Article in the Wall St Journal on Diabetes

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Article in the Wall St Journal on Diabetes


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Old 07-10-2012, 13:44   #1
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I opened up my newspaper this morning to this article on Diabetes. It is on the front page of the Personal Journal Section. I don't know if you can access it online if you don't subscribe to to the journal. The basic premise of the article is that they are rethinking Strategies to treat diabetes. The biggest one that blew my mind was for older Diabetics they are going to raise the HbA1c for good control from 7 to 8. They also say they want to be less dogmatic about different approaches and let patients take more control. They also question intensive drug therapy in the beginning to stop the progression of diabetes. Of course they touch on Bariatric surgery since they assume all type 2's are morbidly obese. Everything in this article is just so wrong. In the past few months I have seen several articles leaning in this direction. I wonder with our new healthcare system in the US, wheter we are going to see this less aggressive approach towards treating diabetes to save money. I can already see the next article how bg testing for type 2's is a waste of resources.

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Old 07-10-2012, 14:00   #2
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I read something similar recently in a set of guidance notes on the management of the condition.

The justification for the easing of control was something along the lines of "...it is appropriate to consider life expectancy and quality of life in setting targets for HbA1c. ....."

I translated the waffle to "... if the patient is old and already has problems, write him off..."

And as you say more economies are on the way. Over here in the UK and France, they already hold the view that testing for non-insulin diabetics is a waste of resource. I fully expect that by next year I will have to buy my own test strips without the benefit of a prescription from the doctor.


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Old 07-10-2012, 14:16   #3
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The article really surprised me. I would think with more and more Pre D's and Diabetics being dx'd everyday we would want to get tighter with control not looser. Telling Diabetics they can still eat all sorts of carbs and don't worry about your HbA1c is juggling a time bomb. I know personally when my bgs go above 130, I start getting diabetic symptoms like frequent urination, blurry vision and tiredness. I do think a lot of this goes back to that flawed ACCORD study a few years ago where older diabetics died when they tried to throw too many meds/insulins at them to lower HbA1c. What they are missing here, is that these D's had many years of poor control which set them up for heart disease. So it was not the lowering of the HbA1c that killed them but the many years of poor control. Plus they probably threw meds at them without significant diet change.
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Old 07-10-2012, 15:32   #4
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It always pains me to see that agencies that are supposed to be helping and protecting people fail so utterly to understand basic science. I don't know what crud "studies" they are basing these recommendations on or what moron they are paying to interpret them but they should get their money back and start over.

I just don't see what's so hard to understand?
* Diabetics have a broken carbohydrate metabolism.
* The by-products of this broken metabolism (BG, MG, etc) cause horrible complications.
* People will have a higher quality of life if they make changes to address the poor carb metabolism and reduce complications.


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Old 07-10-2012, 15:37   #5
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I remember at my one and only visit to the dietician, she basically told me I could still eat everything I wanted, including processed food, just watch portions. Well, I wasn't overweight so I really didn't need to watch portions, but my bgs were in the 240-high 300's range so I did need to watch carbs. But nothing was said about that. I was told to eat lots of whole grains ( which I did before diabetes) and of course eat low fat ( which I did before diabetes). Just imagine how differently the Diabetic population would look if dieticians told them up front that Diabetics was a disease of poor carb metabolism and you should test everytime you eat carbs to see how your body processes them. Also if they told you that FAT is good, not bad and will help you lose weight and stabalise bgs.

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Old 07-10-2012, 16:40   #6
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Regretably as long as our medical advisors are in the pocket of the big drug companies and processed food producers (Same thing?), I don't think we can look for them to 'fess up to the tripe they have been dishing up for the last generation.

It took me about a week to wake up after my diagnosis (ok, Judy was way ahead of me) and I find it impossible to accept that most doctors don't realise what the issue is.

However, talking of Judy, just after my diagnosis she decided to formalise her knowledge with a nutrional qualification. She hunted for a course that seemed good and for several weeks her assignments were sympathetic to Low Carb, then suddenly she started an assignment which started with something like....
"As has been proven, the High Carbohydrate Diet is the most effective and healthy......"

Judy blinked - she's missed the proof and after searching back through her course information, it became clear that someone had stolen the information from her files. We are now on the search for the data thief.

In reality, Judy dropped the course when it became clear that to get acreditation the main requirement was to toe the official line despite it being nonsense!

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Old 07-10-2012, 18:06   #7
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The biggest one that blew my mind was for older Diabetics they are going to raise the HbA1c for good control from 7 to 8.
My grandfather's doctor feels the same way. She doesn't care about his blood sugar at all and figures something else will kill him before diabetes does. Of course, those other 'somethings,' like heart disease, were probably caused by and are worsened by uncontrolled diabetes.

I think you're right about the ACCORD study. I'm only 29 and my doctor even mentioned it to me when cautioning me about my "low" blood sugar in the 70s and my A1c of 5.3% at the time.

He also essentially told me that diabetic complications were inevitable. If you believe that as a medical professional, then what's the incentive to monitor your patient's blood sugar or prescribe effective treatment methods? From his perspective, the effort was probably futile, and I might as well just enjoy my life - after I lose weight, of course. Because fat causes diabetes and I wouldn't have diabetes if I weren't so fat. He thought his job was mostly to lecture about my weight, run lab work, and keep me from dying of hypoglycemia. High blood sugar would be another doctor's problem in 10 years.

This article just reflects the false dilemma being presented to diabetics: run higher-than-normal blood sugar or aggressively treat your diabetes with a dangerous cocktail of medications on a high-carbohydrate diet with seemingly little health benefit. If those are my options, then maybe I'd pick the first one, too. Sadly, there's little mention of how important diet is to blood sugar control.
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Old 07-10-2012, 18:38   #8
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When I was dx'd I had already lost most of my excess weight and was in great shape. I ate a vegan diet and exercised a ton in the gym. When I was dx'd the first thing my doctor told me was to lose weight and exercise more. I was already in the gym or tennis court 2-3 hours a day. I looked at him and questioned his advice. So I think they are told to tell everyone that no matter what they weigh. I remember when I went to the dietician, I cam armed with all my food logs and bgs and carb counts. The dietician was quite impressed and then proceeded to give me the standard ADA diet of 60-75 carbs a meal. She gave me this little book with all these breakfast cereals, processed foods. I remember I asked her about unsweeten greek yogurt and she didn't know what it was. She recomended the higher carb yogurt with all the artificial junk. She gave me a free bg meter that came with a DVD. The DVD was sponsored by Kraft Foods. The meals they suggested for good control were all high carb.

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Old 07-10-2012, 19:00   #9
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They also say they want to be less dogmatic about different approaches and let patients take more control.
I don't know about the rest of the article, but this bit sounds good to me. If you don't want bad treatments and advice to get entrenched then you need competition and involved patients. If more patients were involved and less inclined to blindly follow their doctor's advice, and instead doctors just managed to objectives, the truly successful strategies would bubble to the top fairly quickly.

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Old 07-10-2012, 19:04   #10
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It always pains me to see that agencies that are supposed to be helping and protecting people fail so utterly to understand basic science.
I expect it. They have the same incentives as anyone else, and drug companies pay more than we do, plain and simple. Plus they're disconnected. The day to day information you and I get from living with the disease isn't something they see or experience by and large.

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