When Talking About SMBG – Researchers Rig Results

When I was diagnosed with type 2 diabetes, I wondered what was ahead. Experiences in my life have been varied, but in my research on self-monitoring of blood glucose (SMBG), I experienced something unlike anything else. I did not realize that whole industries and governments rely on and participate in funding studies fabricating false and misleading information to demean and direct fraudulent intent at a group of people with type 2 diabetes on no medications or oral medications.

These fabricated studies have been reported in trusted reviews, belying the truth in the way the studies were assembled and carried out. The editor of leading diabetes community website Diabetes.co.uk, Benedict Jephcote states: “There are a number of problems with the way results are presented within the Cochrane review. For instance, in the UK, there are many people with type 2 diabetes that are actively interested in self-testing and significant numbers of these people have to buy test strips from their own income. Studies which exclude these people cannot therefore give a fair representation of people with type 2 diabetes in the UK."

Cracks along the above line are already showing evidence to prove just that. In addition, in the future, researchers that are more honest will begin to refute these false studies. What is astounding is that the US Government has participated in this cover-up of studies that are done to show patients with type 2 diabetes do not need to self-monitor their blood glucose levels. The National Institute of Health leads the way and the Center for Medicare and Medicaid Services follows by cutting testing supplies for people needing them. By not educating Medicare and Medicaid patients about the value of self-monitoring of blood glucose and showing them how and when to test, they can support many studies proving that people with type 2 diabetes do not need the testing supplies.

This study by Roche shows that when a study is properly organized and follows the Structured Testing Protocol (SteP) standards, the results are more accurate and SMBG does help people with type 2 diabetes and not on insulin obtain lower A1c's and better glycemic control without harming the quality of life.

Other writers proclaim that the studies are right and say that the results beyond a year do not hold up. I can understand this because these study participants are no longer given the supplies with which to self-monitor blood glucose. Many of the study participants probably are unable to afford the testing supplies and therefore without them the results would be expected to not hold up. That is one reason to have long-term studies of three to five years.

The key in studies is the education which I blogged about here. Whom do you think will obtain the best results? Those just handed a meter and testing supplies and told to test are not likely to understand the results or possibly even care? My bet would be on people that were handed a meter and testing supplies and required to attend classes where they learn when to test, the reasons for testing, how to interpret the test results, and the overall benefits in watching for trends. Better results and longer-term results will be obtained when additional education is done to reinforce good habits and find and attempt to eliminate bad habits.

Although it would be great to have physicians trained at the same time, patients that are educated in testing and have learned the value of managing diabetes for better health will in the long-term be able to do this without physician assistance. With physician assistance, they will do even better.

A Few Tidbits from Medical Blogs

Many topics come across my computer screen and many times, I just read and forget about them. However, lately they have become more interesting and a few are worth blogging about.

The first short article really got my attention. Having diabetes and having much information shoved at me in a “one-size-fits-all” mantra by the ADA, AADE, and many other medical professions, this article makes me very happy. John Goodman titles his blog “Why One-Size-Fits-All-Medicine Doesn’t Work.”

The second short article is about healthcare acronyms. I actually laughed about the dilemma that doctors have with some acronyms. Just this short article was interesting by itself, but the reference link at the end is really what I want to emphasize. Do not be in a hurry to skim over it as it is a 51-page PDF file, and loaded with information. I have not yet read it all, but I will be later as there is a lot to digest, includes some very handy graphs, and charts.

The third blog is about generic insulins. Don't get excited. Apparently this will not be likely to happen under current FDA regulations. Too many hoops to jump through and Big Pharma is working hard to keep this from happening. Still, it does add to the problems people with diabetes will continue to face and the budget will not get relief soon.

The fourth and final item for this blog is about adding nurse practitioners to a doctor's office. In some states this is already working where there are not enough doctors to meet the demand. Still, this may have drawbacks unless the mindset of doctors is changed, states legislate this as a possibility, and nursing education is upgraded in some states.

Researchers Do Make Up Desired Results

Every once in a while studies like this come along that makes a person wonder about all studies. The disclosure in this blog on John Goodman's Health Care Blog is very interesting. The blog title is “When Data Don’t Cooperate, Make Up the Answer You Want” and the researchers did just that.

I will let you read the blog and comments and follow the link to the abstract and full text to get the full picture. I have to wonder what other studies I have been reading about fat, sodium, sugar, and statins, have fabricated results. We all know that some researchers have agendas, but the question is how far are they willing to go and completely ruin their reputation. Or do they not care?

This is just another clue about our medical researchers and their behavior. In looking back over some studies I have not blogged about, I realize how easy this may be accomplished with observational studies. Often you can tell when there is an agenda, but sometimes they do hide the agenda and make you think they actually can conclude what they “discovered.” This is not what we need to retain confidence in our medical research, or nutrition research.

What Are Friends For When Diabetes Is in the Mix?

In the group of us that meet to discuss diabetes, most of us are (6 of 8) on insulin. The latest addition to our group asked why we were testing so often. We had answered many of his questions before, but this time we knew he was fishing for a different answer. I asked Allen about the purpose behind the question this time. He stated that two in his group were only testing infrequently and generally just before they were to have their A1c test.

We knew that they are allowed two test strips per day, and asked if he knew if they were using them all within a few days. He said he was not sure what was happening. I ask Allen how many were eligible for Veterans benefits and he stated all of them. We found out that only Allen was actually receiving VA medical benefits. The rest were a question mark and he was not sure why they were not receiving benefits. I knew what Allen and I were going to be doing. I told Allen to find out where they had their DD 214 forms and we would accompany them to the local VA office.

In the process, we contacted Sue to help her brother. Sue said she was sure her brother was already on the VA roles, but that she would check and find out what was happening. I asked her to let us know as soon as she could. The next day, she called me and said he was, but for two years had not submitted a means test and he was denied benefits. She also stated something that would interest all of us. Her brother was slowly losing his eyesight and his last A1c had been above 9.0. Sue would not say exactly what it was, but the cause of her brother’s depression was now known. Sue was sure that we were on the right track in getting him reestablished with the VA.

I asked if she would help and she asked what she could do. I explained what should be needed and gave her the telephone number of the VA office where she could check what may be needed to get her brother back under VA benefits. She then asked if anyone would be able to help with her brother and I said I would talk to Allen and he would talk to the other two who had assisted him. She said that would be okay and appreciated if they would contact her.

A couple of days later, Sue contacted me and said she had the information needed to get her brother reinstated for VA benefits. She stated Allen was to accompany her to the VA office after she, her brother, and Allen had been to the attorney's office. Sue said that her middle brother (also with type 2 diabetes) was in the process of moving back and would help in the future. They were going to the Attorney's office to have a general power of attorney executed for her and her middle brother and a medical power of attorney for them also with Allen on the medical power for times when the other family members were unavailable.

I expressed my support for what was being done and hoped that everyone in that group would soon be able to have VA benefits and this should lessen the hardship they were feeling. Sue said that she was also going to work with the other group to encourage regular and more testing. She did state that her eldest brother was now on insulin and they both would be sitting in when possible with our group since so many were on insulin. I said that would be great as there is a lot to be learned.

The experiences of the last couple of weeks have been good for all of us and we have all learned from the depression and testing problems. We have been doing a volume of research to know what we need to discuss and answer questions about for Sue and her eldest brother. We are all waiting to meet her second brother.

Allen did say that the VA applications have been filed for everyone now and it is just a waiting game.

Please understand that the names are not their real names and done only to make reference easier to follow. This is the agreement with my fellow members of the group and I will abide by their wishes.

Another Reason for Not Diagnosing Based on A1c

Ever since the American Diabetes Association made the recommendation of using the A1c for diagnosing diabetes and prediabetes, more studies are showing this to be a questionable decision. One study that I had found in the past is no longer available as when I click on the link the message I get is “page not found.” Apparently, there were some reasons for the study to have been pulled.

The A1c has been proven ineffective for use on people undergoing dialysis. This is not done for diagnosis, but should cast some serious doubts on the reliability of the A1c test for all tests. There is still a lot of discussion that for non-whites, the test is not an accurate reflection as it is for white Anglo-Saxons. Some are openly stating that the A1c test needs to be standardized for each ethnic group.

This makes sense as each ethnic group can be very different and react to medications differently. My own wife reacts very differently to medications that do not create problems for me.

Now we learn that another study proclaiming that the A1c cannot be used for diagnosis on people with iron-deficiency anemia. This study does come out of India, but highlights a very real problem in populations that are iron-deficient. Iron-deficiency increases erythrocyte survival. This elevates HbA1c concentrations at a glycemic level disproportionately.

This in turn gives a diagnosis of prediabetes or diabetes when in fact neither may be the case or prediabetes may be the correct diagnosis. The study clearly points out the problems for nutritionally compromised populations, in other words, more than half of the world's population.

Most Adverse Events in Hospitals Go Unreported

I am not sure how to react to this report. Yes, I believe the study and I am surprised it is not more of a horror story. Having experienced a few incidents first hand which I doubt were reported, anything is possible. Some hospitals are indeed better than others are, but I believe this comes from the top down. If the head of the hospital is conscientious and concerned, generally he will employ physicians and nursing staff that are concerned. Anyone can hire a bad apple, but it is the hospital administrator that sets the tone. In some cases, it is the hospital board of directors that establishes the standards.

The study reports that about 86 percent of patient mishaps in hospitals go unreported and are not entered into any incident database. Whether better reporting will improve the quality of care or patient safety remains to be seen. A big surprise in a way is that 62 percent of adverse and “temporary harm” events that were not reported were believed not reportable by hospital staff.

The Office of Inspector General (OIG) in the US Department of Health and Human Services (HHS) recommends that the Centers for Medicare and Medicaid Services (CMS) collaborate with the federal Agency for Healthcare Research and Quality and develop a master list of potentially reportable events. Then hospitals and other healthcare providers could use this list to eliminate any confusion. Presently, the three organizations that accredit hospitals - the Joint Commission, the American Osteopathic Association, and Det Norske Veritas Healthcare — do not have standardized lists of reportable patient incidents.

I seriously wonder if there will be any changes made, as you have to think that hospitals will continue on the present path. If nothing more than to minimize lawsuits, they will resist reporting adverse events. With hospitals now employing many doctors, they will continue to be profit motivated to a fault and to avoid legal problems. Nurses will continue to be dismissed when they do their job and counsel patients to the detriment of potential profits.

You may read the study here and the situation about the nurse here.

What Are Best Tests for Neuropathy?

Two articles both cite the 1996-2007 Health and Retirement Study to identify individuals with a diagnosis of peripheral neuropathy. They focused on 15 relevant tests and examined the number and patterns of tests six months before and after the initial diagnosis.

What the two articles concentrate on is holding up the expensive MRIs that many doctors order which is less than definitive for diagnosis. Then they make a leap that does upset me. They assume that most everyone with neuropathy has diabetes and declare that the oral glucose tolerance test (OGTT) be performed instead. The OGTT is cheaper and may be a solution, but it is far from the most reliable as well when done by itself.

What are they going to do next when the patient does not have diabetes? I have a hard time understanding researchers that assume neuropathy means you have diabetes. There are other causes of neuropathy and the researchers focused on 15 relevant tests. They may mention them in the full study report, but the press release just focuses on MRIs and OGTT.

I must have been fortunate as four tests were used to determine that I had neuropathy and MRI and OGTT were not among them. I was diagnosed several years prior to the diagnosis of diabetes. The neurologist also did a thorough examination of my feet, hands, and lower legs. Then he did the tests before stating that I had peripheral neuropathy.

We do need to use tests for neuropathy that are definitive and not just the expensive tests. Therefore, the researchers are pointing out a real problem we have in our medical system.

Potatoes, Rice, and Bread = Carbohydrates

When reading blogs written by people required to follow the dogma of the American Diabetes Association (ADA), I can only say that the advice needs to be scrutinized very carefully. They tend to treat topics like carbohydrates as a “one size fits all” mantra.

This means you should trust your meter and what it is telling you about the foods you are consuming. Then adjust your portion size to fit what your meter is telling you. Yes, some people can eat all three foods in the title above, and others must eliminate all three from their menu. This means that each individual must find their level and follow it. Periodically you may need to retest to see if anything has changed as this can happen.

We must understand that the ADA promotes the USDA MyPlate solution for starches. Promoting them as the source of nutrients can be misleading as many of the vitamins and minerals can be found in other foods and often in higher quantities. There are people that cannot tolerate gluten found in grains, but these people are often ignored in their advice.

The question included potatoes, rice, and bread, but bread is often the main topic of discussion and brown rice is just given a mention. Potatoes are often completely ignored and a broad statement is made about starches. While potatoes are starches, some types of potatoes create lower blood glucose problems than others. Here again, testing is the only way I know that will give you answers of what types will work for your body chemistry. I am still able eat some potatoes, but not as often or as much as before diabetes.

What I have been surprised about is the rice. One variety (white rice) that everyone has told me to avoid, I can have a decent size serving and have only a small increase in blood glucose. Now brown rice does raise my blood glucose more than 60 mg/dl with just a small serving. This is why each person needs to find out what their body tolerates and not rely on others and what works for them.

Educators will not tell you that if you have a weight problem, elimination of wheat from your diet may help the most in weight reduction. They will only say to eliminate the highly processed bread and use whole wheat bread. Both contribute to the weight problem and it is the quantity of bread consumed. If you can tolerate wheat, consider greatly limiting the quantity.

Everyone needs to be confident of what they eat in relation to the level the food will raise your blood glucose. Meters today are slowly becoming more accurate and we need to trust them. I still find changes that I need to make as I age and my body becomes more sensitive to certain types of carbohydrates.