ADA, Diabetes 'Battle' Is Not for Patients

Again, we as patients need to question what the American Diabetes Association may do to help provide assistance for the patients. I am aware that the ADA is for the medical community, but even there, this seems little hope in receiving help from the medical community – especially primary care physicians. With Dr. Robert Ratner, chief scientific and medical officer for the ADA who says, “Many people with type 2 diabetes who are on medications don't need to do home glucose monitoring at all," in talking about oral medications.

Until Dr. Ratner changes his message or is no longer an officer of the ADA, people with type 2 diabetes need to boycott any activities by the ADA. I realize many people support the ADA unconditionally and my message falls on deaf ears.

The interview that Kevin L. Hagan did with Medscape in October 2015 is another indication of how far out of touch the organization is with people with type 2 diabetes. The first question sets the tone.

“Medscape: This is a big anniversary year for the ADA. Where do you see it headed in the near future?

Mr. Hagan: The roots of the ADA are as a professional medical association; we were founded by 28 physicians 75 years ago. Over the course of the past 75 years, our mission has evolved, and today we serve both healthcare professionals and consumers.”

If we are consumers, then the ADA has nothing of value for us and we would not shop there. We are patients and we certainly don't receive much of value from the ADA. Most of the ADA's efforts are aimed at people with type 1 diabetes. I have no objection to this, as especially children with type 1 diabetes need this support.

Mr. Hagan: “The cost of diagnosed diabetes is more than $245 billion annually, and it is an escalating price. For me, the front lines of that war on diabetes is at the level of the primary care physician (PCP). As an association, we need to give greater attention to that group.”

These are my thoughts and not Mr. Hagan's. This is the purpose of the ADA and we cannot expect better as patients with type 2 diabetes. Some doctors do treat patients with respect, but too many doctors are guilty of some or all of the following:

• Accuse the patient of causing their diabetes.
• Threaten patients with insulin to keep them on oral medications, when they should be on insulin.
• Refuse to give patients any information on diabetes, lack of education.
• They talk at us rather than with us to arrive at the best treatment for what ails us.
• Doctors say, “More knowledge for patients is not always better…”, “Lay people just don’t understand these issues…”
• Doctors will not individualize treatments for the elderly unless forced into this.
• When we dare ask about insulin for better diabetes management, we are chastised for failing to manage our diabetes with oral medications.
• Some doctors also say that using insulin is our punishment for failing to manage diabetes with oral medications.

Yes, many doctors do not treat patients with diabetes with respect, but bully and bad mouth patients behind their back and to their face. Until doctors learn to respect patients and treat them with respect, the battle will continue. The doctor /patient relationship is in disrepair and communication is sadly absent.

The Questionable ADA

I do need to say that I do not follow the guidelines of the ADA. I did refuse for a couple of years to read what was happening on the ADA (American Diabetes Association) website, but that was a mistake. Even if a person does not follow the ADA, we still need to know what they are saying and what guidelines and research is published by them. Some of the research is behind a pay wall, but some is available to the public.

The reason I do not follow the ADA guidelines is that the blood glucose levels they promote are levels that result in the development of the complications. Knowing this is the reason doctors say that diabetes is progressive. When the ADA says they recommend an HbA1c of 7.0 percent is their guideline, this is also in the range for complications to develop. This also causes patients to only attempt to achieve this when an HbA1c below 6.0 percent is nearer normal and while complications can still develop, they will not develop as rapidly.

Having an A1c below 5.5 percent is better, but this is not achievable by everyone. I also admit I cannot attain this level without severe hypoglycemia. I would urge people to read this by David Mendosa, Normal A1c Level. He also discusses what Dr. Bernstein says about normal A1c levels.

Although the ADA has relaxed their food plans in the last two years and in October 2013 issued new guidelines for food plans that includes low-carb, the registered dietitians (RDs) still promote high-carb/low-fat diets even though many were on the committee that developed the ADA food plans.

The ADA is too lax in their guidelines for blood glucose levels two hours after first bite (they recommend not higher than 180 mg/dl) and this will promote complications. The guidelines also say at bedtime that our blood glucose level should be less than 180 mg/dl. Their one-size-fits-all standard is not a good thing and we need to realize this, as people are all different in the way we are capable of managing our diabetes.

The last time the ADA lowered the definition for diabetes was in 1997 that dropped the criteria for diabetes from fasting blood glucose of 140 mg/dl to 126 mg/dl or higher -- a change that increased the number of people with diabetes by millions. It is now 17 years later and a poorly named term of prediabetes needs to be changed. It is not an official designation by the ADA, but with research showing that damage occurs in the prediabetes range of 100 mg/dl to 125 mg/dl it is time to declare this diabetes and move on to having it treated.

Yes, this will add approximately 86 million people to the diabetes numbers, but if done properly, many should be able to stop the severity of diabetes for decades or at least years. Knowing the ADA, this is highly unlikely. The medical profession likes to have people to treat rather than practice any form of preventive medicine.

The ADA also needs to include in their guidelines the concept of moving insulin from the treatment of last resort, to prescribing insulin at the early stages. This has proven effective in allowing the pancreas to rest and partially heal, making oral medications effective for a longer duration. Read this by David Mendosa for further clarification. Many in the medical profession will not do this because of their overwhelming fear of hypoglycemia.

I hope this explains some of the more salient reasons for not following the ADA guidelines.

Today's World with Diabetes

As in the United States, diabetes education is lacking around the world. Who is responsible for the lack of diabetes education? The medical professionals in all countries of course, because they treat all diabetes as a progressive and a lifestyle disease. They have the feeling of why waste the resources on people that cannot manage their diabetes.

With American and World Diabetes Month upon us, all people with diabetes need to be pushing for diabetes education. Without education, the world diabetes epidemic will continue and the numbers will grow. In addition, the costs will continue to rise and eventually become uneconomical for most governments. Diabetes education could go a long way to stem the diabetes epidemic. If done properly, patients would know that diabetes does not have to be progressive and could be held in check for a few years or for decades. The cost of education could reduce overall costs and be beneficial for patients and governments.

Yet, without the medical communities being on board, the education will not happen, diabetes will continue to grow in numbers, and continue to be progressive for those that will not self-educate themselves about diabetes. Yes, doctors, you need to support education about diabetes. In addition, doctors will need to screen more patients for diabetes, especially since about half of the people presently with diabetes do not even know they have diabetes. This also applies to the millions that have impaired pancreases and are progressing to diabetes, because doctors will not warn these people and give them the education to make proper food plans and exercise.

Some statistics that should make doctors want to educate patients include:

#1. Over the next 20 years, the number of people with diabetes in Africa will almost double. This region has the highest mortality rate due to diabetes.

#2. 21.2 million people in Europe don’t know that they have diabetes.

#3. 6 of the top 10 countries for diabetes prevalence are Pacific Islands.

#4. China has 114 million people living with diabetes. India follows up in second with 63.0 million, and the U.S takes third with 24.1 million.

#5. More people in the United States die each year from diabetes than AIDS and breast cancer combined.

#6. In 2012, 4.8 million people died due to diabetes.

#7. 471 billion U.S. dollars were spent on healthcare for diabetes in 2012 alone.

#8. WHO projects that diabetes will be the 7th leading cause of death in 2030.

“One of the main issues involving diabetes is the lack of attention and funding we have seen from governments. Considering the number of people affected and its cost impact, diabetes prevention and research does not receive nearly as much support as diseases like cancer and HIV/AIDS. For people with diabetes to be able to take the important action of monitoring their blood sugar regularly, we need to make it financially feasible for them to purchase the supplies they need, and we need to teach them and their care team why and how they need to do this monitoring.” This is a statement by William Hsu, M.D, Senior Director of Joslin Health Solutions International. Bold is my emphasis.

Dr. Hsu continued, “Getting governments involved is just one of the issues faced in this growing epidemic. Nearly half of people with diabetes are undiagnosed, this makes it an impossible problem to solve when people don’t know there in an issue in the first place. Diabetes awareness –including prevention, diagnosis and treatment– must start at the community level. We must reach out across spheres of influence to help take the stigma out of diabetes, to help people realize that it is better to know about, and then take control of their diabetes, rather than to ignore it. We also need to take the long view, building to the future. Training medical students and junior doctors and nurses from other countries in diabetes knowledge and skills in listening to and engaging patients will ensure that we can affect the next generation and beyond.”

WHO (World Health Organization) is another organization that is dedicated to preventing and minimizing the complications of diabetes globally. Through their Diabetes Programme, WHO “oversees the development and adoption of internally agreed standards and norms for the diagnosis and treatment of diabetes, its complications and risk factors.” It promotes and contributes to the surveillance of diabetes as well as advocates for the prevention and control of diabetes in vulnerable populations.

“The International Diabetes Federation (IDF) is dedicated to engaging in action to tackle diabetes from the local to global level. At IDF, the main focus is worldwide awareness and advocacy. Aiming to increase public awareness and encourage health improvement, IDF promotes the exchange of high-quality information about diseases and provides education for people with diabetes and their healthcare providers.” This is from their website.

Why can't the other organizations have similar goals? At present, all the doctors seem to want to accomplish is let diabetes continue without education and testing supplies, to be able to treat the complications of diabetes. The shame of this will be on them.

Healthy Plate By Joslin, Maybe Not So Healthy

If you are a follower of the ADA food plan, you will enjoy the Joslin healthy plate. If you need to gain some weight, you will love the Joslin healthy plate. Does this tell you what you need to know about the Joslin healthy plate?

It is not as interactive as a person would like and in fact is rather rigid in options, as you would expect a registered dietitian to be because of being a proponent of BIG Food. I attempted to get a variance to help with weight loss, but everything I tried came up the same when I wanted Joslin healthy plate to do the calculations. If I were to follow the plan, I could figure on gaining approximately 5 pounds per month. Some weight loss plan!

Even using a meal plan that you may have and then following this route would not let you have fat or products containing fat. This shows that unless you use their high carbohydrate – low fat (HCLF) foods, you will not even be able to have a balanced meal that you might like to eat. Yes, those with diabetes that are able to consume the HCLF without causing spikes in their blood glucose levels can eat this. For the majority of people with type 2 diabetes, the Joslin healthy plate food plan will not be one that you will find satisfactory.

I can only surmise that the American Association of Diabetes Educators (AADE) and the Academy of Nutrition and Dietetics (AND) has been more influential in reminding their members to follow certain guidelines instead of allowing any deviation from positions not supported by BIG Food.

While the American Diabetes Association (ADA) does now support other food plans including low carbohydrate – high fat (LCHF), the AADE and AND will not allow what the ADA allows. These two groups will continue to loose support among the patient population for their rigid position.

Diabetes Experts versus Diabetes Patients

When a couple members from the support group saw this title, one made the comment, “Here we go again!” I asked what he saw in the title and he said that it was another blog about oral medications. I had to agree, as that is my intent. I must declare I am on insulin (long acting and short acting) plus a minimal dosage of metformin.

I do believe it is time for patients to declare their intentions, especially if they are on some of the medications that are being reported with serious side effects. I have nothing against metformin in the extended release version, as the gastrointestinal side effects are often minimal when taking it. Many people have no side effects with the extended release version. And the fact that it is generic and the cost is affordable and makes this an economical treatment for type 2 patients.

Yet, our diabetes experts want to stack one oral medication on top of another oral medication for several medications. I complain that this is not good and this practice by physicians needs to stop, the AACE Diabetes Algorithms not withstanding. The American Diabetes Association and the American Association of Clinical Endocrinologists don't want this to happen and advise keeping patients on oral medications. The sad part of this advice is the corporate sponsors of these two organizations are the beneficiaries and the officers of the ADA and AACE receive fees from these same sponsors.

It is convenient for me that one of the studies reported out of the ADA 2103 Scientific Sessions June 22, is about stacking three medications and the author reports starting people newly diagnosed with type 2 on triple drug therapy. You may read about this ongoing study here at Medscape. This has to make the ADA and AACE very happy.  I hope this becomes fully tested as the side effects may be great and dangerous.

This relationship with the pharmaceutical companies has to end for any trust in the ADA and AACE to be restored. How can we place trust in the guidelines issued and the recommendations of their officers when we know that they are influenced heavily by the fees they receive from the pharmaceutical companies? Then in addition, they are well paid as officers from the contributions or sponsorships of these same pharmaceutical companies to their respective organizations.

Yes, I will continue to blog about the guidelines issued by the ADA and AACE, but everyone needs to be aware of the biases built in and the underlying motives for some of their misdirected guidelines. Comprehensive the guidelines are not and with the built in discrimination by researchers when they exclude the elderly and the young from participating in research, the people that are using the majority of the medications have not had the medications tested on them. This adds more reason to take a jaundiced view of the guidelines. Insulin anyone?

And before I forget, I salute the people with type 2 diabetes that are able to manage diabetes without medications. Some have been able to manage without medications from the start while others have been able to wean themselves off medications and continue to manage without further medications.

ADA Standards of Diabetes Care in 2013

This article from Diabetes in Control is not one I expected. Then when Dr. Robert Ratner, chief scientific and medical officer for the ADA says, “Many people with type 2 diabetes who are on medications don't need to do home glucose monitoring at all," Bold is my emphasis. I must wonder if he is many bricks short of a full load. He sounds a lot like a doctor I heard of recently that does not use the A1c, but only the oral glucose tolerance tests for diagnosing patients and adjusting medications later.

With people like this in positions of responsibility in the American Diabetes Association, I am not surprised at the telemarketing scandal that was reported here last year. Why would someone make statements like this? Yes, I can rant and become angry, but with leaders like this, how can I even respect the ADA. This even removes hopes that may have been there for help, when we have leaders that open their mouth and make stupid statements like this. For what purpose? Are they trying to divert attention away from something more idiotic someone said or did? Quite possibly.

Then why do they even make statements like this, when they pull the rug out from underneath many people with type 2 diabetes (in the above bold red statement). "For patients who aren't on insulin, self-monitoring has to be linked to education on what to do. Patients need guidance on what to do when the numbers are out of line. Do they need to call their doctor? Change their diet or take medicine? They have to be taught how to utilize the information." It seems ridiculous how they can kick people when they are down and then make something sound so promising. I think this is “feel good” hype and a way to keep people off balance while they do nothing.

Maybe the statements were made to deflect the criticism for ADA partnering with Domino Foods, Inc. This cannot be a good reflection on the American Diabetes Association. However, this article appeared on January 15, 2013, and the earlier statements were written on December 27, 2012. Either way, the ADA is not living up to doing anything for the patients they are supposed to serve or even helping the physician members who need the support. This also reminds me of the activities of the Academy of Nutrition and Dietetics which is also in bed with the food industry.

Going back to the last quote in red above, I am keenly aware of the fact that many patients need to learn completely on their own how to self-monitor their blood glucose and interpret what the blood glucose readings mean. This is what I had to do before I started on insulin and this is something the members of our group do to help each other whenever needed. Sue has been very appreciative that we have been very willing to help her in determining what the different blood glucose readings may mean and how to learn to determine this for herself. The three new members on oral medications are asking questions and happy that we are willing to answer any questions they have. So, for us, the ADA can keep their “feel good” hype.

Even though none of us within the group has any of the formal training for diabetes self-management education, we seem to be doing very well at working with others and educating them about managing their diabetes. We do become upset when the leaders of the ADA make statements like the first quote as these people need the test strips to be able to determine what their blood glucose readings are to become educated. They need to understand what happens with their bodies in processing blood glucose and what different foods can do to their blood glucose levels.

ADA Changes Blood Glucose Monitoring

If the American Diabetes Association believes they have undone the damage that their 2003 Guideline set in motion; they may have another thing to consider. What happened in the 2003 Guidelines was a recommendation for people with type 1 or type 2 diabetes who use insulin in multiple daily injections or with an insulin pump should self-monitor blood glucose “three or more times daily.” Most payers interpreted this to mean that three tests per day was sufficient for all patients on insulin.

To find out if the new 2013 guidelines had changed any minds, I have decided to correspond with my insurance company, Medicare, and inquire from a few other medical insurance companies that cover part D. I now have a response from the medical insurance companies and a brief statement of “no anticipated changes” from Medicare. Even the Veterans Administration stated that there are no anticipated changes. One medical insurance company said they are taking a wait and see stance about what other companies are thinking. My medical insurance company stated that since I don't use them for my test strips, they are not responding further. I talked with my agent and he asked. He was told there would be no changes at present. The last medical insurance company said they are still asking questions, but anticipate only minor changes if accompanied by an order from the doctor.

This made me contact another company and I was told in a phone conversation that there would be no changes until the ADA decided that a certain number was needed. This raised my hackles, and I said they did. We discussed the section and I was told the key words were “many patients” and that until ADA clearly stated for “most” patients, they would continue the current limit. Then I was asked about the Joslin blog of January 16. I stated I had read this. I was told that this also confirmed the current position of no change. This is about as big a slap in the face as you can get. This insurance company said the the Joslin blog is also the reason they will be limiting type 2 diabetes patients not on sulfonylureas to one test strip per day. It had been two per day.

I can also envision insurance companies requiring doctors to forward meter downloads to prove that the patients need as many test strips as requested. I know that this is on the mind of one of the companies I have corresponded with as they asked if I would be willing to do this. I know many diabetes clinics and a few doctors do have the software to do this, but most primary care physicians do not. Think of the cost and if you think they are not going to pass this on to the patient, you are in for a surprise. Another statement one insurance company clearly made is, “if this was that important, why did they (ADA) wait ten years to make a statement like this?”

I personally think that until ADA includes more people from the medical insurance industry and a few patients (type 1 and type 2), they will continue to be laughed at and not believed to be setting recommendations and guidelines for the patient, but in their interests only. In recent years, this seems to be the trend. Even we, as patients, have to wonder what they are doing for the patient. They are great at wording that means and says very little. This has to be what the medical insurance industry thinks about their wording and their reasoning for no anticipated changes. Even though ADA is saying they made some changes, in the real world, there may not be changes.

One section says the following, “The frequency and timing of SMBG should be dictated by the particular needs and goals of the patient. SMBG is especially important for patients treated with insulin to monitor for and prevent asymptomatic hypoglycemia and hyperglycemia. Most patients with type 1 diabetes and others on intensive insulin regimens (MDI or insulin pump therapy) should do SMBG at least prior to meals and snacks, occasionally postprandially, at bedtime, prior to exercise, when they suspect low blood glucose, after treating low blood glucose until they are normoglycemic, and prior to critical tasks such as driving. For many patients, this will require testing 6–8 times daily, although individual needs may be greater.” The bold words is my emphasis and is the wording used by two companies below.

The above is the section quoted back to me by two of the insurance companies, one that will make no changes, and the one that will use a doctor's order and consider the need.

Another area that was also used is, “Because the accuracy of SMBG is instrument and user dependent, it is important to evaluate each patient’s monitoring technique, both initially and at regular intervals thereafter. Optimal use of SMBG requires proper review and interpretation of the data, both by the patient and provider.”

In reading the section, type 1 is specifically mentioned, but other areas only use the term MDI (multiple daily injections) and self-monitoring of blood glucose (SMBG). This leaves those of us with type 2 on insulin wondering if we will be excluded from obtaining support for intensive testing.

Again, the ADA has played down the importance for people with type 2 diabetes on oral medications and on no medications of the need for testing and also the need for being tested more than two times per year by the A1c. This statement is typical of the ADA's attitude, “The evidence base for SMBG for patients with type 2 diabetes on noninsulin therapy is somewhat mixed. Several randomized trials have called into question the clinical utility and cost-effectiveness of routine SMBG in non–insulin-treated patients. A recent meta-analysis suggested that SMBG reduced A1C by 0.25% at 6 months, while a Cochrane review concluded that the overall effect of SMBG in such patients is small up to 6 months after initiation and subsides after 12 months.”

For me this is almost criminal in both the attitude and actions they have about not educating these people with type 2 diabetes and then preventing those that know the importance from obtaining the necessary testing supplies.

And if you doubt what I am saying, why then would the Joslin Diabetes Center post the blog they did on January 16, 2013 (mentioned above), in which they ask the question, “When Should I Check My Blood Sugar?” “The answer depends on the medications you are taking, your current level of control and what information you are looking for. For example, people with type 1 diabetes who take insulin four times a day need to check at least as many times. People with type 2 who control their glucose levels with lifestyle or lifestyle and metformin may check only once, or perhaps twice, a day.”

Patients at Joslin need to be concerned about the side Joslin is on, as it clearly is not for the patient. This blog seems a clear rebuttal of the 2013 ADA Guidelines. Don't think the medical insurance companies won't see it this way (two companies have). This is just one more reason they have for not making changes. When a well known and prestigious diabetes clinic publishes information like this for patients, they are not doing us any favors.

The two companies (mentioned above), did have me call them and talk to an office that make the determination. They admitted that there will be controversy over this, but that with a leading diabetes clinic saying only four times in difference to the ADA of six to eight times, the decision will remain no change until everyone is in agreement. When I asked about meter downloads for proof that a person was testing more frequently, the answer was that this was under consideration, but that not all physicians would be capable of submitting this information. They did say that to force this issue now could be considered discriminatory, but that it is under consideration for future years. They said with a doctors order for the testing and the meter downloads being submitted, this could be a factor when everyone is in agreement as to the number of testing requirements for both type1 and type 2 on insulin.

In the phone conversations I also asked about those type 2 people on oral medications. Both companies stressed that they will be allowing two test strips for those on sulfonylureas and will be allowing more if there is a doctors order because of repeated episodes of hypoglycemia. Others, to include those on no medications will remain on one test strip per day without a doctors order proving the need for more test strips. They would not discuss what the doctors orders needed to state.

Then to read another article also questioning ADA's attempt to change the minds of insurance companies, read this from Diabetes in Control. Dr. Richard Grant, incoming chair of the ADA Professional Practice Committee says, "We're trying to say it's very situation-dependent …. both by the patient and the patient's context." This really says nothing even if they are claiming otherwise.

This statement really drives home the point that ADA has not succeeded, “With regard to the removal of the three-times-daily number, Dr. Yehuda Handelsman (Metabolic Institute of America, Tarzana, CA) expressed concern that insurers might actually interpret that as endorsing less frequent testing for patients who use insulin. How messages are conveyed matters, he said. "It's about how you define the goals and where you put the emphasis."

According to Grant, the new document was the ADA's best attempt to balance the evidence from the literature with the needs of the individual patient. "Evidence-based guidelines apply to populations of patients with diabetes, but we really need to tailor these population-level recommendations to the individual in front of us."” In other words, this is why insurance companies are saying loud and clear, “no anticipated changes” So forget what ADA claims.

For other perspectives and more hope in others areas of the country, read this blog from Diabetes Mine and this blog from Diabetes Self-Management.

What Is the American Dietetic Association Attempting?

This is definitely a two-edged sword and I have to wonder at the basis for the name change. The American Dietetic Association (ADA) changed its name to the Academy of Nutrition and Dietetics (AND) in January 2012. Does this mean that they now have an organization for teaching nutrition and dietetics? Or, is this now an organization through which they will enforce their mafia-style tactics on their members to keep them in line and preaching their mantras. I suspect all of this and more after reading this article in forbes dot com.

The article is several pages and points out a frightening array of changes ahead as they attempt to gain control of the field of nutrition. They are doing this through credentialing and state licensure. In the process, people that have degrees in nutrition and are practicing their profession will no longer be allowed to under efforts being supported and lobbied for by the AND. Until they become credentialed under the Commission on Dietetic Registration, they will be forced to stop what they are teaching. Under the laws supported in some states, if they do not stop, they may face jail time and severe financial penalties.

I even have to wonder if they will go after instructors teaching nutrition in our colleges and universities. This remains to be determined, but under the laws of a few states, this may be possible. We do not need nonsense like this crowding our over worked court system.

What the AND has done in effect is to prevent the nutritionists from forming their own group and credentialing organization. They are in effect legally taking over by bringing this group of people under their control, and credentialing. If you doubt this, why else would this organization apply to the US Patent and Trademark Office for a series of certification marks, a type of trademark related to credentialing, for a comprehensive array of nutrition-related professional titles, including:

• Certified Nutrition Associate
• Certified Nutrition Coach
• Certified Nutrition Educator
• Certified Nutrition Manager
• Certified Nutrition Professional
• Registered Nutrition Associate
• Registered Nutrition Coach
• Registered Nutrition Educator
• Registered Nutrition Manager
• Registered Nutrition Professional

The certification mark applications, in conjunction with the name change, suggest that the AND is attempting to expand its scope and influence, from its decades-old role as the industry group for Registered Dietitians, to now encompass the entire field and professional practice of nutrition.

To quote from the article “The document specifically bemoans that the word “dietitian” (the trade group’s decades-old area of coverage and specialty) is regulated far more heavily than the word “nutritionist”:

Simply put, governments more strictly regulate the work of and qualifications for dietitians than it does for nutritionists, and competitors are explicit about their intention to exploit this dietetics/nutrition distinction. An array of competitors is already providing would-be clients with personalized health education and nutritional counseling in growth areas such as prevention and wellness and in private practice careers. The required and necessary skill set of RDs competing with these other nutrition professionals may not necessarily be the same that clinical dietitians [sic], but RDs cannot cede this expanding market to others who clearly intend to provide nutrition services. [Emphasis added]”

The document does list in detail the competitive threat posed by many different types of non-RD practitioners who give nutrition advice and includes the threats from nurses, pharmacists, personal trainers, chiropractors, and naturopaths and homeopaths.

As the author of the article was so careful to document, “the devil is in the details.” In several states the then ADA was able to force several qualified nutritionists out of business because the law was not specific enough for their profession in allowing for them to dispense nutritional advice as part of their practice and thus ADA succeeded in forcing them out.

It will be a sad day for nutrition if this is allowed to run its course and obesity will become even more of a problem. Plus we will be forced to live closer to USDA guidelines. If the AND makes further intrusions into the healthcare system, we may be forced to pay fines for not eating by their guidelines.

Carefully read what the full article says and especially take time to read this PDF from the files of the then ADA, now AND.

Why Do You Let Teaching Moments Pass?

I could list many people that write about this, but I am interested in why they let teaching moments for diabetes get away from them. This raises many questions and provides very few answers.

Is it the setting, the time, or the place that stops them? Are they people that want to keep their diabetes a secret to be kept in a closet? Are they too embarrassed to speak up? Or, is this an invisible disease that keeps people tongue-tied?

When compared to breast cancer, awareness on a national level is more recognizable and better advertised. People have ribbon stickers on their cars, have larger, more publicized events and in general have come out of the closet in their battle against breast cancer.

What is it going to take to get the diabetes community to come out of the closet? The International Diabetes Federation (IDF) is trying to lead the way in a color and a symbol. But the American Diabetes Association (ADA) is determined not to become part of this effort. They want their own color and their own symbol and seem to downplay the efforts of the IDF.

However, let the IDF have some success and the ADA will find a way to either hog the credit or say they had a large part in it. Sometimes they have a legitimate claim to a little of the credit, but they seem to want to have it all. Not a very professional or humanitarian thing to be doing is the way I view this.

The ADA does little to promote coming out of the closet and using education to promote the prevention of diabetes or giving the support to adult patients with diabetes. The ADA does not promote discussing diabetes to help people understand this chronic disease to the general public. They do not promote many activities for the cure of diabetes. The ADA is basically an association of and for doctors and this they do poorly. Why else would there be so many doctors that will not aggressively work to diagnose diabetes and try to stem the rising epidemic of obesity.

The only claim that the ADA can make is their enforcement of laws on the books protecting children and their rights in the public school system. They do also use the Americans with Disabilities Act laws to protect the rights of people with diabetes. This is their only claim to fame. While medical professionals look to the ADA for guidance in the field of diabetes, the ADA is very much behind the times in its pronouncements and guidance about the types of diabetes and effective ways to treat diabetes. Often this is five to ten years after the medical professionals have made the decision on their own.

There is research available and verifiable, but the ADA keeps looking for more on which to base a directive or issue guidance. This in turn leaves the patient with little to rely on in discussions and trying to make sound decisions for their own health.

Therefore I lay the fault of why patients avoid educating others about diabetes on the steps of the ADA and the medical profession. They wish to be the ones controlling the patients and having patients totally rely on them. The ADA feels that patients are incapable of learning about this chronic disease called diabetes. Before you think I am totally against the ADA (which I am), they are responsible for American Diabetes Month, but do little to promote education within this month.

Now that the American Association of Clinical Endocrinologists (AACE) has a web site of approved and vetted diabetes sites (this is still in the formative stage and more sites need to be added), will the ADA follow and claim credit. I can see the press release about how they have had all the information available on their site. Yes, it may be there, but finding it and having access to it are two different things, both equally difficult and often costly, as they will not offer much freely, but for a fee. The AACE did think to include the ADA on their list of approved and vetted sites.

ADA Is Now Fear Mongering

When I opened my browser today, like normal my email list shows first.  American Diabetes showed in bold letters. I had to wonder as I don't normally receive emails from the American Diabetes Association. If it is for contributions my spam filter redirects it and I don't even see it. So I thought why not and clicked on it.

In a way, I am glad I did and in another it got my blood pressure one bang of a jolt. Now that I have had time to relax and think about it, it makes sense that since this affects the pocket books of its medical professionals, they would turn to fear mongering. This is a common tactic among politicians to get reelected, but I had not thought a professional medical organization would stoop to such a low-life tactic. Actually, I should have realized that this is just an expansion of the fear tactics they use on their patients all the time.

It is not surprising that when something has the potential to put a dent in the income level or retirement plan of a doctor, the professional organizations will rally to the cause. What rubs me wrong about the tactic of using the ADA is that the organization has little concern for patients or people with diabetes in the first place, but they will ask for our support when their pocket book might take a hit.

Where is the ADA when they are needed for other issues? Oh yes, when there is a public relations opportunity – they will be there. If there is an issue where they can scratch the back of their legal friends – they will be there. If they can somehow be made to look like the good-guy, count on it – they will be there.

Do not expect any support from the ADA when those of us with diabetes just happen to need support to prevent euthanasia because we are going to cost too much money to be keep alive. They will be happy to nail the lid on our coffin.

Where is the ADA when we need test strips for Type 2 diabetes? Yes, they helped the medical insurance companies restrict the number of test strips we may use. So ADA, if you are wondering why you get no sympathy from me, start behaving like professionals and do a few things for patients for a change instead of worrying about your pocket book so much before it happens. Posturing will not get my attention, only my wrath. Both political parties are making with the threats to get support and bring people to their side. It is all posturing for the voters.

What will count in the ballot box in 2012, is the actions taken now, not the fear mongering actions of a medical group. If you feel that way about things, run for political office, then when you use fear mongering, we will know what you mean and how we can vote to chase you out of office. Now we have to live with your threats to instill fear in a community that is tired of this tactic from doctors.  (IDEA*!) That may be a solution, make it an added requirement that they (doctors) must receive so many votes to retain their license on a four year basis.  The use of fear might just disappear - poof!!!  Oh well, it was just a thought.

If you advocated more for patients and their well being over your financial condition, you might receive more support. If we are ever to recover from this financial mess, everyone will need to share the burden – and that includes you – the fear mongering doctors of the American Diabetes Association.

Americans with Disabilities Act Gets Amended

This is an insight into what I have been working on the last few days and will take more time to fully digest – I don't like the pieces here and other pieces over there. I knew this was happening, but had not continued to follow it after the comment period was over. There is quite a few changes in the Americans with Disabilities Act that will affect many of us. From people with diabetes to service dogs, there is a lot digest and determine how regulations have changed and affect us.

The American Diabetes Association made this release which kicked my backside into action. The ADA is applauding the changes which provides clear and clear regulations protecting the rights of people with diabetes in the workplace. How far this will go in creating better climates and working conditions for people with diabetes is not as clear as I had hoped.

Some of it is bound to be tested in the courts and possibly to the Supreme Court. But I will leave this to those in the legal profession. Some changes are definitely for the best and hopefully some of these will undergo further definition in the future as there are some gaping holes still existing that need addressing. But I am straying away to areas not covered in the ADA press release.

The ADA boasts about their participation which is all well and good and I am satisfied that they did what they were able considering all the groups participating and demanding this and that regulation. Yet, I do wonder if they left some areas that were in need of action to get other regulations. This is the problem within our political system of compromise which leaves needs on the table.

Employment discrimination is a big issue addressed and for that I am thankful. The new regulations will benefit people with diabetes and employers. It will simplify the determination as to whether an individual is covered under the law and allow attention to be put on the issue of whether a person with diabetes is discriminated against because of diabetes.

I have much more information to work through and it is a time consuming task. I just wanted you to know some of what is occupying my time and why I needed a break from blogging.  And I am enjoying some time away from research.