to scroll down to the list of big pharma companies. She would not, but stated this was for support of the AADE and did not affect CDEs.

I did not go further as it would not have accomplished anything other that create a more hostile atmosphere.

Telemedicine to Help Manage Diabetes

Telemedicine is obtaining a chance to prove itself in the state of Mississippi. With the second highest rate of diabetes diagnosis behind West Virginia, Mississippi has developed a plan for delivering top of the line diabetes management to some of its neediest residents.

This plan is implementing steps to cut the devastating effects on the state economy - $2.7 billion annual cost and improve the overall health of Mississippians. In January, the University of Mississippi Medical Center and three private technology partners developed a plan to help low-income residents manage their diabetes via telemedicine. This will be accomplished by helping these residents keep the diabetes in management and avoid unnecessary hospitalizations while remaining active and productive.

The Mississippi legislature passed and Governor Phil Bryant signed the bill which was enacted in March. This requires private insurers, Medicaid and state employee health plans to reimburse medical providers for services dispensed via computer screens and telecommunications at the same rate they would pay for in-person medical care. This means those with insurance or Medicaid will have their providers reimbursed. The telemedicine project will be free to the poor uninsured participants.

Mississippi's telemedicine law goes further than any other state to remove what the telehealth industry considers its biggest impediment, lack of insurance reimbursement.  Twenty states, plus the District of Columbia, have requirements that private insurers must pay for some telemedicine services. Most states pay for certain services through Medicaid, but the Mississippi law requires parity from all insurers for all types of telemedicine services. In April, Tennessee joined Mississippi with a similar law.

Beginning in June, about 200 people with diabetes in one of the state's poorest regions, the Mississippi Delta, will be given internet-capable computer tablets load with the necessary software. Then medical professionals at the University of Mississippi and North Sunflower Medical Center, will be able to monitor patients' test results and symptoms. The third technology partner will provide technical support for the wireless telecommunications services required to transmit the medical data.

Local clinicians in Sunflower County are choosing diabetes patients who are the sickest in the community. The idea is to show that even patients with the least-managed diseases can see improved health outcomes with careful monitoring. Each patient will have a baseline exam and a treatment program. This will require each patient to check blood glucose levels two to four times daily using a home testing kit. These results will be transmitted to medical teams at both hospitals. Patients will also check their weight and blood pressure daily and transmit the information.

The medical team at the University of Mississippi will include a dietitian, a pharmacist, an ophthalmologist, an endocrinologist, a diabetes education expert, and a nurse practitioner. They will work with the medical providers at Sunflower Medical Center to assist and provide a full range of specialty care for the patients. A member of the team will consult with patients daily using video teleconferencing to make sure they are making the lifestyle changes needed to improve their conditions.

This proactive patient monitoring should improve patient care and patient health outcome. It will be interesting to see the interim progress if we are informed and I will be watching for these reports. The diabetes project will run 18 months and interim results will be released during this time. Hopefully the progress will be significant in 18 months that other states will feel encouraged to do longer studies and the results will stem the diabetes epidemic.

Mobile Health Apps' Data Bypasses Doctors

Most data from mobile health apps (mHealth apps) does not get into the hands of doctors. Even with the explosion of mHealth and fitness applications, most doctors continue not to recommend mHealth apps to their patients. The number of apps many say that exist and are available in Apple's iTunes store of 43,000 may be over counted. Due to the lack of evidence of the clinical benefits, doctors continue not to recommend them.

The article claims the absence of research for the impact of mobile technologies on health outcome, that doctors are not convinced that patients can change their health behavior or improve disease management by using these apps. As a result of this, doctors show reluctance to embrace mHealth and consumers (patients) are cutting medical professionals out as they pursue mobile technology.

The study discussed in the above article surveyed 1,000 users who use or plan to use health and fitness apps and found that 70 percent of respondents use apps on a daily basis to track calorie intake and monitor physical activities. Only 40 percent actually share their data and insights with their doctors. Thirty-four percent of the mobile health and fitness app users indicated that they would increase their use of apps if their physicians actively recommended them.

Scott Snyder, president and chief strategy officer at mobile engagement vendor Mobiquity says, "Our study shows there's a huge opportunity for medical professionals, pharmaceutical companies and health organizations to use mobile to drive positive behavior change and, as a result, better patient outcome."

Other studies also confirm that physicians have a lot of ground to make up when it comes to gaining credibility in their patients' eyes vis-à-vis mHealth. One study showed that a quarter of respondents trust website apps, symptom check mobile apps, or home-based sign monitors as much as the do their physician. An equal number often use these instead of office visits.

On the doctors' side, excessive consumer trust in mobile technology increases the potential risk for misdiagnosis and mistreatment of disease. Example, several popular smartphone apps designed to evaluate photographs of skin lesions to determine the likelihood of malignancy are not accurate. Three of four apps in the study incorrectly classified 30 percent or more of melanomas as unconcerning.

How Do You Prepare for Blood Glucose Testing?

I hadn't planned on revisiting this topic so soon, but a discovery made it almost mandatory. Apparently, there is a lot of disagreement about how to clean you hands before blood glucose testing. The following facts from Discuss Diabetes have me in a more than a little concerned.

 

This is just one of many polls that appear on the site. My concern is for those people that use the last two methods before testing and need to wonder why they are not concerned about the accuracy of their testing. I have had the hospital nurses use the hand-sanitizer when in the hospital and unable to get out of bed to use the bathroom, but they always used the alcohol pad for the finger they were going to use. All but one of the nurses used the second drop of blood. This meant that they wiped the first drop off with a cotton swab and used the second drop.

I am concerned about those that use the alcohol swab, but only for those that may have been processing or handling cut up fruit before testing. Well, I am also concerned about those in the winter climates that may have their fingers dry out and crack by using the alcohol swabs. The first will cause higher readings on the meter and if they are injecting insulin, they may inject too much insulin causing hypoglycemia. The second will make testing quite painful.

I have written about the above paragraph here and there is a good article on the same topic when dealing with fruit here. Please find it in your heart to read and follow the correct method for cleaning your hands before testing.

Yes, that is the first method in the poll above. This is important and most test strips have this in the instructions packaged in the box holding the test strip container of test strips. Wash your hands with warm water and soap and pay particular attention to the finger to be used for testing. Rinse and dry your hands thoroughly because your do not want to handle the test strips with wet fingers and waste test strips.

Take time to read the instruction with your test strips please. I see more people with diabetes misusing their test strips and not carrying them in the container they came in. You cannot get accurate readings from mishandled test strips.

Health Scams and Diabetes Con-Artists

This is an odd coincidence. During the middle of April, I received a call from someone saying they were from the Joslin Diabetes Center, had heard that I had diabetes, and had something that they wanted me to participate in as part of a trail. It sounded interesting until the request for money came to cover my transportation to Chicago to be interviewed to see if I qualified for the trial.

The tip-off was when they requested $1,500 for airfare and taxi from the airport. I can drive from my home to downtown Chicago and back home for about $100 at the current gas prices. And I saw no need to travel to Chicago for what could be done over the telephone for a trial interview.

Then to have a blog from Joslin Communications on April 16, on diabetes health scams written in anonymity really had me wondering if my calling the person on the telephone a scammer may have been right on target and maybe it was actually a Joslin employee. No, I don't think that, as Joslin does not call people unless they are an established patient or have responded to call for trial participants.

It is a shame that Joslin Communications does not identify their bloggers as the blogger of this article did a great job of covering some of the types of scams targeting elderly patients. Not covered was the type of scams con-artists attempt by using the names of medical centers or other diabetes organizations. Scammers have a way of using names of recognized medical centers to lend authenticity to their scam.

Yes, using your own brain and a healthy dose of common sense is your best defense against fraud. While everyone to used the trite saying, “If it sounds too good to be true, it probably is,” scammers are also adding some reality and big name medical centers to make it more realistic. Diabetes is one disease that draws con-artists and they know they have a captive audience that is searching for the elusive cure. Because the treatments can be hard on the pocket, many people with diabetes are desperate for a cure as this is the twenty-first century after all.

Most people are in such a panic about having diabetes and don't realize that diabetes can be managed with nutrition, exercise, and medication. Unfortunately, a cure does NOT yet exist. But because people with diabetes often think that there is a cure, they are often gullible to con-artists.

Since I agree with what the Joslin blogger said for things to do and not to do, I will quote their list. “Things to do & not to do:

1. Never give out financial information over the telephone unless you have initiated the call. Government agencies, Medicare, and legitimate diabetes organization do not ask for your financial information over the telephone without you initiating the call.
2. Report fishy calls to the Office of Inspector General OIG Hotline at 1-800-HHS-TIPS or online at http://oig.hhs.gov/fraud/report-fraud. Be sure to include the company’s name, telephone number, and address if you know it and a summary of your conversation with the caller.
3. Check your Medicare Summary Notice and other medical bills to make sure you weren’t billed for things you didn’t order or billed multiple times for the same item.
4. Do not accept things you haven’t ordered. If you haven’t opened the item, you can refuse delivery or return the item to the sender without paying additional postage or delivery fees.
5. Check out any supplements you are considering taking at the Office of Dietary Supplements and inform your health care provider before taking a supplement. Look for the US Pharmacopeia, or Consumer Labs seal on supplements you do buy. This will assure you that what is in the bottle matches what is on the label.”
   

It is also a shame that many doctors are so against supplements that they will not test for deficiencies so that you can know whether you actually need the vitamin or mineral. I can agree that most are available in the foods we eat, but as we age, develop certain diseases or conditions, and limit some of the foods, our bodies sometimes become incapable of utilizing what is in some foods.

Please realize that unless you are a patient at a medical center, you generally will not receive calls from them. If they insist on giving you a telephone number, do record it, call your telephone provider, and ask if the number is a legitimate telephone number for the medical center. Most telephone and cell phone companies will do this free or a small fee.