December 14, 2012

Poor Glucose Control Impacts on Cognition

Now they want to add another complication to the list of diabetes complications. Cognition decline is now the result of poor blood glucose management. Cognition is the mental act or process by which knowledge is acquired, including perception, intuition, and reasoning. I can understand this happening, but how do they classify other people with cognition decline. Are they people with undiagnosed diabetes? I would be guessing, but I do believe some may have undiagnosed diabetes, but not a large number.

The study in Archives of Neurology says that, “poor glucose control in older, well-functioning adults with no dementia are linked to reduced cognitive function and higher cognitive decline.” The researchers conclude: "This study supports the hypothesis that older adults with DM have reduced cognitive function and that poor glycemic control may contribute to this association. Future studies should determine if early diagnosis and treatment of DM lessen the risk of developing cognitive impairment and if maintaining optimal glucose control helps mitigate the effect of DM on cognition."

Therefore, they are not saying type 2 only, but all with diabetes mellitus. The researchers from the University of California, San Francisco and the San Francisco VA Medical Center assessed 3069 patients and administered two tests. The two tests were the Modified Mini-Mental State Examination (3MS) and Digit Symbol Substitution Test (DSST). These tests were done at the beginning of the study and repeated at selected intervals over the 10-year period of the study. The average age of the patients was 74.2 years. Of the participants, 42% were black and 52% were female.

Of the participants, 717 had diabetes at the beginning of the study and 2352 has no diabetes. During the study, 159 participants developed diabetes. At the start of the study, those with diabetes had lower 3MS and DSST test scores than those without diabetes. At the 9-year mark, participants without diabetes had a similar pattern of decline. Those with diabetes and that developed diabetes, showed a marked decline in both the 3MS and DSST tests compared to those not having diabetes.

This points out how important good blood glucose management is for our brain health and the fact that poor management can bring on not only many complications, but cognitive decline as well.

December 13, 2012

FDA Creates Group to Speed Medical Devices to Market

Will this be the answer for many people, to accelerate medical devices to market, or just another stepping-stone to slow the process? I hope for many people that the first is true. Yes, the FDA has created a group – nonprofit, public-private partnership. The object of this partnership is to speed safe medical devices to market. The underlying aim is to encourage competing manufacturers to pool their knowledge about product testing. This last part may be the death of many medical devices as some manufacturers do not want to share information and may leave the market rather than be forced to share information.

Sounds great for patients if products do make it to market sooner, but in telephone conversations with a couple of manufacturers, there is little enthusiasm for the idea. Many are concerned about the procedures and who will have control of the testing. If the FDA is the only one doing the testing with only people from the company's device present during testing, then maybe this will work. If any company can be present during testing, it is doubtful some companies will participate. Both agreed that it is still too early in the process to know how this will work.

One spokesperson did say that this will make acquiring some of the good ideas from cash strapped start-ups a lot more difficult. He also said that the value added from FDA approval will be great for the smaller companies, some will be able to find the funds for manufacturing, and others will still sell the product to larger manufacturers.

Both admitted that if this group, called the Medical Device Innovation Consortium (MDIC), was actually able to make it easier to bring products to FDA approval, then everyone would gain, including the patients.

December 12, 2012

Nurse Practitioner Groups Unite

Primary care physicians move over, the new American Association of Nurse Practitioners (AANP) is now united (as of January 1, 2013) and looking to expand their role in healthcare. As of this date, the American Academy of Nurse Practitioners and the American College of Nurse Practitioners will be the above AANP and have a combined membership of 41,000. The merger will strengthen NPs' influence; the growth of the specialty has already amplified its voice. NP numbers have risen nearly 80% in just more than a decade, from 87,000 in 2001 to 155,000 in 2012, with 11,000 graduating from NP programs this year alone.

There are many reasons for the two groups to merge, but the largest is the Patient Protection and Affordable Care Act (ACA) which will mean about 30 million more patients will enter the healthcare system through 2019. Then according to a recent study in the Nov/Dec issue of Annals of Family Medicine, the shortage of primary care physicians is expected to exceed 52,000 by 2025. Then factor in the fact that the medical groups are coming out in favor of limiting the functions of NPs, makes it even more important that they present a united position.

NPs have been doing the right thing and working to present a consistent front in the establishment of national guidelines for scope of practice. Currently this varies from state to state. Some states require NPs to practice under the supervision of doctors, and in other states, they can practice independent of doctors. One objective that may be required under the ACA rules is the ability to order home healthcare for patients. Presently, to be reimbursed by Medicare, NPs can order home care only through physicians.

There are many other areas that NP can work in as well. I don't care the arguments raised by the American Academy of Family Physicians (AAFP) and other professional medical organizations, we are headed for a primary healthcare dilemma of great seriousness and the professional medical organizations are thumbing their noses at those that can help. If you are ready to accept long delays in seeing your doctor and even longer delays between appointments then support the physicians. Read my blog here to understand that NPs are on a par with doctors and may actually help reduce the cost of healthcare. Doctors are not really working to reduce healthcare costs because they continue to order more and more costly tests because they can.

Review this map for the states that are welcoming NPs and those that doctors have presently under their control. The map shows the states still allowing NPs to practice very much like primary care physicians.