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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