January 4, 2014

Many Patients Claim, Not Informed About Vision Loss

This in one topic that will part of our January meeting, weather permitting. I was very skeptical when I first read this article. I can only say that I am very fortunate that I have had this explained to me by my primary care doctor and my eye doctor several times. Even my endocrinologist brings this up once a year to check that I have kept my eye exam appointment. I even become annoyed by how often I am reminded to have my eyes checked. Since vision is so important, I am very shocked that people don't remember they were told to have a yearly eye exam.

According to the reported study, less than half of the adults who are losing their vision to diabetes have been informed by a doctor that diabetes could damage their eyesight. Vision loss is a complication of diabetes named retinopathy. The vision loss is caused by damage done to the small blood vessels within the eye.

Johns Hopkins researchers found that many diabetics aren't taking care of their eyes. They are not even aware that vision loss is a potential problem. Nearly three of every five adults with diabetes in danger of losing their sight told the researchers they couldn't recall a doctor describing the link to diabetes and vision loss. The study appeared in December 19 online issue of the journal JAMA Ophthalmology.

Study leader Dr. Neil Bressler, a professor of ophthalmology at the Johns Hopkins University School of Medicine, and chief of the retina division at the Johns Hopkins Wilmer Eye Institute, says that many of the participants were not seeing an eye doctor for eye problems. Two in five hadn't received a full eye exam with dilated pupils.

Dr. Bressler said that this is a shame because in many of these cases you can treat this condition if you catch it in an early enough stage. With one-third of the people already experiencing some vision loss related to their diabetes, Dr. Bressler said vision damage can be prevented or halted in about 90 to 95 percent of cases, if doctors see the patients early enough.

Dr. Ratner of the ADA called the finding frightening and depressing. He says, “This paper is an excellent example of where the American health care delivery system has fallen down in an area where we can do better.” He then continues as only Dr. Ratner could by saying, “Doctors need to enforce standards of care and that type 2 people with diabetes ought to receive full examinations with pupil dilation every two years.” The ADA standards of care say these patients should be promptly referred to an eye specialist. He finished by saying. "We will continue to push for health care professionals to meet the minimum standards of care."

Again, I would disagree with Dr. Ratner, because I am being told by my eye doctor to have an appointment every year, and this is the same as my endocrinologist keeps telling me. The study did most of the study on people with type 2 diabetes who had "diabetic macular edema." This condition occurs when high blood sugar levels associated with poorly controlled diabetes cause damage to the small blood vessels in the retina, the light-sensitive tissue lining the back wall of the eye.

As the vessels leak or shrink, they can cause swelling in the macula, a spot near the retina's center that is responsible for your central vision. Macular edema can ruin your ability to see detailed images and objects directly in front of you, and ultimately can lead to permanent vision loss. Recent reports estimate that the eye disease affects about 745,000 people with type 2 diabetes in the United States.

For more information on diabetes and vision problems, visit the U.S. National Eye Institute at theirwebsite.

January 3, 2014

Is GlaxoSmithKline for Real?

This is news from last year, but still news. Is the gravy train stopping for doctors? We can only hope that this announcement from GlaxoSmithKline (GSK) is a trend for things to come. Unfortunately, this will not go into full effect until 2016. This will allow doctors to find other sources of income and time for GSK drug reps to be reassigned where needed. I also suspect there are several reasons behind this action.

A large part of this action, denied by GSK, is the fraud action in China against GSK. In the USA, Medicare may have forced the issue with the cuts they are putting in place to reduce the cost of medications for Medicare patients. This is only a logical supposition
I can see making GSK take this action. In order to be competitive in the Medicare marketplace, expenses need to be reduced. This means that doctors will stop receiving money for prescriptions filled; speaking engagements and the drug reps will be receiving a wage and not current incentives.

GSK will not release figures for the costs and incentives paid out to doctors for prescribing their medications, but it has to be quite large. And, before we forget, these dollars will appear on the web beginning in 2014. I thought the site was operational, but apparently, it is down while issues of reliability are ironed out to satisfy the different medical groups.

Another medical group, the American Association of Clinical Endocrinologists (AACE), must be feeling the pinch as their training school for drug company reps will be affected. It has been reworded and moved since the last time I visited the site. It is now listed as “AACE Industry Training & Certification Program. It is still a PDF file.

GSK says it will continue to pay doctors consulting fees for market research. GSK says this is necessary for the company to gain insight about their products; however, this will be limited in scope. A GSK spokesman said the company spends “tens of millions” of dollars globally each year on the practices that they are ending, but would not be more specific.

Maybe this will let our doctors become more transparent and not be pushing certain drugs for compensation. It is interesting reading some of the comments to the article in the NYTimes. Now the question remains, how many other drug manufacturers will follow GSK and how long will it take.

Andrew Witty, GSK's chief executive, stated that while details are still being worked out, the company intends to provide grants to respected educational institutions and medical societies. He continued that he is looking for these partners and he does not envision these partners being companies or pseudocompanies. I suspect medical schools will be the partners of choice to spread the word about GSK products.

January 2, 2014

Beware of Snoopy Technology Apps

When I wrote this blog, I suspected it was just the tip of the iceberg. With the disclosure of what our National Security Agency (NSA) is collecting about us, it should be no surprise that our technology companies are doing the same. They are collecting information about you and making it possible in some cases for others to do the same. Some of this is through ignorance, but some is not. Sales or additional income drives much of this collection of data about you.

This article from PC World is rather disturbing about how Americans and others are being used to collect data. When the president of the United States is not allowed to have an iPhone, but is limited to a BlackBerry, you know security is behind this. Of course, neither the president nor the Secret Service is willing to say exactly how security could be compromised with an iPhone. One security risk is the unpredictable nature of both iPhone and Android apps. An information security company called Trustwave said this month that file-sharing apps for iPhones and iPads can compromise user security —even simple picture-sharing apps or apps that enable users to exchange documents.

Hewlett-Packard conducted a study about the security of business apps and found that more than 90 percent of those apps had privacy or security flaws. Many of them give themselves permission to access phone features and user data that make no sense for the apps. Many of the flaws coincide with unencrypted data and insecure protocols. About 20 percent of the apps send user data via unprotected HTTP and about the same use HTTPS, but don't get it right. Other problems were found that could compromise user security and privacy not through malice, but through incompetence.

Another report from Trend Micro is disturbing also. The company found that there are now one million “malware and high risk apps” in the wild. These apps are those that aggressively serve up ads that lead to dubious sites and are about one quarter of the total apps. A good number of these apps open up an insecure file server on the device, which makes the file vulnerable to copying and even for malicious crackers to upload files of their own because many apps don't require user authentication. This can be compounded by apps running on older versions of the operating system.

Anyway you slice this, security problems grow with added apps regardless of the platform they are installed on. We all need to be cautious and not rely on an app being secure because it is highly rated or popular. Education is the best defense and even then we are not infallible. The best defense is that users need to realize that the Apple App Store, the Google Play Store, and other Android stores are laden with apps that can compromise your security and privacy without you even knowing about it.

Even if this is not about diabetes, you still need to know that your diabetes data stored or transmitted via cell phones, iPhones, iPads, and Android cell phone and tablets may not be secure.

January 1, 2014

A New Year, Let's Manage Diabetes

I ended 2013 on a down note as a result of conversations with a doctor and his request. I know why he would not blog about them, but he asked me as a favor to tackle a couple of topics. He knew I would not pull back in what I said and I have received his thanks for the way I handled them.

Now that we are in the new year, I will be more positive. However, when something needs to be written about, I will not pull back from writing about it. There are many topics that need writing about for education and some for action. I will be reviewing some of the topics from previous years that need further discussion. I have many topics that are being suggested by our support group and even a few from other diabetes support groups. I even have a couple from readers that I have not covered before.

I will be working on a few more blogs about self-monitoring of blood glucose, which our doctors refuse to educate people with diabetes. Another topic of request is about the attitude of many certified diabetes educators and their cloaked refusal to work with type 2 diabetes patients. Granted our support group will not meet with any of them, but this resulted because of their less than positive attitude.

There are many new studies coming in this year, but many are still done for the hype and are poorly designed. Why money is wasted on some of these studies remains a mystery and others are to promote an agenda that people are pushing. It is with some worry about what the American Diabetes Association will post for their guidelines for 2014. Are they going to ignore some excellent studies, or will they develop some great guidelines following their nutrition guidelines.

We will see more about what the pharmacists are accomplishing to help people with diabetes and this is a positive for people with type 2 diabetes. Unless the American Association of Clinical Endocrinologists does something unusual this year, don't expect news from them. The same applies to the American Association of Diabetes Educators.

The Academy of Nutrition and Dietetics (AND) will more than likely continue to make headlines in an unfavorable light. Their drive to make themselves the only source of nutrition information at the Federal and state level is being opposed by more organizations and rightfully so. We need the option of being able to select where we obtain our nutrition information considering AND is in the pocket of Big Food.

We can expect a few more oral diabetes medications to be approved by the FDA and possibly a new or more concentrated insulin. As much as I would like to see a few of the new applications for nanotechnology come on the market, too much testing needs to be accomplished first to satisfy FDA. Another area of concern is the host of meaningless apps coming on the market. Many will still be a single use only and not capable of communicating with other apps. Therefore, many will still be hyped, but still not worth the money or of assistance for diabetes and especially not of value for the geriatric crowd.

What else will be news worthy remains to be seen, but it should be an interesting year.
Amy Tenderich writing for DiabetesMine has her observations of much of what happened in 2013. There were some great happenings, but I will urge you to read her blog.

Nancy Finn has her predictions for 2014 here. Hot Trends for 2014 is the beginning of her blog title. Granted, “What Health Care Consumers and Providers Need to Know,” is important for all of us, but does not include diabetes. These are topics of interest for me and I am hoping much of her predictions are fruitful. I do feel that she is overly optimistic for 2014 about mhealth apps, as I feel there are too many problems still to be worked out for beneficial use. I anticipate 2015 may be a better target.

December 31, 2013

Elevated A1c Means Elevated Dementia Risk

Are you concerned about dementia? Apparently, many people with type 2 diabetes are not concerned. Questions still need answering. What are doctors doing to help people manage their diabetes? Are patients being informed of the increased risk for dementia by having an A1c above 7.0%? Diabetes is an established risk factor for dementia.

The sad part is our doctors are doing very little to help people manage their diabetes. When it comes to dementia, doctors are not even talking about this. Yes, there are a very few that stay current and inform their patients, but the vast majority could care less. What is even more alarming is the number of patients that do nothing to learn about diabetes and managing their diabetes.

This study is reported in the New England Journal of Medicine. Sandra Adamson Fryhofer, MD reports on this study in Medscape. “The study included more than 2000 patients, about 800 men and 1200 women, with a mean age of 76 years at the start. None had dementia but about 200 of them had diabetes. The rest did not. They were followed for 7 years. Blood sugars and hemoglobin A1c levels were closely monitored. By the end of the study, 524 people had developed dementia, 74 of whom were diabetic. The remainder of those diagnosed with dementia were not.”

The study discovered that patients with higher blood glucose levels on average were more likely to develop dementia. Among people with diabetes, the risk for dementia was 40 percent higher for those averaging around 190 mg/dl when compared to those with average blood glucose levels around 160 mg/dl. Other surprising facts come from the pre-diabetes range. Those with average blood glucose of 115 mg/dl were about 20 percent more likely to develop dementia that those with average blood glucose levels of 100 mg/dl.

Insulin resistance and microvascular disease of the central nervous system may also affect dementia, but these have to be studied. Another factor that needs to be studied is patients at the certain ages may have early onset of dementia that causes them to not take care of their diabetes as well as they might otherwise.

This study does suggest that any increase in blood glucose levels above the normal range increases the risk dementia. For those people with diabetes, the risk for dementia is more elevated. Therefore, it makes preventing dementia even more important by maintaining blood glucose levels at the normal range. This means between 80 to 100 mg/dl or below 5.7% for A1c.

The problem is eating the right foods, keeping weight in the idea range for height and frame size, as well as great management of blood glucose levels.

December 30, 2013

Medical Community Turns Against People with T2 Diabetes

On December 13, Catherine Price posted a blog on why you should be depressed about the government's attitude toward diabetes. Whether you are a person with type 1 diabetes, or type 2 diabetes, you owe it to yourself to read it. She listed it as part 1 and I will wait for part 2. In the meantime, I will write my blog about the actions of our medical community and how they are turning against people with type 2 diabetes, especially those not on insulin.

This started in June 2013 and earlier if you listen to ADA's Dr. Robert Ratner. He is quoted back in December 2012 as saying people with type 2 diabetes, not on insulin, did not need to test. He is the tip of the proverbial iceberg of the problems now presenting to people with type 2 diabetes. Next, we have Dr. Alan J. Garber of the AACE who believes people with type 2 diabetes and not on insulin need only rely on A1c tests.

If you think I am angry, you are right. Next, the Society of General Internal Medicine (SGIM) and their “Choosing Wisely” choice of "Don't recommend daily home finger glucose testing in patients with Type 2 diabetes mellitus not using insulin.” This was in early September. Next, was the AACE entry in “Choosing Wisely” saying almost the same, but allowing for testing for oral medications that cause hypoglycemia.

Now in December, we have the Oregon's Health Evidence Review Commission (HERC) limiting test strips for people with type 2 diabetes. If it had not been for DiaTribe this may have been even worse. DiaTribe at least alerted their subscribers and the Diabetes Online Community about the intention to stop test strips for people with well-managed diabetes.

Then we also hear some of the remarks by members of the HERC and this is very indicative of the attitude of many doctors - “More knowledge for patients is not always better…”, “Lay people just don’t understand these issues…” To this, I ask if the doctors are going to make themselves available 24/7 to answer questions from people with diabetes. Since I know they will not do this, we as patients with diabetes do need to take action and oppose every attempt to limit testing supplies.

This means the battle is on with the Centers for Medicare and Medicaid Services (CMS), many state medical groups and especially the groups mentioned above that only want people with type 2 diabetes operating in the dark. All these supposedly medical professionals want to do is cause harm and have the complications to treat for steady income.

If the medical community really wanted to reduce medical costs, they would do some education, work more diligently to help diabetes patients, and actually encourage people with diabetes to manage their diabetes.

The doctors now have shown their true colors and we know that we cannot depend on them. They openly declare that diabetes is progressive and that the complications will develop. We know that we need more information, but many of the studies and clinical trails continue to be put behind the pay wall where most cannot afford to see them. Even the ADA and AACE are making things more difficult for people with diabetes, and especially people with type 2 diabetes.

December 29, 2013

Are Our Doctors to Blame? – Part 2

This is a continuation of my last blog. When Dr. Leana Wen first posted this blog, I thought (correctly) that she would come under a lot of criticism from many of her colleagues. The criticism has been there, but the surprise has been the number of doctors that have supported her.

From her post on October 15 until today, many doctors have come to her support and asking how they can help. Even many patient organizations have voiced their support. They have called for reestablishment of the doctor-patient trust that has declined in recent years to almost non-existent.

Yes, the criticism has been there and some are more vocal than others. Like these doctors belittle their patients, they have tried to belittle Dr. Wen. My own personal observation is that these doctors have shown their true colors and medicine would be better off without them. They seem to care less about doctor-patient trust and more about their own self-image than about how they can rebuild patient trust. Yes, the patients are now seeing these doctors among the rubble of their pedestals, yet many doctors won't be able to rebuild them and don't want to rebuild trust, just their wallets.

Some of their comments have been very caustic and I would say that if I had seen the names of any of my doctors among these comments, I doubt I could retain any of them as part of my team. When several of the medical blogs and medical reporting groups have given her coverage and positive comments, these doctors have still see it their duty to try to put Dr. Wen in her place and put her down.

With what we are seeing in the medical community transpiring today, patients are slowly being made second-class citizens by the medical community. Doctors are being directed to communicate with patients and provide quality care, but doctors are pushing back and taking from patients what many have worked long and hard to accomplish. This is happening in the world of diabetes and in other areas.

Yet there is hope as some doctors are working with patients to better their position in life and health. These are the doctors that will be highly regarded in the future and respected for their actions, not the fullness of their wallets. Their wallets will be overflowing with riches of all types and not the riches of greed that many doctors are doing today to line their coffins.

These doctors are speaking in a language that patients find easy to understand and follow, not the language of techno babble the doctors of greed use. These doctors talk with or treat their patients with respect while the doctors of greed talk down to their patients. As we move further into the world of the Affordable Care Act, this distinction will become even more apparent and we as patients will know it.

Therefore, yes, many doctors are to blame for the poor healthcare we are receiving today, but they will be replaced slowly by the more caring, concerned doctors that are showing respect today.