This small study (actually two very small studies) seems to have a life of its own. Every year, it seems to be resurrected and trotted out as a larger authority on the issue. In addition, every year, more and more worshipers are encouraged to join the church according to Carol Johnston, PhD from Arizona State University, Department of Nutrition.
Vinegar does aid some people to manage blood glucose levels. Since there is no funds for additional studies, no one knows how long this works and why it does not work for others. Everyone believes the studies as the gospel according to Carol Johnston on vinegar.
Because some people do have some benefits from vinegar, this is constantly brought back annually to introduce it to potential new believers. After a couple of months, the hoopla begins to wane and more people realize that it no longer works for them. So approximately once every year, the believers present it for new converts.
I am no longer a convert as vinegar worked for about two months and then no more. Therefore, I believe that there was something in vinegar that my body needed and once it had been supplied, I received no more benefits. I will not tell you that it won't work for you, but only to not be disappointed if the benefits do not last long. If you get benefits for a longer period, enjoy them.
Do I use vinegar? Yes, on salads and any food that calls for it. I use any variety that works for me and allows me to avoid the sugar-sweetened salad dressings and other foods that are over sweetened with high fructose corn syrup. Other than for a few weeks when I took vinegar by itself to see if the effects worked, once the needs of my body were met, vinegar no longer had any effect on my blood glucose readings.
You can expect to see the push for vinegar about once a year as they try to win new converts, but for those of us that it no longer works for will continue to remind people that what works for one person may not work for others. Yes, if your body needs some of the chemicals found in vinegar, expect to see temporary improvements in blood glucose readings and some people may actually have some long-term improvements.
Read about other articles promoting the use of vinegar here and here. I refer you to my previous blog here. Although most refuse now to put a date on Carol Johnston's studies, at least this one does list two other studies in 2005 and 2006 which were a few years after her studies.
June 6, 2011
USDA Ditches Food Pyramid for a Healthy Plate?
The United States Department of Agriculture laid an egg on June 2. Color it, slice it, and try to understand it, but it missed the target. Fat is still out which is a mistake and giving whole grains over 25 percent of the plate will do nothing to slow the obesity epidemic in the US.
There are already many articles promoting this "new" distribution. Fortunately there are those who see the weaknesses of this approach. Nothing has improved in the overall scheme of food nutrition. There is no standardization or bringing down the serving sized on food labels or improving the label relationships among the different foods. Many mixed messages still need clarification. The largest problem is that one plate size seems to fit all which anyone with diabetes knows does not work. Individualization is the key for best results.
I know that to lose any weight, I do not need 2000 calories, but this seems to be the message - everyone needs 2000 calories per day. The question of portion sizes, fat intake, and energy expenditures are not figured into the equation. Also too many areas are open to interpretation and misinformation.
The need to stop obesity in adults and children is a worth goal, but the plate icon falls short of setting any real objectives. As for the aah ha moment many have written about, I am afraid this is an ooh no presentation. It is doubtful that the "MyPlate" icon will change Americans' eating lifestyle because it is still dependent on personal responsibility. It can only be hoped that the larger picture will eventually catch the public's attention and interest to learn how to make healthier food choices.
The plate design shows a plate divided into four sections:
Red is for fruit
Green is for vegetables
Orange is for grains
Purple is for protein, and then add
Blue as a side dish (or cup) for dairy.
The USDA has improved the portion size from the food pyramid, but a lot is left to be accomplished.
Read the USDA press release here, and a WebMD assessment here. Then take time to read another report here and a report from a nutritional standpoint here. An very interesting blog by Dr. William Davis is here.
There will be many articles and assessments appearing in the months ahead, so be prepared to read both good and bad reports.
There are already many articles promoting this "new" distribution. Fortunately there are those who see the weaknesses of this approach. Nothing has improved in the overall scheme of food nutrition. There is no standardization or bringing down the serving sized on food labels or improving the label relationships among the different foods. Many mixed messages still need clarification. The largest problem is that one plate size seems to fit all which anyone with diabetes knows does not work. Individualization is the key for best results.
I know that to lose any weight, I do not need 2000 calories, but this seems to be the message - everyone needs 2000 calories per day. The question of portion sizes, fat intake, and energy expenditures are not figured into the equation. Also too many areas are open to interpretation and misinformation.
The need to stop obesity in adults and children is a worth goal, but the plate icon falls short of setting any real objectives. As for the aah ha moment many have written about, I am afraid this is an ooh no presentation. It is doubtful that the "MyPlate" icon will change Americans' eating lifestyle because it is still dependent on personal responsibility. It can only be hoped that the larger picture will eventually catch the public's attention and interest to learn how to make healthier food choices.
The plate design shows a plate divided into four sections:
Red is for fruit
Green is for vegetables
Orange is for grains
Purple is for protein, and then add
Blue as a side dish (or cup) for dairy.
The USDA has improved the portion size from the food pyramid, but a lot is left to be accomplished.
Read the USDA press release here, and a WebMD assessment here. Then take time to read another report here and a report from a nutritional standpoint here. An very interesting blog by Dr. William Davis is here.
There will be many articles and assessments appearing in the months ahead, so be prepared to read both good and bad reports.
June 3, 2011
Do Your Homework Before Taking Supplements - P2
Now that I have covered manufacturer seals and the lack of significant backing for them, we need to cover the supplements and the cautions put out by the National Institutes of Health.
"Supplement is a broad term that includes vitamins, minerals, herbs and botanicals," says Carol Haggans, a registered dietician and science and health communication consultant for the Office of Dietary Supplements of the National Institutes of Health.
“Herbs and botanicals are derived from plants, while other supplements may include animal sources. Vitamins are essential nutrients made up of organic compounds, while minerals are an imprecise term for certain chemical elements necessary to life, like calcium.”
"They're regulated under the umbrella of foods and are not intended to treat, diagnose, mitigate, cure or prevent disease. If something claims to do that, then it becomes a drug under FDA regulation," Haggans says.
This last statement is where things fall through the cracks of oversight. Too many claims that should bring supplements under FDA regulations go uninvestigated. The manufacturers have learned over time where the line is and don't cross the line. They leave that up to the stores to have leaflets and pamphlets available for customers making these claims. Then if a complaint is filed, they can righteously claim not to have made any such statements.
Haggans adds, "The FDA has instituted 'good manufacturing practices' (GMP) that manufacturers must follow to ensure the identity and quality of supplements and they can take enforcement action if it's unsafe or unfit for human consumption, but they do not routinely test products." Once manufacturers implement these practices, they can display a seal on their packaging, noting their compliance. The problem with this is that the FDA has not issued regulations outlining the GMPs. People think that because congress authorized this, that it must be so.
To be clear about this, the Dietary Supplement Health and Education Act of 1994 (DSHEA) authorized but did not require the FDA to adopt new federal regulations for GMPs for dietary supplements. Under DSHEA, the FDA can issue GMP regulations for dietary supplements that are modeled after food GMPs. To this day, the FDA has not issued any regulations about GMPs.
Like drugs, supplements can combine with other medications in unhealthy ways. "Dietary supplements can interact with both over-the-counter and prescription medication," Haggans says. "That's one reason we tell people to talk with their doctors about all the supplements that they're taking." For example, the anticoagulant medicine warfarin (Coumadin) can interact with gingko biloba and with garlic and cause bleeding. St. John's wort, which is often used to treat depression, can weaken the effects of birth control pills and other medications. Vitamins C and E can also potentially interfere with chemotherapy used to treat cancer.
Doctors might not know about interactions between supplements and prescriptions and since supplement labels don't list warnings, patients need to do their own research: look for guidance from the sites listed in the resource section and talk to a nutritionist or check with reliable sources at "health food" stores or reputable "wellness" centers. This is a situation where watching carefully for side effects is especially important and consumers are mostly on their own to be vigilant.
Some supplements can be monitored by testing blood levels. This can be expensive but it might also reduce problems related to potential toxicity or unusual individual reactions. Check with your doctor to see if blood tests might be suitable for you.
Where can consumers get information? Check with the Office of Dietary Supplements, the National Center for Complementary and Alternative Medicine, and the Memorial Sloan-Kettering Cancer Center. Both keep regularly updated fact sheets on the most commonly used herbs, supplements and vitamins.
Read this article about the supplements.
"Supplement is a broad term that includes vitamins, minerals, herbs and botanicals," says Carol Haggans, a registered dietician and science and health communication consultant for the Office of Dietary Supplements of the National Institutes of Health.
“Herbs and botanicals are derived from plants, while other supplements may include animal sources. Vitamins are essential nutrients made up of organic compounds, while minerals are an imprecise term for certain chemical elements necessary to life, like calcium.”
"They're regulated under the umbrella of foods and are not intended to treat, diagnose, mitigate, cure or prevent disease. If something claims to do that, then it becomes a drug under FDA regulation," Haggans says.
This last statement is where things fall through the cracks of oversight. Too many claims that should bring supplements under FDA regulations go uninvestigated. The manufacturers have learned over time where the line is and don't cross the line. They leave that up to the stores to have leaflets and pamphlets available for customers making these claims. Then if a complaint is filed, they can righteously claim not to have made any such statements.
Haggans adds, "The FDA has instituted 'good manufacturing practices' (GMP) that manufacturers must follow to ensure the identity and quality of supplements and they can take enforcement action if it's unsafe or unfit for human consumption, but they do not routinely test products." Once manufacturers implement these practices, they can display a seal on their packaging, noting their compliance. The problem with this is that the FDA has not issued regulations outlining the GMPs. People think that because congress authorized this, that it must be so.
To be clear about this, the Dietary Supplement Health and Education Act of 1994 (DSHEA) authorized but did not require the FDA to adopt new federal regulations for GMPs for dietary supplements. Under DSHEA, the FDA can issue GMP regulations for dietary supplements that are modeled after food GMPs. To this day, the FDA has not issued any regulations about GMPs.
Like drugs, supplements can combine with other medications in unhealthy ways. "Dietary supplements can interact with both over-the-counter and prescription medication," Haggans says. "That's one reason we tell people to talk with their doctors about all the supplements that they're taking." For example, the anticoagulant medicine warfarin (Coumadin) can interact with gingko biloba and with garlic and cause bleeding. St. John's wort, which is often used to treat depression, can weaken the effects of birth control pills and other medications. Vitamins C and E can also potentially interfere with chemotherapy used to treat cancer.
Doctors might not know about interactions between supplements and prescriptions and since supplement labels don't list warnings, patients need to do their own research: look for guidance from the sites listed in the resource section and talk to a nutritionist or check with reliable sources at "health food" stores or reputable "wellness" centers. This is a situation where watching carefully for side effects is especially important and consumers are mostly on their own to be vigilant.
Some supplements can be monitored by testing blood levels. This can be expensive but it might also reduce problems related to potential toxicity or unusual individual reactions. Check with your doctor to see if blood tests might be suitable for you.
Where can consumers get information? Check with the Office of Dietary Supplements, the National Center for Complementary and Alternative Medicine, and the Memorial Sloan-Kettering Cancer Center. Both keep regularly updated fact sheets on the most commonly used herbs, supplements and vitamins.
Read this article about the supplements.
June 1, 2011
Do Your Homework Before Taking Supplements - P1
Have you heard of GMP (good manufacturing practices)? Most people have not and for good reason. Congress authorized FDA to set up a plan, but did not make it mandatory. Several organizations that have members among the supplement manufactures set up and submitted some plans to the FDA, but nothing happened. The Federal Drug Administration has done nothing about this, except, yes there is always an exception, occasionally rattling the cage about investigating some supplement here and there.
If you are looking for a reliable manufacturing seal on supplements, forget about it. Those that do exist have no weight of enforcement behind them and are industry developed to say that they have seals of quality for the supplement. The level of quality varies greatly from manufacturer to manufacturer and does not guarantee absolute quality or even that what may be claimed on the product can be depended upon.
I have had health store employees tell me that their products are manufactured under the GMP and have a quality guarantee seal. When I ask who issued the seal, they look at me as if I must have misunderstood their statement and repeat it. When I ask to see the official government seal, they point out the manufacturers seal. I ask if it has been approved by the FDA. Their answer is often yes. Then I ask under which government authorization act was this authorized. Smiles come then and they say The Dietary Supplement Health and Education Act of 1994 (DSHEA). Thinking they had me, they want to know which supplements I wish to purchase.
I then say that I am aware of the act of 1994, but it only authorized FDA to set up regulations, but that the FDA had never set up any regulations. I then say I don't like smoke being blown up my - you know where - and promptly leave the store. One store even had the nerve to call me back to inquire which government agency I worked for. I refused to answer naturally, but did say a full report would be filed. This I did, but to my congressional representative in an email, which I am sure was routed to the delete file.
Over the years, I have only had one store that answered my questions correctly and admitted there was no way to be sure of the quality in every batch from the manufacturer, but that if I felt that something was wrong with any purchase I made they would refund any money upon presentation of the store receipt. I was tempted, but could not bring myself to pay the price asked as it was almost double what I would have paid from any grocery store or warehouse type store.
Do I use any supplements? Yes, I do after I have check out the manufacturer and found few, if any complaints via their local better business bureau and several other agencies. I also look at their internet site for possible claims they make about their products.
There are many conflicting sites of information about supplements and I may not have the best ones, but I looked at approximately 20 sites and chose these. Site 1, Site 2, Site 3, and Site 4. Even though several of the sites show seals to be applied to products, none of them have any government enforcement authority to assure quality.
If you are looking for a reliable manufacturing seal on supplements, forget about it. Those that do exist have no weight of enforcement behind them and are industry developed to say that they have seals of quality for the supplement. The level of quality varies greatly from manufacturer to manufacturer and does not guarantee absolute quality or even that what may be claimed on the product can be depended upon.
I have had health store employees tell me that their products are manufactured under the GMP and have a quality guarantee seal. When I ask who issued the seal, they look at me as if I must have misunderstood their statement and repeat it. When I ask to see the official government seal, they point out the manufacturers seal. I ask if it has been approved by the FDA. Their answer is often yes. Then I ask under which government authorization act was this authorized. Smiles come then and they say The Dietary Supplement Health and Education Act of 1994 (DSHEA). Thinking they had me, they want to know which supplements I wish to purchase.
I then say that I am aware of the act of 1994, but it only authorized FDA to set up regulations, but that the FDA had never set up any regulations. I then say I don't like smoke being blown up my - you know where - and promptly leave the store. One store even had the nerve to call me back to inquire which government agency I worked for. I refused to answer naturally, but did say a full report would be filed. This I did, but to my congressional representative in an email, which I am sure was routed to the delete file.
Over the years, I have only had one store that answered my questions correctly and admitted there was no way to be sure of the quality in every batch from the manufacturer, but that if I felt that something was wrong with any purchase I made they would refund any money upon presentation of the store receipt. I was tempted, but could not bring myself to pay the price asked as it was almost double what I would have paid from any grocery store or warehouse type store.
Do I use any supplements? Yes, I do after I have check out the manufacturer and found few, if any complaints via their local better business bureau and several other agencies. I also look at their internet site for possible claims they make about their products.
There are many conflicting sites of information about supplements and I may not have the best ones, but I looked at approximately 20 sites and chose these. Site 1, Site 2, Site 3, and Site 4. Even though several of the sites show seals to be applied to products, none of them have any government enforcement authority to assure quality.
May 30, 2011
Do You Think the Medication Label is Excessive?
There are many doctors saying that the medication's label leads to information overload. Then why do these doctors want to prescribe medications with many side-effects that may harm their patients? Because, this is what they do and many do not even read about the medications they prescribe. They listen to what the Big Pharma salesperson says and start prescribing.
Then they have patients that start having some of the side-effects listed on the label and know they have problems and just want to believe it is in the patient's head. That is the main reason they want less side-effects listed so they have an easier time convincing their patients that it is all in their heads. This is just my take and the article has not changed my mind.
Yes, the doctors are saying that this information overload is having a negative effect on some people who could benefit from certain prescription medications. The doctors seem rather insistent in their request and want Big Pharma to reduce the number of side-effects listed.
Jon Duke, MD, an assistant professor of medicine at Indiana University School of Medicine in Indianapolis and a researcher at the Regenstrief Institute says he and his colleagues are developing software to help filter, prioritize, and personalize relevant drug safety information. He says he envisions “a dynamic label that uses electronic medical records to pull in the information that is most relevant.”
Unless and until such changes are made, “the key thing is to ask your doctor about side effects because doctors are pretty good filters,” Duke says. “There are some things that most people will never, ever get yet patients are often afraid to take the medicines because of how scary the labels are."
The big question is how well the doctors know the side effects, how they are able to determine which ones are the ones that need concern, and how well do they know their patients. Many doctors fail to take into account the individual patient and how they may be affected by the different side-effects. Certain patients have a greater tendency to be sensitive for certain side-effects while other patients can tolerate the same side-effects. So how does the doctor know?
While this whole thing is directed at the FDA, the side effects may be more that the patients desire if the problems from side effects are not reported until after the patient has problems and ends up in the emergency room or worst yet the morgue. I would rather know about the side effects than having them get the best of me.
Read the article here.
Then they have patients that start having some of the side-effects listed on the label and know they have problems and just want to believe it is in the patient's head. That is the main reason they want less side-effects listed so they have an easier time convincing their patients that it is all in their heads. This is just my take and the article has not changed my mind.
Yes, the doctors are saying that this information overload is having a negative effect on some people who could benefit from certain prescription medications. The doctors seem rather insistent in their request and want Big Pharma to reduce the number of side-effects listed.
Jon Duke, MD, an assistant professor of medicine at Indiana University School of Medicine in Indianapolis and a researcher at the Regenstrief Institute says he and his colleagues are developing software to help filter, prioritize, and personalize relevant drug safety information. He says he envisions “a dynamic label that uses electronic medical records to pull in the information that is most relevant.”
Unless and until such changes are made, “the key thing is to ask your doctor about side effects because doctors are pretty good filters,” Duke says. “There are some things that most people will never, ever get yet patients are often afraid to take the medicines because of how scary the labels are."
The big question is how well the doctors know the side effects, how they are able to determine which ones are the ones that need concern, and how well do they know their patients. Many doctors fail to take into account the individual patient and how they may be affected by the different side-effects. Certain patients have a greater tendency to be sensitive for certain side-effects while other patients can tolerate the same side-effects. So how does the doctor know?
While this whole thing is directed at the FDA, the side effects may be more that the patients desire if the problems from side effects are not reported until after the patient has problems and ends up in the emergency room or worst yet the morgue. I would rather know about the side effects than having them get the best of me.
Read the article here.
May 27, 2011
Diabetes and Sunscreens
Have you been out in the sun lately? Have you gotten your first sunburn? If you are a person with diabetes, did the sunburn make you blood glucose levels go up? Most people with diabetes have this problem of managing their blood glucose levels when they get sunburned. I did not say tanned. Tanning it totally another way of living, but becoming sunburned should not happen if you wish to manage diabetes effectively.
This brings us to the question of how best to prevent sunburns. Each year the sunscreen and sunblock creams and lotions are improving. The sun protection factor (SPF) is better and more effective. A couple of years ago, a SPF rating of 15 was considered a good product. Today the better sunscreens require a SPF rating of 30 and some are as high as SPF 100.
I do not follow the rules recommended by most dermatologists. They recommend staying out of the sun as much as possible. They worry about skin cancer and other skin problems that can happen with exposure to the sun. They want you to cover up as much as possible by wearing long-sleeved shirts, wide-brimmed hats, sunglasses, and stay in the shade if possible.
There are several common sense rules that need to be used to prevent sunburn. Use a good sunscreen – with a SPF of 15 and preferably higher. Apply sunscreen 30 minutes before going out in the sun. Apply the sunscreen liberally as most sunscreens now recommend. Reapply sunscreen frequently – at least every hour if you remain exposed to the sun. Reapply more frequently if you are swimming or perspiring a lot. If you have a skin type that burns easily, then consider using the recommendations of the dermatologists.
The SPF rating does not consider the damage caused the UVA (ultraviolet A) rays which is responsible for aging. It is therefore advised to look for and purchase a sunscreen that has a broad spectrum protection for UVA and UVB (ultraviolet B) rays.
UVB rays are the ones that cause the burning that many people suffer from.
Skin types normally are listed as six types. They range from type 1 to type 6. This means that a person with type 1 skin always burns easily, never tans, and is extremely sun-sensitive. Type 6 means a person that never burns, deeply pigmented, and has sun-insensitive skin. Read about the six different types here.
If you are planning on being outdoors and not in the shade for long periods of time, be sure to liberally apply sunscreen. Do not forget your lips. Find a good lip gloss with a SPF of at least 15 or higher and apply regularly.
One point to remember is that the sunscreens do not require FDA approval and thus may not be the best for us. Europe has the best sunscreens available. In the US manufacturers can make any health claims they desire and do not have to provide proof to any regulatory agency. CORRECTION: As of June 14, 2011, the FDA has issued rules for sunscreens, and please read about it on my blog here.
Here are some additional sources to read. Article 1, Article 2, and my blog from May 2010.
This brings us to the question of how best to prevent sunburns. Each year the sunscreen and sunblock creams and lotions are improving. The sun protection factor (SPF) is better and more effective. A couple of years ago, a SPF rating of 15 was considered a good product. Today the better sunscreens require a SPF rating of 30 and some are as high as SPF 100.
I do not follow the rules recommended by most dermatologists. They recommend staying out of the sun as much as possible. They worry about skin cancer and other skin problems that can happen with exposure to the sun. They want you to cover up as much as possible by wearing long-sleeved shirts, wide-brimmed hats, sunglasses, and stay in the shade if possible.
There are several common sense rules that need to be used to prevent sunburn. Use a good sunscreen – with a SPF of 15 and preferably higher. Apply sunscreen 30 minutes before going out in the sun. Apply the sunscreen liberally as most sunscreens now recommend. Reapply sunscreen frequently – at least every hour if you remain exposed to the sun. Reapply more frequently if you are swimming or perspiring a lot. If you have a skin type that burns easily, then consider using the recommendations of the dermatologists.
The SPF rating does not consider the damage caused the UVA (ultraviolet A) rays which is responsible for aging. It is therefore advised to look for and purchase a sunscreen that has a broad spectrum protection for UVA and UVB (ultraviolet B) rays.
UVB rays are the ones that cause the burning that many people suffer from.
Skin types normally are listed as six types. They range from type 1 to type 6. This means that a person with type 1 skin always burns easily, never tans, and is extremely sun-sensitive. Type 6 means a person that never burns, deeply pigmented, and has sun-insensitive skin. Read about the six different types here.
If you are planning on being outdoors and not in the shade for long periods of time, be sure to liberally apply sunscreen. Do not forget your lips. Find a good lip gloss with a SPF of at least 15 or higher and apply regularly.
One point to remember is that the sunscreens do not require FDA approval and thus may not be the best for us. Europe has the best sunscreens available. In the US manufacturers can make any health claims they desire and do not have to provide proof to any regulatory agency. CORRECTION: As of June 14, 2011, the FDA has issued rules for sunscreens, and please read about it on my blog here.
Here are some additional sources to read. Article 1, Article 2, and my blog from May 2010.
May 25, 2011
SMBG Can Reduce A1c's For Type 2 Diabetes Patients
Self-monitoring of blood glucose (SMBG) is a term quite well understood by many patients, but it is surprising to see researchers use it in the way this study did. And the report of the study by one of Big Pharma's own. This is a surprise and a pleasant one. Alan at loraldiabetes has been writing about the lack of respect and understanding SMBG has been receiving since at least 2006 and he has not missed much in the lack of understanding by researchers and the medical community.
So it is with respect that I need to report this study which I think for the first time does partially what Alan has been challenging researchers and patients to do. I think this study could have been taken many steps farther, but it is a start in the right direction, and for once it gives patients some insight into what may be accomplished as well as their physicians.
As it is reported by Roche, “an innovative diabetes management concept including structured self-monitoring of blood glucose (SMBG), data visualization, pattern analysis and derived therapy adjustments can significantly reduce HbA1c values, improve glycemic control and enhance patients' quality of life. These are the key findings of the 12-month data from the Structured Testing Protocol (STeP) Study, newly published in Diabetes Care and presented at an exclusive event on effective and structured diabetes management held in London in March”.
“SMBG is a well-established element of therapy management for people with type 1 or type 2 diabetes on insulin therapy. However, there have been controversial views on the question of whether regular SMBG is similarly beneficial for non-insulin treated people with type 2 diabetes. To gain new insights on this subject, the STeP Study was performed: A prospective, cluster-randomised, multi-centre clinical trial, which examined the impact of structured SMBG upon glycemic control in 483 non-insulin treated people with type 2 diabetes who evidenced poor glycemic control (HbA1c ≥ 7.5%) at baseline. The results provide new and significant evidence on its effectiveness”.
The study was designed to analyze the differences between the usual diabetes care and structured diabetes management. Those in the active control group (ACG) and the structured testing group (STG) were in the study for 12 months and all received a baseline evaluation. Then they had scheduled visits at 1, 3, 6, 9, and 12 months. The difference between the two groups was the STG received the SMBG-focused structured diabetes management concept. Free BG monitors and test strips were given to both groups.
The STG used the 7 BG testing profiles (fasting, preprandial, and 2-hour postprandial at each meal, and bedtime) for the three days prior to scheduled healthcare visits. They were to document blood glucose values, meal sizes, plus energy levels, and comment on their SMBG experiences. The STG patients all used the the Roche 360 3-day profile tool and discussed the obtained profiles with their caregivers. The good part was both the patients and caregivers received standardized training in SMBG and pattern analysis. In addition the doctors were equipped with an algorithm suggesting appropriate medication strategies.
The study concluded with finding significant improvement in glycemic control and reduced HbA1c values in the non-insulin treated Type 2 diabetes patients in the STG using the SMBG diabetes management.
Read the article about the study here. You may read Alan's blogs Dec 2, 2006, July 1, 2007, Feb 16, 2010, and Mar 14, 2010. The full study can be read here.
So it is with respect that I need to report this study which I think for the first time does partially what Alan has been challenging researchers and patients to do. I think this study could have been taken many steps farther, but it is a start in the right direction, and for once it gives patients some insight into what may be accomplished as well as their physicians.
As it is reported by Roche, “an innovative diabetes management concept including structured self-monitoring of blood glucose (SMBG), data visualization, pattern analysis and derived therapy adjustments can significantly reduce HbA1c values, improve glycemic control and enhance patients' quality of life. These are the key findings of the 12-month data from the Structured Testing Protocol (STeP) Study, newly published in Diabetes Care and presented at an exclusive event on effective and structured diabetes management held in London in March”.
“SMBG is a well-established element of therapy management for people with type 1 or type 2 diabetes on insulin therapy. However, there have been controversial views on the question of whether regular SMBG is similarly beneficial for non-insulin treated people with type 2 diabetes. To gain new insights on this subject, the STeP Study was performed: A prospective, cluster-randomised, multi-centre clinical trial, which examined the impact of structured SMBG upon glycemic control in 483 non-insulin treated people with type 2 diabetes who evidenced poor glycemic control (HbA1c ≥ 7.5%) at baseline. The results provide new and significant evidence on its effectiveness”.
The study was designed to analyze the differences between the usual diabetes care and structured diabetes management. Those in the active control group (ACG) and the structured testing group (STG) were in the study for 12 months and all received a baseline evaluation. Then they had scheduled visits at 1, 3, 6, 9, and 12 months. The difference between the two groups was the STG received the SMBG-focused structured diabetes management concept. Free BG monitors and test strips were given to both groups.
The STG used the 7 BG testing profiles (fasting, preprandial, and 2-hour postprandial at each meal, and bedtime) for the three days prior to scheduled healthcare visits. They were to document blood glucose values, meal sizes, plus energy levels, and comment on their SMBG experiences. The STG patients all used the the Roche 360 3-day profile tool and discussed the obtained profiles with their caregivers. The good part was both the patients and caregivers received standardized training in SMBG and pattern analysis. In addition the doctors were equipped with an algorithm suggesting appropriate medication strategies.
The study concluded with finding significant improvement in glycemic control and reduced HbA1c values in the non-insulin treated Type 2 diabetes patients in the STG using the SMBG diabetes management.
Read the article about the study here. You may read Alan's blogs Dec 2, 2006, July 1, 2007, Feb 16, 2010, and Mar 14, 2010. The full study can be read here.
May 23, 2011
Communication About Alternative Medications Lacking
This subject just won't go away. And I can understand why. Too many people feel that the doctors and other medical occupations, including pharmacists have no reason to know about what natural remedies they use. Complementary and alternative medicine (CAM) is prevalent in most countries and under reported by patients.
This is dangerous because some can have deadly effects when taken with prescribed medications. While this was a survey, it still indicates the people over the age of 50 often do not inform their healthcare providers of the CAM supplements they are taking. One question apparently not asked is whether they are doing this on their own or from recommendation of homeopaths. Either way, many are putting themselves at risk of fatal combinations of medications.
CAM is a diverse group of medical and healthcare interventions, practices, products, plus disciplines that are not generally part of conventional medicine. While older Americans wish to lead healthy and active lives, the CAM, which includes herbal supplements, manual therapies, and mind/body practices such as chiropractic care, massage, acupuncture, and meditation are sometimes counter productive with medical interventions.
Mainly it is the herbal supplements, but any of them can cause problems depending on the medical treatment a patient is receiving. I do use chiropractic care, but there have been times the chiropractic doctor has wisely refused treatments as they would have interfered with the medical treatment I was receiving. So communication is important with all concerned, not only to prevent problems, but for your own medical safety.
CAM can be an important factor in staying healthy, but care needs to be taken as some CAM products will make certain conventional medications less effective and lead to potentially deadly interactions. Patients need to communicate with their doctors and vice versa.
The AARP/NCCAM survey also found that it was the patients that brought up the topic of CAM most frequently. The two main reasons respondents gave for not discussing it was that the doctor never asked (42 percent) and the patients did not know they should bring it up (30 percent).
AARP is the American Association of Retired Persons which I do not belong to for personal reasons, and NCCAM is the National Center for Complementary and Alternative Medicine.
The article about the study can be read here.
This is dangerous because some can have deadly effects when taken with prescribed medications. While this was a survey, it still indicates the people over the age of 50 often do not inform their healthcare providers of the CAM supplements they are taking. One question apparently not asked is whether they are doing this on their own or from recommendation of homeopaths. Either way, many are putting themselves at risk of fatal combinations of medications.
CAM is a diverse group of medical and healthcare interventions, practices, products, plus disciplines that are not generally part of conventional medicine. While older Americans wish to lead healthy and active lives, the CAM, which includes herbal supplements, manual therapies, and mind/body practices such as chiropractic care, massage, acupuncture, and meditation are sometimes counter productive with medical interventions.
Mainly it is the herbal supplements, but any of them can cause problems depending on the medical treatment a patient is receiving. I do use chiropractic care, but there have been times the chiropractic doctor has wisely refused treatments as they would have interfered with the medical treatment I was receiving. So communication is important with all concerned, not only to prevent problems, but for your own medical safety.
CAM can be an important factor in staying healthy, but care needs to be taken as some CAM products will make certain conventional medications less effective and lead to potentially deadly interactions. Patients need to communicate with their doctors and vice versa.
The AARP/NCCAM survey also found that it was the patients that brought up the topic of CAM most frequently. The two main reasons respondents gave for not discussing it was that the doctor never asked (42 percent) and the patients did not know they should bring it up (30 percent).
AARP is the American Association of Retired Persons which I do not belong to for personal reasons, and NCCAM is the National Center for Complementary and Alternative Medicine.
The article about the study can be read here.
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