8 Responses

  1. Tim Steinert
    Tim Steinert January 21, 2014 at 4:25 am | | Reply

    These are exactly the metrics and rules that should be used in determining how to treat diabetes!

    I went to see my new endo at the Managed Care health system that I am now receiving through Medicaid. I feared that I would be treated by a doctor who is overwhelmed by a mountain of patients and limitations. I was shocked that his concerns and motivations were ALL based upon what would help me to manage my diabetes best!

    I truly was impressed with his commitment to getting the best tools and treatment options to me. I even heard through the pharmacist that he was irate with my medical plans blood glucose meter, saying something like, “that piece of junk?!!

    That feeling that someone is fighting for you is one of the most encouraging things that we diabetics encounter. It encourages me to believe that I’m not alone in this fight for good control and a long life.

  2. Mary Dexter
    Mary Dexter January 21, 2014 at 6:14 am | | Reply

    According to the American Diabetes Association, the cost of diabetes is approximately $245 billion per year and the biggest chunk of that cost (43 percent) is spent in hospital care. Keeping people out of intensive care would save up to $105 billion.
    Random trials are doing us more harm than good. While researching The Sweet Lowdown I learned that many of the studies linking obesity to diabetes do some serious cherry-picking, which is why they never go any further than to say the two are linked. “Linked” as in “happening to be in the same place at the same time.”
    The original study done by the ADA that found that testing made no difference measured the effect of testing Once a Week with testing Once Every Other Week, and the numbers were rarely looked at, much less used to change treatment. The more recent study found the opposite to be true, but is much less well known.
    Once a study is done, we get a brief synopsis of what the media wishes us to know, not necessarily what the study says in the fine print.
    The time has come for us to fight. Next year, instead of
    Stepping Out to Prevent Diabetes, maybe we should march to dispel the myths and misunderstandings that are killing us.

  3. StephenS
    StephenS January 21, 2014 at 7:29 am | | Reply

    I particularly identify with Rule #4. ALL costs should be considered when deciding what to cover, and how. And never, ever, should an insurance company’s profit margin or a CEO’s potential bonus be part of that discussion.

    I often work with our benefits team at my job, and I have already had informal discussions with them on plan design. Mostly from a “what will help the most” and “here’s one patient’s opinion” perspective. I think Rem brings up a lot of great points here.

  4. Bennet
    Bennet January 21, 2014 at 11:41 am | | Reply

    Excellent essay. Thanks,

  5. Scott S
    Scott S January 21, 2014 at 1:12 pm | | Reply

    While I agree about Randomized Clinical Trials (RCTs) having no real way to “blind” a study and as a result there can also not be a placebo, hence medical outcomes for diabetes drugs and devices might be better in well-designed prospective observational studies rather than in RCTs, there are thousands who disagree unequivocally. That’s why these same entities also argue that HbA1c is the best measure of success or failure (such as is the case with a new medicine or medical device, or in so-called public health interventions such as seizing patient medical records without disclosure in the name of surveillance).

    The best place to start on changing that is a side-by-side comparison of a RCT and perspective observational study. Few have bothered doing so.

    As I said, the best way to start is a comparison of these things, followed by another, and another. Whether we see that anytime soon when so many are fixated on the idea of randomization remains to be seen.

  6. Natalie ._c-
    Natalie ._c- January 21, 2014 at 1:24 pm | | Reply

    Having gotten to THAT age, and knowing that there are many others, I think it’s really important to advocate to Medicare about coverage of CGMs. In order to save money and prevent hospitalizations and deaths, the criterion should be simply hypoglycemia unawareness as documented by a doctor, and not whether you’ve had a hypo that required medical assistance or hospitalization in the last 6 months. If you come into Medicare with a CGM, then it should be grandfathered in, because maybe the reason you haven’t had such a hypo IS the CGM. Medicare should be more responsive to individual needs, and not so dependent on blanket coverage based on studies which may or may not even exist, or may be poorly designed.

  7. Scott E
    Scott E January 30, 2014 at 9:45 am | | Reply

    I really have nothing to add other than to say that I agree with this. All of this. It’s a perspective and a concept I admit to never giving much thought, but am glad that I have.

    That last part – the call to action – leaves me scratching my head a bit. I’m not sure what to say or what to write, other than point them to this article or to plagiarize it, neither of which leaves me feeling too good. Would anyone be able and willing to provide a little more guidance as to what to do…and how? To effect change, our message needs to be concise and consistent.

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