Tag: "diabetes"

Is that Granola Bar Really Healthy? Nutritionists Say No!

Healthy eating and “eating clean” is all the rage among health conscious consumers. So-called Super Foods like blueberries, kale, Swiss chard and quinoa supposedly supercharge the body, cleans the colon and all around make people healthier. A recent New York Times article explores the misconceptions people have about healthy eating and how what constitutes healthy foods differs from nutritionist and the public.

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Medicare Pays for Prevention – Finally!

man-in-wheelchairThe Centers for Medicare & Medicare Services has announced Medicare (that is, taxpayers) will pay for lifestyle-intervention program that prevents type 2 diabetes:

In 2011, through funding provided by the Affordable Care Act, CMS awarded the National Council of Young Men’s Christian Associations of the United States of America (Y-USA) more than $11.8 million to enroll eligible Medicare beneficiaries at high risk for diabetes in a program that could decrease their risk for developing serious diabetes-related illnesses. Beneficiaries in the program attended weekly meetings with a lifestyle coach who trained participants in strategies for long-term dietary change, increased physical activity, and behavior changes to control their weight and decrease their risk of type 2 diabetes. After the initial weekly training sessions, participants could attend monthly follow-up meetings to help maintain healthy behaviors. The main goal of the program was to improve participants’ health through improved nutrition and physical activity, targeting at least a five percent weight loss for each individual.

The results of the Diabetes Prevention Program model are striking:

  • Medicare beneficiaries enrolled in the program lost about five percent of their body weight, which is enough to substantially reduce the risk of future diabetes. Average weight loss was 4.73 percent of body weight for participants attending at least four weekly sessions.  Participants who attended at least nine weekly sessions lost an average of 5.17 percent of their body weight.
  • Over 80 percent of participants recruited attended at least four weekly sessions.
  • When compared with similar beneficiaries not it the program, Medicare estimated savings of $2,650 for each enrollee in the Diabetes Prevention Program over a 15-month period, more than enough to cover the cost of the program.

After years and years of jawboning about preventing disease and reducing health spending by catching health problems early, the federal government has finally approved one intervention that actually appears to achieve this goal!

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Are We Winning the War Against Diabetes?

Federal researchers on Wednesday reported the first broad national picture of progress against some of the most devastating complications of diabetes, which affects millions of Americans, finding that rates of heart attacks, strokes, kidney failure and amputations fell sharply over the past two decades.

The biggest declines were in the rates of heart attacks and deaths from high blood sugar, which dropped by more than 60 percent from 1990 to 2010…

Beyond the declines in the rates of heart attacks and deaths from high blood sugar, the study found that the rates of strokes and lower extremity amputations — including upper and lower legs, ankles, feet, and toes — fell by about half. Rates for end-stage kidney failure dropped by about 30 percent.

Unfortunately, diagnoses continue to increase: “The number of Americans with diabetes more than tripled over the period of the study and is now nearly 26 million.”

(Sabrina Tavernise & Denise Grady, New York Times)

Diabetes Monitoring 24/7

MiHealth-Oximeter-575x381ost glucometers use ancient technology that provides only a snapshot of information….Many diabetics still log their results using pen and paper.

[T]wo diabetes meters that aim to change that are able to instantly send results to a smartphone over a Bluetooth wireless connection. Each offers an app that collects and analyzes the readings, and gives a picture of how their users are doing over time. Both apps can also send reports from the phone to a doctor or other person. (WSJ)

Headlines I Wish I Hadn’t Seen

mortazavi20110914075159873Diabetes kills one person every six seconds, new estimates show.

Happy tweet from the White House (“Thanks to ObamaCare, more than 500,000 Americans have already signed up for health coverage.”) gets a Pinocchio from the Washington Post.

“In the vast majority of states the ObamaCare exchanges will offer less, not more, insurer competition than the state’s current individual market [and the plans are] something akin to Medicaid managed care for the middle class.

Jon Gruber: Genetic “lottery winners” have been paying an “artificially low price.”

More navigators advising people to lie about their income when applying for ObamaCare insurance.

Hits and Misses

gavel-judge-court-OHIO-millUnintended consequence of the welfare state: man was declared legally dead years ago; judge refuses to declare him “alive” today.

Questionable Nobel prizes.

Does diabetes cause obesity rather than the other way around?

Why businesses give you a receipt, even when you don’t ask for one.

How Climate and Violence Are Linked, and Other Links

252d77333798d2381f8b9ffa69af7bf4Does global warming cause violence?

iPhone can do an EKG; let diabetics monitor their glucose as they eat.

Beer brands associated with the most ER visits: Budweiser, Steel Reserve, Colt 45, Bud Ice and Bud Light.

Can music determine how safely you drive?

Is it Ethical to Withhold Medical Care Unless Patients Follow Doctors’ Orders?

“Hospitals Prescribe Big Data to Track Doctors at Work,” a July 12, 2013, article in The Wall Street Journal, describes a California health system that monitors physicians and grades them on the basis of what percentage of their patients meet certain metrics, such as a blood glucose level (as measured by HbA1C) of less than 8 percent.

But if some diabetes patients refuse to come in for visits, physicians can’t track their progress. If their blood sugar is elevated when they do come in, the measurement system gives the physician a black mark.

Dr. Keith Lee has found a solution to this problem. He refuses to give such patients long-term prescriptions. This forces them to come in for checkups in order to get new prescriptions. “I cut them short, and then they get the message,” he reportedly said.

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Failing to Change Behavior

According to the July 11, 2013 issue of The New England Journal of Medicine, the Look AHEAD trial has been canceled on the “basis of a futility analysis” after 9.6 years of follow-up. It was designed to study whether an intensive lifestyle intervention for weight loss would decrease cardiovascular morbidity and mortality among overweight or obese patients with Type 2 diabetes. Short of interning people in exercise camps, it is hard to imagine a more intensive intervention.

The 5,145 participants were randomly assigned to either a control group or an intensive lifestyle intervention group. The control group received the usual information about behavioral strategies for adopting standard recommendations about how to eat right and exercise.

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The Whole Idea of a Clinical Trial is Inconsistent with Personalized Medicine

…even after some 400 completed clinical trials in various cancers, it’s not clear why Avastin works (or doesn’t work) in any single patient. “Despite looking at hundreds of potential predictive biomarkers, we do not currently have a way to predict who is most likely to respond to Avastin and who is not,” says a spokesperson for Genentech, a division of the Swiss pharmaceutical giant Roche, which makes the drug.

That we could be this uncertain about any medicine with $6 billion in annual global sales — and after 16 years of human trials involving tens of thousands of patients — is remarkable in itself. And yet this is the norm, not the exception. We are just as confused about a host of other long-tested therapies: neuroprotective drugs for stroke, erythropoiesis-stimulating agents for anemia, the antiviral drug Tamiflu — and, as recent headlines have shown, rosiglitazone (Avandia) for diabetes, a controversy that has now embroiled a related class of molecules. Which brings us to perhaps a more fundamental question, one that few people really want to ask: do clinical trials even work? Or are the diseases of individuals so particular that testing experimental medicines in broad groups is doomed to create more frustration than knowledge?

Researchers are coming to understand just how individualized human physiology and human pathology really are. On a genetic level, the tumors in one person with pancreatic cancer almost surely won’t be identical to those of any other. Even in a more widespread condition like high cholesterol, the variability between individuals can be great, meaning that any two patients may have starkly different reactions to a drug.

More at the NYT.