Friday, January 11, 2008

The Good News, and The Bad News

Well, you've probably already seen the news on the ADA's website, and while this is the first indication that all of the efforts of patients, their doctors and CDE's have yielded actual proof that their efforts have paid off. But naturally, a slight majority (60%) isn't good enough.

Dr. Earl S. Ford, of the Centers for Disease Control and Prevention, Atlanta said "As welcome as the recent favorable trends in glycemic control are, additional efforts are needed to help the approximately 40% of patients with diabetes who do not have adequate glycemic control."

But I think its very unrealistic to assume it will get much better than this -- honestly. First of all, the struggle to achieve this was monumental, with tools that could best be described as prehistoric at best. Think about how crude they are: most patients puncture themselves regularly to test, and the insulin injections, the Symlin injections, the Byetta injections or pumps also involve another puncture. For those who take meds, a majority experience some kind of nasty gastrointestinal side-effects, or perhaps yet-undiscovered side-effects, all of which aren't very pretty.

Then there is the bigger issue which AmyT has brilliantly written about, which indicates the outlook isn't all that pretty. And if that wasn't bad enough, but its really the tip of the iceberg! There's also the other issue which leaves some 3 million Americans with diabetes without healthcare insurance.

I thought I'd share that report the ADA has cited with you. "Is Glycemic Control Improving in U.S. Adults?"; Thomas J. Hoerger, Joel E. Segel, Edward W. Gregg, and Jinan B. Saaddine; Diabetes Care 2008 31: 81-86.

From my perspective, I think it is an admirable goal to improve glycemic control in patients with diabetes, but I also think in today's environment, it is unrealistic to expect much in the way of future improvement until we can resolve the issue of universal healthcare coverage and the shortage of diabetes educators.


Jenny said...

Don't forget that though the ADA buried a tepid admission that low carb dieting works for weight loss they still do not publish anything that suggests that carb intake is directly linked to blood sugar and that lowering carb intake is a great way to control blood sugar especially for Type 2s.

And even in the document with the tepid admission that low carb dieting won't kill you, they go on to say that low fat dieting might be easier for people with diabetes.

Whaaaa? A diet that raises blood sugars dangerously high and results in those blood sugar swings that cause relentless hunger is easy?

Too bad NO ONE formulating ADA policy has diabetes. Statements like that make it pretty clear they don't.

Until the ADA tells people who are controlling diabetes with diet alone that cutting significant amounts of carbs from their meals is far more effective in normalizing blood sugar than any drug on the market, I will continue to blame them for the plague of unnecessary amputations, kidney failure, blindness and death.

Anonymous said...

I've stopped caring about what the ADA does. The ADA isn't relevant for Type 1 diabetics and I'm sick of how they use us as part of their PR machine. For example, wanna motivate some overweight Type 2 diabetics to exercise? The ADA will trot out one of their convenient Type 1 athletes as an example, even though the diseases are different and never mind the fact that a Type 1 diabetic will respond differently to exercise than a Type 2 diabetic. I don't go to the ADA website and have written the organization off as being more concerned about the Type 2's that will bring in advertising money than about Type 1's. I could care less about better glycemic control - if they want to prove their relevance to use, they'll get us a cure. Now.