June 10, 2011

Why Are You Missing Work?

While I had not really thought about it this way, it does answer some questions I was asked by some employers recently, specifically the human resource departments. I attended because the speaker wanted someone with diabetes he could call on. We had prepared for the meeting, but were hit with a few questions that took all of us by surprise. There were four of us on a panel (representing different non-contagious diseases) to answer questions plus the speaker.

This article goes a long way to answer one of the questions and another blogger did a good blog that covered another question. One of the questions was how liberal an employer should be in allowing absences by people with chronic diseases. Most of us had covered absences for doctor visits and other possible related absences. None of us was ready for one question. What about the times when an employee is unable to work a full day, but has no doctor appointment.

We all fumbled with this one. I mentioned depression as one possibility and hypoglycemia as another, but did not realize how much time was being lost. So this survey results article has been sent to the speaker to forward to the employers in attendance.

This survey was recorded from four countries – U.S., UK, Germany, and France and involved 1404 people with Type 1 and Type 2 diabetes that had reported a hypoglycemic event in the preceding month.

The average loss of workplace productivity on a per person, per month basis from a night-time hypoglycemic event was 14.7 missed hours of work or estimated dollar value of $2,294 per person, per year. It is noteworthy that 22.7 percent arrived late or missed a full day and events occurring during work hours showed 18.3 percent needing to leave work early or miss a full day.

Another piece of information also forwarded to the speaker and then to the employers is this from Diabetes Care via a BD Newsletter. This covers work loss and employees leaving work because of disability after age 55. Rather shocking and large numbers.  I had been alerted to this a few days ago by a fellow blogger.

The one recommendation the entire panel agreed should be considered by every employer was having a health screening at least annually for all employees. This would be a preventive measure and could be conducted during the workday and might help catch health issues before they became serious and then with follow-up would encourage people to take the steps to maintain good health. Emphasis was on stopping obesity, hypertension, diabetes, and related health issues.

These studies and the growing numbers of new diabetes every year is creating concern for employers. Some employers are taking positive actions and some are not handling the situation.

June 9, 2011

Victoza for Type 2, Helps Type 1 As Well

Who would have thought of this? People with Type 1 diabetes taking a medication developed for people with Type 2 diabetes. Apparently it works! While this is a very small study, only 14 adults, the results are surprising. We have had Type 1 people take Metformin and this is well documented (but still off-label use).

The people included in the study had well controlled Type 1, but found that they had even better control with Victoza and lost an average of 10 pounds in six months. They also required less insulin. Those that continued this treatment for a full year continued to see improvement and felt much better overall. This is according to the study leader Paresh Dandona, MD, of the State University of New York. Buffalo.

This was reported at the annual meeting of the Endocrine Society in Boston. Of the 14 adults, all used the insulin pump for their insulin and received Victoza for either one week or 24 weeks. Continuous glucose monitoring showed tight control with insulin, yet all had highs and lows at unusual times.

When Victoza was added to the insulin regimen, the highs and lows were eliminated and after one week the average fasting and blood sugar levels each dropped by approximately 15 percent. Then the added benefits for preprandial insulin decrease of 30 percent and long acting insulin decrease of 32 percent make for further success.

The groups in the 24-week treatment had further decreases in insulin doses and lost an average of 10 pounds. HbA1c levels dropped from 6.5 percent to 6.1 percent. According to Dandona, the patients that have now been treated for up to a year are continuing to have the good effects that they had at the beginning.

Neither Victoza nor Byetta is approved for use in Type 1 diabetes. Dandona says that doctors could prescribe these medications for Type 1 diabetes as “off-label” use, but should only be tried by an endocrinologist specializing in diabetes, and only with careful and frequent monitoring of the patient.

Dandona says the study was done without any drug company support, but that Novo Nordisk is paying for a larger clinical trial. Dandona has asked the National Institutes of Health to support a large-scale study if this larger study yields similar results compared to the pilot study.

Read the report here.

June 8, 2011

Why Does Everyone Go Crazy Over Small Studies?

This small study (actually two very small studies) seems to have a life of its own. Every year, it seems to be resurrected and trotted out as a larger authority on the issue. In addition, every year, more and more worshipers are encouraged to join the church according to Carol Johnston, PhD from Arizona State University, Department of Nutrition.

Vinegar does aid some people to manage blood glucose levels. Since there is no funds for additional studies, no one knows how long this works and why it does not work for others. Everyone believes the studies as the gospel according to Carol Johnston on vinegar.

Because some people do have some benefits from vinegar, this is constantly brought back annually to introduce it to potential new believers. After a couple of months, the hoopla begins to wane and more people realize that it no longer works for them. So approximately once every year, the believers present it for new converts.

I am no longer a convert as vinegar worked for about two months and then no more. Therefore, I believe that there was something in vinegar that my body needed and once it had been supplied, I received no more benefits. I will not tell you that it won't work for you, but only to not be disappointed if the benefits do not last long. If you get benefits for a longer period, enjoy them.

Do I use vinegar? Yes, on salads and any food that calls for it. I use any variety that works for me and allows me to avoid the sugar-sweetened salad dressings and other foods that are over sweetened with high fructose corn syrup. Other than for a few weeks when I took vinegar by itself to see if the effects worked, once the needs of my body were met, vinegar no longer had any effect on my blood glucose readings.

You can expect to see the push for vinegar about once a year as they try to win new converts, but for those of us that it no longer works for will continue to remind people that what works for one person may not work for others. Yes, if your body needs some of the chemicals found in vinegar, expect to see temporary improvements in blood glucose readings and some people may actually have some long-term improvements.

Read about other articles promoting the use of vinegar here and here. I refer you to my previous blog here. Although most refuse now to put a date on Carol Johnston's studies, at least this one does list two other studies in 2005 and 2006 which were a few years after her studies.

June 6, 2011

USDA Ditches Food Pyramid for a Healthy Plate?

The United States Department of Agriculture laid an egg on June 2. Color it, slice it, and try to understand it, but it missed the target. Fat is still out which is a mistake and giving whole grains over 25 percent of the plate will do nothing to slow the obesity epidemic in the US.

There are already many articles promoting this "new" distribution. Fortunately there are those who see the weaknesses of this approach. Nothing has improved in the overall scheme of food nutrition. There is no standardization or bringing down the serving sized on food labels or improving the label relationships among the different foods. Many mixed messages still need clarification. The largest problem is that one plate size seems to fit all which anyone with diabetes knows does not work. Individualization is the key for best results.

I know that to lose any weight, I do not need 2000 calories, but this seems to be the message - everyone needs 2000 calories per day. The question of portion sizes, fat intake, and energy expenditures are not figured into the equation. Also too many areas are open to interpretation and misinformation.

The need to stop obesity in adults and children is a worth goal, but the plate icon falls short of setting any real objectives. As for the aah ha moment many have written about, I am afraid this is an ooh no presentation. It is doubtful that the "MyPlate" icon will change Americans' eating lifestyle because it is still dependent on personal responsibility. It can only be hoped that the larger picture will eventually catch the public's attention and interest to learn how to make healthier food choices.

The plate design shows a plate divided into four sections:
     Red is for fruit
     Green is for vegetables
     Orange is for grains
     Purple is for protein, and then add
     Blue as a side dish (or cup) for dairy.

The USDA has improved the portion size from the food pyramid, but a lot is left to be accomplished.

Read the USDA press release here, and a WebMD assessment here. Then take time to read another report here and a report from a nutritional standpoint here. An very interesting blog by Dr. William Davis is here.

There will be many articles and assessments appearing in the months ahead, so be prepared to read both good and bad reports.