The ADA on Older Adults, 2015

It is somewhat surprising that the ADA has continued to promote guidelines for the elderly. At least they admit that there are few long-term studies in older adults demonstrating the benefits of intensive glycemic, blood pressure, and lipid control. Patients who can be expected to live long enough to reap the benefits of long-term intensive diabetes management, who have good cognitive and physical function, and who choose to do so via shared decision making may be treated using therapeutic interventions and goals similar to those for younger adults with diabetes. As with all diabetic patients, diabetes self-management education and ongoing diabetes self-management support are vital components of diabetes care for older adults and their caregivers.

I can accept this, but I admit I am having trouble with the recommended levels for A1c goals as they say for some that goals can be similar to those for younger adults with diabetes. Then the tables used say the opposite with the minimum upper level being an A1c of less than 7.5. To me this one-size-fits-all guidance does seem very discriminatory and nothing is mentioned about properly assessing and individualizing any treatment when it comes to the elderly.

I do understand their fear of hypoglycemia, but why are they not concerned about hyperglycemia. I could guess they want people to develop complications, but as doctors, why do they insist on doing harm to patients.

The above is not the full table and below in the explanation for the 8.5%.

†A1C of 8.5% equates to an estimated average glucose of 200 mg/dl. Looser glycemic targets than this may expose patients to acute risks from glycosuria, dehydration, hyperglycemic hyperosmolar syndrome, and poor wound healing.

This gives me some insight into why the Diabetes Clinic that I was using always wanted me to raise my A1c to the 7.5 to 8.0% level. Not that I will do this and I am no longer intending to return. My last A1c was higher that I like, but it will be back down by the next A1c in April and my eating habits are changing and my blood glucose levels are reflecting this.

Thoughts at Year's End

There are a lot of thoughts buzzing through my mind and I hope that I can put some of them into words.

Things in general are not moving as fast as many would like and I see this as well. We are seeing more advocates for the teaching of Ancel Keys speaking and conducting research to prove medium to high fat with low carbohydrate diets are bad for us and doing a lot of directed research to prove the teaching of Ancel Keys.

Most of us know that fat research done by Ancel Keys has been disproven and that we need the fat as part of our diets. Many on a high fat/low carb diet have improved their triglyceride levels and even have normal cholesterol levels. For more reading about this and that fact it is recommended for type 1 and type 2 people with diabetes, read this. Then read Dr. Kendrick'sblog about a recent article published in the British Medical Journal.

The biggest problem existing today is the dietary guidelines issued by the United States Department of Agriculture. Most of the guidelines are based on expert opinion and not true research. Not only this, it is impossible, as of yet, to find out who these experts are and if any science is used to support the dietary guidelines which are to be released in the year 2015.

This blog appearing in the Healthy Nation website is rather incriminating of the USDA, the American Diabetes Association and the Academy of Nutrition and Dietetics. As well, they should as they are doing their research and with what they are learning from the Freedom of Information Act, they will have more to say about the dietary guidelines issued when they get answers to the requests they have filed. Please read the links in this paragraph for information. The Healthy Nation website is doing their research and trying to expose what is causing the rise in the obesity rate in the United States.

The use of terms such as medical nutrition therapy by the ADA and medical nutrition by prescription by Joslin is another way of promoting low fat, high carbohydrate meal plans and getting patients blindly to follow what they promote. I am learning that whole grains and the nutrients I am being told I am missing can be found in other foods and that I am doing very well without a lot of carbohydrates and am lowering the number that I consume.

The previous year has been very educational for me. I hope you have learned as well. I am hoping this year will continue to teach me more and that I continue to learn.