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dimanche 26 juin 2011


You can read this post in conjunction with the previous post: America by the numbers. You can substitute: Australia, UK, India... in every country, they predict that Diabetes would double in a few years time. and at the same time, they insist on intensive therapies for current patients and prevention therapies at all age levels.

Isn't there something wrong with this logic? Are we accepting defeat of our intensive treatment and prevention intentions, if we accept that Diabetes prevalence would double in a few years' time ?

New drugs are constantly being introduced and they all help a LITTLE BIT.. nothing dramatic.. whether the new generation of drugs or new class of drugs and a whole class is being withdrawn for side effects such as Heart Failure, Bladder Cancer. You get the feeling that everything is being done in a hurry without great thought going into it, so that teachers, professors and researchers (not all of them of course) can change their minds. I have seen prominent Endocrinologists and Diabetologists swearing by a specific drug and then changing their minds when its side effects are revealed. Don't be the first one in your region to use a newer drug, neither be the last one, said a professor of mine.

The fundamental problem is trying to tackle physiologically and pharmacologically diseases which are predominantly social in nature and manifest as cluster of abnormal laboratory values and symptoms (which do have deleterious effects). Always it was given that Blood Sugar be controlled and the world wide rates of control is only about 30 per cent ie seven out of ten people with type 2 Diabetes have uncontrolled blood sugar.
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The newer medications bring down the A1C (laboratory measurement for control of blood sugar) by 0.7 to 0.3 ! which can be achieved by paying attention to Nutrition alone.

This week, some news which should receive greater attention among doctors and diabetes educators:

1. Intensive diabetes control does not provide any great protection to death from cardiac diseases. Since it is understood that cardiac diseases may begin even before diabetes is diagnosed, this makes you think pharmacological therapy is not what is needed, not by itself alone, by intense therapy of social nature is needed.

2. Newly diagnosed Diabetes was reversed by strict diet control, by decreasing the fat in the liver and decreasing insulin resistance.
Among the Native Indians of North America, with whom I work as a Consultant Endocrinologist, my personal experience has been:
the treatment of chronic diseases including Diabetes and Heart Diseases has to be based on a formula of society, social and family life with some help from the doctors and other providers(who would account for about a 1/4 of the help). This culturally oriented, respectful treatment of a disease in the context of suffering and oppression, has produced good results. The fact that Indian Health Service in the USA is not a fee for service system has also been helpful. Some of the best Diabetes care in America are to be found in the two non fee for service establishments: The Veteran's Administration Health Care System and the Indian Health Services. Here, a social illness is approached, not in a piecemeal fashion, but in much more holistic fashion.

May the rest of the Americans one day get such good total Care for Diabetes! !
After I had finished writing and put this blog up, further news came out at the ADA meeting which is being held in San Diego at this moment:

“The results of our research don’t suggest that standards of diabetes care for controlling blood sugar levels, high BP and cholesterol should be changed,” de Boer said in the release. “What the findings suggest is that these treatments alone are not doing an effective job of reducing diabetic kidney disease, and researchers need to find additional ways to do that.”
Diabetic kidney disease has become more prevalent in the US population over the past 2 decades and will likely contribute increasingly to health care costs and mortality,” Ian H. de Boer, MD, MS, and colleagues at the University of Washington, Seattle, wrote in the Journal of the American Medical Association.

if you are a patient with Diabetes, what would you think? Intensive therapy does not protect you from heart disease, medical therapy does not protect you against Kidney disease... wouldnt you look for something else?