August 8, 2016
The Value of SMBG Testing – Part 2
This is a continuation of yesterday's blog on SMBG. Gretchen's blog had this to say - “The Diabetes Educator article notes that the International Diabetes Federation has concluded that "simply recommending SMBG to patients without instructions for testing or use [of] results in [is] a waste of time, money, and resources." That's what we patients said.” In the long run, self-testing along with education about what to do with the results is one of the best way for our medical system to save money." This is from the blog referenced in the August 1 blog.
When we think about the problems and complications that happen with unmanaged diabetes, we can see many costs escalate beyond the cost of test strips, yet the Centers for Medicare and Medicaid Services (CNS) is looking to the short-term cost savings only. And the insurance cartel follows the lead of the CMS. When they start seeing the rising long-term costs, they may begin to understand what their short-term cost savings have wrought.
First, I must point out that much of the research for self-monitoring of blood glucose (SMBG) is suspect. Not only are the participants carefully selected, but also most studies seem to exclude people with type 2 that have an interest in or knowledge of SMBG. Many of the studies are observational in nature or rely in participant-completed surveys, which are not reliable for scientific accuracy. In the USA, many of the studies are funded by the National Institutes of Health (NIH) or the Centers for Medicare and Medicaid Services (CMS). Then on the unscientific information, Medicare takes more test strips away from us.
I have made this accusation before and I will again. This is based on my research and in no way is it scientific. There is a conspiracy happening in the USA between government agencies and medical organizations to keep many people with type 2 diabetes unaware of the damage being caused by our grain industry and low fat mantra, which is promoted by the US Department of Agriculture (USDA). In turn, the NIH and CMS have cooperated by funding non-scientific studies giving Medicare the incentive to reduce our testing supplies.
Then the America Diabetes Association (ADA), the American Association of Clinical Endocrinologists (AACE) promote the USDA line of thinking – whole grains, low fat, and people with diabetes that do not know better listen to them. Then the American Association of Diabetes Educators (AADE) and the Academy of Nutrition and Dietetics (AND) which follow the ADA and AACE do little do encourage people to think for themselves. They are pushing mantras and mandates and expect people with type 2 diabetes to accept the dogma blindly.
The AADE does nothing to promote and teach diabetes self-management education (DSME). They give mandates and mantras that patients are learning is bad for their diabetes health. Most CDEs will not teach patients about self-monitoring of blood glucose (SMBG) for fear that patients will discover the truth about whole grains and low fat. The monopolistic workers for the AND mandate that we consume a minimum number of carbohydrates per day and go ballistic when we do not and literally call us noncompliant and often refuse to work further with us. This refusal is the one good thing for us as patients.
Now some will say that the AADE does promote DSME, which in a small way they do, in some sources and pamphlets, but very little of the information ever reaches the patients. A few conscientious CDEs do teach DSME and even fewer teach SMBG until they are confronted by older CDEs and encouraged to stop.
We know there are doctors that are breaking ranks with the ADA and AACE because of the lack of diabetes education being taught.
I am also aware of doctors attempting to use peer mentors to dispense some diabetes education when CDEs are not available or have taken positions in conflict with the doctors. This may become more common as the increasing numbers of patients diagnosed with diabetes come into existence and the numbers of CDEs entering the field continues at a snails pace. With this gap widening almost daily, is it not surprising that doctors are exploring other avenues to assist in diabetes education. Even more doctors are investigating shared medical appointments to expand education by presenting it to groups of patients when there is not time to do it individually.
The controversy about the registered dietitians will need to play out in the court system before we will know whether their numbers will decline. Nutritionists that are joining other organizations to continue being able to dispense nutrition information may be able to step in and fill the widening gap. This should be great for those of us with diabetes as my experience with these nutritionists has been positive. They are interested in balancing nutrition and not issuing mantras and mandates for us to follow. They will suggest ideas that some of us may disagree with, but will work with us to help us balance our nutrition whether we follow a low carbohydrate, medium fat diet, a paleolithic diet, or even other diet plans. They are not locked into telling us we must eat a required number of carbohydrates.
Patients around the globe need education about diabetes and how to apply this to their daily lives. In the USA, we need Medicare to give us back our testing supplies in sufficient quantity that newly diagnosed patients can determine how the different foods and food combinations affect our blood glucose levels. Then allow enough test strips for people to use on a daily basis and to do random checks when adding new to them foods.
Okay, why do I use Medicare as the scapegoat? Because the medical insurance industry generally follows the lead of Medicare in lock step. If NIH and CMS are going to do studies, let’s have them do studies for three to five years and give continuous education during the studies. Have the education reinforce the principals set out at the beginning and ask the participants what they need in more information to help them. And, have the studies be scientific studies with the proper scientific methods applied and not the observational and survey format from the past. Do not exclude study participants that are interested or have knowledge of SMBG. Teach the study participants SMBG or DSME.