June 25, 2011

HbA1c Ineffective for Patients on Dialysis

I am not sure why it took so long for the medical community to come up with this study. Maybe it is because no one took time to explain glycation to the doctors and what dialysis does to the blood cells and the effects of chronic kidney disease on the body.

This has to be one of the times common sense was not present, and someone saw a chance to spend some money on a study that should not have been needed. Nonetheless, the Wake Forest Baptist Medical Center saw fit to spend the money and determine that indeed the HbA1c test was not reliable for people undergoing dialysis.

The article about this study also uses many catch phrases and terminology to muddy the water and make it seem like the study was of value. Even the opening statement leaves one wondering when the HbA1c became the gold standard for glucose monitoring. There is still a lot of disagreement about this being the appropriate test for diagnosis of diabetes.

Take into account the shorter life span of red blood cells and anemia in dialysis patients, it is no wonder the HbA1c has limited (no, lets state – no value) in dialysis patients. Another test, the glycated albumin or GA assay, appears to be far more effective for dialysis patients. The GA test used in this study is available in Japan, China and South Korea, but is not yet FDA approved in the United States.

I can see the next request for study funding. They will need to know how to translate the HbA1c into meaningful results for patients on dialysis. There will be a new HbA1c table issued for patients on dialysis. This will be related to the GA results so everyone can be on the same page, until the GA test is approved for use in the US.

The researchers instead issued this warning suggesting physicians not rely on the HbA1c in dialysis patients, instead suggesting that blood glucose levels be directly monitored with multiple daily readings until the GA test is available in the states.

Read the article here.

June 24, 2011

What? FDA Has Sunscreen Rules?

On June 14, 2011, and 33 years late, the FDA FINALLY issued a rules statement about sunscreens. This has been long-awaited and much needed for assisting consumers in deciphering the hype about sunscreens.

Sunscreen labels will now have a statement about being a broad spectrum to show the offer some protection against ultraviolet A radiation (UVA) as well as ultraviolet B radiation (UVB). Now the maximum SPF level a product can claim will be “50+”. This maximum is because the FDA says there is no convincing evidence that SPF levels higher that 50 have any meaningful effect.

FDA did stand firm in insisting that sunscreens claiming swim/sweat protection specify how many minutes the protection lasts. This means testing and published results for the FDA to verify. The FDA has also evaluated data and set up testing and labeling requirements for sunscreen products, so that manufacturers can modernize their product information and this will enable consumers to become informed on which products offer the greatest benefit.

UVB is responsible for sunburn and plays a major part in the causation of skin cancer and affects the outer layer of skin only. UVA is less intense than UVB, but is up to 50 times more prevalent than UVB. It penetrates to the deeper layers of the skin and is the dominant tanning factor and is linked to skin aging. While it may cause skin cancer, it can damage skin DNA.

Will the manufacturers be allowed to claim that their product prevents skin cancer? Yes, if they protect against UVA and have as SPF of 15 or higher. Products will need to specify if they protect only against UVB (SPF rating only) or whether the protect against UVA and UVB (SPF rating plus “Broad Spectrum” claim.

Since consumer groups have been waiting since 1978 for new rules, most were expecting more and are of course claiming that this just scratches the surface of what need to be accomplished. Of course they have lots of expectations after waiting 33 years for even this.

The new rules will take effect in one year for most manufacturers, although those with annual sales of less than $25,000 have two years to comply.

Read the article from medscape here. And my blog early about sunscreens here.

June 23, 2011

Aids To Help Avoid Bad Studies and HYPE

This is a blog of a different nature and is done to assist my readers that do research and reading. I have kept these links because of how they have helped me in my research. Oh - yes, I have been suckered into some bad research and "fluff" as Jenny Ruhl calls it. Before these blogs, I had to learn from the college of hard knocks, but now I have experiences of others to rely on and help me.

The first information that you should find helpful is from Gretchen Becker. Please read it carefully as she packs a lot of information in her blog about the spin factor in press releases and offers excellent tips to help us from being suckered by something sounding important when if fact it is all hype.

The next two blogs are by Jenny Ruhl. The first is important as near the end of this week, June 25, the ADA will be meeting in San Diego. So wrap your brain around what she tells you here in her blog as the information will likely be coming fast and plentiful.

The last blog from Jenny is this one - "An all purpose technique for debunking worthless studies". There is a lot of information to be digested before applying what she says. I still have to go back and reread parts.

I suggest if they help you, that you bookmark them for future reference. I have them both bookmarked and printed out - just in case. I have reread each several times and always find something else to think about when reading some studies or the press releases about the studies.

I will very seldom buy the full text of a study - only have done this once, so it is often the abstract of the study I have to rely on for backup to the press release. Occasionally, the full text of the research is available for free. Then the Fun begins. Sorting out all of the relevant facts, data, and tying them to the assumptions made can be boring and tedious, but some are very rewarding and enjoyable.

So enjoy reading and researching more study press releases with the added arsenal of how-to's provided by Gretchen Becker and Jenny Ruhl.

June 22, 2011

Telling It Like It Is About Carbohydrates

This cardiologist is not afraid to speak out about issues. Dr. William Davis has stirred the soup with his blog of April 26, 2011 and he titled it “Real men don't eat carbs”. His understanding about wheat is excellent and makes one wonder why people with diabetes are told to eat so much whole grains.

The price we as men pay for eating “healthy whole grains” is indeed a dilemma. The mantra spouted at us by our physicians, certified diabetes educators, and many of the diabetes dietitians has to make us wonder why we are being called on to eat so many carbohydrates.

Dr. Davis explains it this way. The carbohydrates, and especially those contained in “healthy whole grains”, impair our maleness. If this doesn't get your attention, it certainly grabbed mine. Dr. Davis gives us four reasons for reducing or even eliminating carbohydrates from our diet.

First he says that amylopectin A from wheat because it promotes visceral fat, which increases estrogen levels. Estrogen reduces the effectiveness of the male hormone testosterone. In addition low testosterone and high estrogen can cause depression in males, weight gain, and low libido.

Second, visceral fat, which accumulates, triggers prolactin to be released which in males causes the growth of breasts. Third, the increase in visceral fat activates other chemicals, which impair endothelial functions underlying erectile dysfunction. And fourth, the increased blood sugar provokes the process of glycation, which can also affect maleness.

Read Dr. William Davis's blog here.

June 21, 2011

Medicare Now Offers FREE Preventive Services

I am sorry for those not US citizens and those not yet on Medicare, but this notice is about time.

I had been hearing rumors, or what I thought were rumors, but today's announcement made it official. Guess I may have already missed some opportunities, but I still have much to take advantage of.

Medicare now offers many FREE preventive services and the best part - get this - they are free with no co-pay. The doctors and health care providers will be reimbursed for these services. Whether to their satisfaction is still the question.

The press release was covered in WebMD and may be found here. A printable list (PDF file) of the free services with some explanations is available here, and is several pages in length.  Addition explanations can be found on the Medicare site.

A series of radio, TV, and online ads will soon be out according to Kathleen Sebelius, Secretary of the Department of Health and Human Services. In addition, a "Dear Doctor" letter will be sent to all health care professionals who see Medicare patients.

Those of us with diabetes will not be able to take of advantage of the free diabetes screening, but with a doctor's or other health care provider's written order, we can take advantage of Diabetes Self-Management Training.

June 20, 2011

California Rural Elders Have Highest Disease Rates

Gretchen Becker has a very excellent tongue-in-cheek blog about some California research by UCLA that deserves reading. In the article that started all this, there are some statements that are a little hard to take and that is why I like Gretchen's take on the article in ScienceDaily.

The reasoning of why the rural elderly in California are more likely to be overweight, physically inactive, and food insecure leaves a lot to be desired. Granted the risk factors from these conditions are heart disease, diabetes, and repeated falls. It seems true that many elderly in rural California are in need of better health care.

Did the researchers have some reasonable ideas for improving the situation for the rural elderly? Yes, some were acceptable, but some were clearly from fantasy land and no doubt because the authors live on Los Angeles, and do not have a clue of what rural life is like.

What also makes this a tragedy is the financial condition of the State of California. This tells me that few, if any, of the recommendations will receive any action, and there is a need. Approximately 710,000 or one-fifth of the elderly in the state aged 65 and over are in rural areas and are challenged by the lack of physicians and other medical offices and must travel long distances to get care.

Do people living in rural areas need or even want sidewalks or street lights. I doubt it as that is why people live in rural areas – to get away from these and be able to see the true stars of the sky – not the fake ones from Los Angeles.

It is true that living in a rural area can have an isolating effect – often desired – but can be to isolating for some seniors who do become “trapped” in their homes. One of the better suggestions of the researchers was bringing broadband infrastructure into the rural areas so that the elderly could have access to in-home monitoring, patient self management, and online ordering of prescriptions. They suggest increasing the size of the information technology workforce. Not mentioned is the probable need to training of many of the elderly to use this technology.

They also did right in suggesting that there be assurances that medical insurance companies will fully reimburse rural providers that use telemedicine. The last key point is the promotion of federal subsidies and assistance programs for rural areas, expanded transportation services, and better incentives for primary care providers who work in rural areas. Hopefully, this will not be in the form of “Hi, I'm from the government, and I am here to help you” nonsense that plagues much of America.

Read the health policy in a PDF file here.