July 16, 2013

What Is A Person With Type 2 to Do?

Part 1 of 2 parts

This is a topic that is a torment to put in words, but I must. I see the world of diabetes care being slowly torn apart by several people in the medical field who are or have been in high positions for the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE). That is the primary reason for writing this blog about the two doctors.

One feels that as a person with type 2 diabetes and not on insulin, you should not test, but be satisfied with your quarterly A1c test results. What he fails to say is that many primary care physicians only test type 2 patients once or twice a year. What is a patient with type 2 diabetes on oral medications to do? The view of this doctor is completely out of touch with reality. Maybe this is what working as a Professor of Medicine at Georgetown University Medical School and Senior Research Scientist at the MedStar Health Research Institute in metropolitan Washington, DC does to you.

The other doctor also is a Professor of Medicine, Biochemistry & Molecular Biology, and Molecular & Cellular Biology at Baylor College of Medicine, Houston, Texas. Only this doctor wants to put you in a medical straight jacket and force you to do what he wants and how he wants you to mind the doctor's orders. This is the reason behind writing this blog on the Diabetes Algorithms and this blog on criticism of the Algorithm.

I admit I have respect for other professors of medicine, even when we disagree about issues, for example, Dr. Matthew Mintz. I did one blog very favorable about what he and another doctor have said about diabetes patients, yet I can disagree with his stand in favor of Avandia in his blog here. He has disclosed his conflict of interest and is willing to talk about a variety of topics, but he is not saying this is what it has to be in his discussion of Avandia.

How is the patient that wishes to prevent diabetes from becoming progressive even going to learn how to manage diabetes? One doctor only wants the patient to rely on A1c tests and the other only to follow precise doctor orders. We all should know that in the real world, the one that these doctors don't live in obviously, the patient is the one needing to learn to manage diabetes. Their doctor cannot be with them 24/7/365. How else will the patient be able to take ownership of their diabetes?

Then the other battle people with type 2 diabetes continually face is obtaining enough testing supplies to learn how the different foods and daily exercise affects his/her blood glucose levels. Our medical insurance companies listen to the “expert” medical professionals and their associations and will not cover the number of test strips people need shortly after diagnosis. Even the study I blogged about here is not receiving much attention or creditability by the profit greedy insurance companies.

Two other diabetes related professions make it difficult for patients to receive education and learn how to manage their diabetes. The first is the Academy for Nutrition and Dietetics (AND) which is lobbying the states to make them the only profession to be able to teach nutrition, and then goes out and criminalizes other nutritionists that are actually teaching nutrition. The AND is a front for Big Food and promotes what they sell. Instead of assessing the patient for nutrition, we are told to eat so many calories and carbohydrates, balanced or unbalanced nutritionally, that many are unable to manage their diabetes and it becomes progressive, and the complications become a fact of life. Now they are lobbying at the federal level to expand their monopoly and become the most acceptable organization to counsel people with obesity. If this organization is allowed their way, our choices for obtaining dietary information will be extremely limited and again we, as patients, will suffer.

The second organization is the American Association of Diabetes Educators (AADE). The AADE is so enamored with their amount of education (sic) that they will not consider creating a group of peer mentors or peer-to-peer workers to help educate people with type 2 diabetes. The AADE claims a membership of 13,000, but many of their members are retired, writing books and going on speaking tours, working for organizations that are not doing education, or only work part-time, that they probably have fewer that 5,000 full-time certified diabetes educators (CDEs). The sad part of these people is there is so much that they need to learn that many do not know how to correctly assess patients and match their needs. In addition, but with a few exceptions, most CDEs will not deal with depression, sleep apnea, and others of the comorbid conditions of diabetes patients. Many find it easier to use mandates, mantras, and dogma instead of good education when dealing with type 2 patients.

Thankfully, some doctors are seeing the need and working with knowledgeable patients to give them the extra education to work as peer-to-peer workers. Some doctors in largely rural areas are working with peer mentors and using video conferences for education.

Because the current medical system is so time constrictive for doctors, many people that do realize the need for education are left with the internet for education. Fortunately, some find the good websites and then realize that there are many poor websites for diabetes information. Yet many patients fall victim to the “snake-oil” salespeople that do nothing but separate them from their money. Is it any wonder they become embittered with the system.

With the ADA and AACE beholden to Big Pharma, the AND in bed with Big Food, the AADE believing only they, with their exclusive education should be the source of it, and the internet riddled with poor information, where do people with type 2 diabetes turn?

Before leaving this and listing some solutions, one more weakness needs to be reemphasized. The weakness is diabetes research for type 2 which discriminates against the elderly and the young. This means for the largest segment of the type 2 diabetes population, there is almost no clinical research that doctors can rely on for treatment of the elderly. This causes doctors and even endocrinologists to experiment on us as patients. Some do very well and others leave much to be desired. Even the diabetes algorithms cannot cover this with certainty.

The next blog will discuss some possible solutions.

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