Re: I need proof of why Type 2s need to test test test
- From: "palm" <palm650@xxxxxxxxx>
- Date: 29 Aug 2005 10:12:15 -0700
<<So educate them and they will
control this T2 themselves for the time that there is no pill available
which
will cure T2. >>
You are confusing two different things: frequency of self testing and
self management. Self management of diabetes (diet, exercise,
following of test and medication regimen prescribed by doc, frequent
communication with healthcare professionals) are very important and
have no relation to increase of self testing, above MD recommendations.
<<"There is
a strong and growing body of evidence that everyone with diabetes gains
from
strict blood glucose control," said Catherine Cowie, PhD, who oversees
EDIC for
the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK).>>
No argument about that. But, again, you are confusing two things,
frequency of self testing and strict blood glucose control, which in
context of this article, means increasing medication (they assume that
in terms of diet and exercise everything possible is done), and
increasing of meds has it's own problems, like increase of episodes of
hypoglycemia and increase of side effects and complications of meds.
This is why this idea of "tight glucose control" is debated. Not
because docs don't know "should we let diabetics to became blind or
not".
<<Compairing groups who tested once a day and none at all , not asked
what they
did with the test results , not tested for their knowledge about
diabetes , food
etc. Like Alan S says the research has not yet been done , the
population has
not yet been sampled... >>
This is incorrect.
<Overall, 48.43% subjects tested their blood glucose levels at home >
or = 1 time per day, 29.63% tested their blood glucose levels > or = 1
time per week and 7.81% tested their blood glucose levels < 1 time per
week, whereas 14.06% patients never practiced SMBG.>
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15002260&query_hl=1
<their frequency of SMBG was 1.36 +/- 0.95 strips per patient per day.
Postimplementation, 974 of 1,278 persons with diabetes had HbA1c tested
(HbA1c = 7.86% +/- 1.54%; P= .63 vs baseline); frequency of SMBG
decreased by 46% to 0.74 +/- 0.50 strips per patient per day (P <
..0001)>
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12068962&query_hl=1
What do you think they did with test results? They showed them to their
docs, and they were changing their treatment according to test results.
<<Till now I did not find anything on the long term effects of finger
testing . If
you do find something I would be interested>>
Here we are:
http://tinyurl.com/8wc59
GysdeJongh wrote:
> "Bastian" <bastian@xxxxxxxxxxxxxxxx> wrote in message
> news:jYMPe.21227$5m3.3524@xxxxxxxxxxxxxxxxxxxxxxxxxxxx
> <snipped some>
>
> > Primarily I need researched information that is backed up with
> > references as to why it is essential that a Type 2 diabetic must test
> > test test.
> >
> > Secondary is relating to the long term effects on the fingers of testing
> > upwards of eight times a day.
> >
> > Tertiary is why the patient must read and understand their results and
> > control their diet to reduce PostP BG spikes.
> >
> > Assistance appreciated, I can't do this without all you wonderful people.
> >
>
> Hi Bastian,
> all good questions :)
>
> This is from the ADA in : DIABETES CARE, VOLUME 28, SUPPLEMENT 1, JANUARY 2005 :
> PROBLEM STATEMENT - Diabetes Self-Management Education(DSME) is the cornerstone
> of care for all individuals with diabetes who want to achieve successful
> health-related out-comes.
>
> Very recent information from a trusted site. I think this will answer your
> Tertiary. If you think about it than this is the only working strategy : there
> are too many people with T2 and too few docters . So educate them and they will
> control this T2 themselves for the time that there is no pill available which
> will cure T2.
>
> Than for me just plain logic demands that the patient can only manage his T2 if
>
> 1) He gets all the test results , your Primarily
> 2) Lots of education in order to interpret the results , the new ADA strategy
>
> Your doc does the same
> He will send you to the lab
> Wait till he gets all test results
> Act on it as he did the education already
> So nothing for him to object
>
> As you can see from the above article the ADA is really serious about this.
>
> This is a press release from the last congress of the ADA :
>
> http://www.nih.gov/news/pr/jun2005/niddk-12a.htm
>
> Sunday, June 12, 2005
> Tight Glucose Control Lowers CVD by About 50 Percent in Diabetes
> The longer we follow patients, the more we're impressed by the lasting benefits
> of tight glucose control," said Saul Genuth, M.D., of Case Western University.
> Dr. Genuth chairs the follow-up study of DCCT participants, called the
> Epidemiology of Diabetes Interventions and Complications (EDIC) study, which has
> been looking at the long-term effects of prior intensive versus conventional
> blood glucose control. "The earlier intensive therapy begins and the longer it
> is maintained, the better the chances of reducing the debilitating complications
> of diabetes."
>
> Is glucose control just as important for people with type 2 diabetes? "There is
> a strong and growing body of evidence that everyone with diabetes gains from
> strict blood glucose control," said Catherine Cowie, PhD, who oversees EDIC for
> the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
>
> I think this again can be used to persuade your doc to let you be at the helm of
> the T2 ship :). Testing is needed. But not only blood glucose. Also HDL , LDL ,
> triglycerides , microalbumin , A1c , creatinine. Persuade your doc to give you
> the lab results. Cost me a lot of argueing. What you can do yourself is measure
> your Body mass index :
>
> http://nhlbisupport.com/bmi/bmi-m.htm
>
> Find an exercise and how many calories it burns :
>
> http://www.caloriecontrol.org/exercalc.html
>
> Learn what is in your food so you can adjust your calori and nutrient intake at
> :
>
> http://www.nal.usda.gov/fnic/foodcomp/search/
>
> Than all this testing is worthless if you do not know how to act on it.
> Education is is needed , even before you start to test. So ask your doc for the
> Diabetis Self Managenment Education , read here , search for yourself. Here is
> a place to learn about your meds :
>
> http://www.mercksource.com/pp/us/cns/cns_home.jsp
>
> Test without knowledge is dangerous
>
> Example :
> If I would go to the fried chicken and order lots of chicken
> Lots of mustard and mayonaise
> Have a bottle of red wine to flush it down
> And two cigars to feel happy
> My meter would not move an inch
> If I were stupid enough to decide on that test result alone to make this my only
> meal than I would expect to die on heart attack , long cancer or liver cirroses
> quickly.
>
> Conclusion
> Education is needed
> More tests than blood glucose alone are needed
>
> The problem is not "Test" but "Diabetis Self Managenment Education"
> Once you start to look in that direction , instead of the "Test frequency"
> direction , much more literature can be found.
>
> DIABETES CARE, VOLUME 24, NUMBER 6, JUNE 2001
> The second half of the 20th century saw a major shift away from the
> paternalistic "doctor knows best" philosophy, which characterized patients as
> passive unquestioning recipients of care at the hands of all-powerful,
> all-knowing medical practitioners. Most patients, given sufficient information,
> now wish to be active participants, fully involved in making decisions relating
> to their medical assessment and management.
>
> Also read the comment on the above article at :
> DIABETES CARE, VOLUME 25, NUMBER 1, JANUARY 2002
> Their objections were mention in this thread by Quentin and Alan S
> Compairing groups who tested once a day and none at all , not asked what they
> did with the test results , not tested for their knowledge about diabetes , food
> etc. Like Alan S says the research has not yet been done , the population has
> not yet been sampled...
>
> Also read the comment on this article :
> BMJ USA VOLUME 4 NOVEMBER/DECEMBER 2004 (p 558)
> The effectiveness of any glucose monitoring program is highly dependent on the
> ability of patients and providers to integrate home blood glucose monitoring
> into an overall program of self-care and therapeutic decision making.
>
> Responsibility should be placed on the care system to actively promote patient
> understanding of the monitoring plan and its purpose.Confirmation of patients '
> understanding of medical information is critical but is frequently
> overlooked,especially in individuals with low health literacy who are most in
> need of this counseling.
>
> Here is another article with the same flaws : self monitoring once per day...no
> knowledge check etc...
> Frequency of Blood Glucose Monitoring in Relation to Glycemic Control in
> Patients With Type 2 Diabetes
> DIABETES CARE, VOLUME 24, NUMBER 6, JUNE 2001
> Conclusion : the frequency of self-monitoring was not related to glycemic
> control, as measured by HbA1c level.
>
> as expected...
>
> Here another negative advice for blood glucose testing with conflicting
> arguments:
>
> http://www.zoeticzone.com/p/articles/mi_m0CUH/is_6_28/ai_n14705098/pg_2?pi=zoe
>
> The original article is :
> Counterpoint: self-monitoring of blood glucose in type 2 diabetic patients not
> receiving insulin: a waste of money
> Diabetes Care, June, 2005 by Mayer B. Davidson.
> This is a very recent review article , so you can use the references in it to
> trace back the literature
>
> It first says :
> There are at least three possible explanations for the lack of an effect of SMBG
> in patients. First, patients receive little or no feedback on their results.
> Second, related to the first, they are not taught the self-management skills
> required to lower the measured glucose values. Third, in my experience, the vast
> majority of patients measure their glucose level either fasting or
> preprandially, rather than postprandially. Fasting values serve neither to
> educate (there is no information on the effect of meal composition or size) nor
> to effectively motivate (postprandial values are much higher).
>
> And than :
> However, given the lack of evidence for a beneficial effect of SMBG on A1C
> levels in these patients, I personally do not recommend it.
> ???? instead of recommending better feedback , more frequent post prandial
> testing and education to the patients ????
>
> Here is a more positive one :
> Diabetes Care. 2003 Nov;26(11):3048-53.
> Integrating medical management with diabetes self-management training: a
> randomized control trial of the Diabetes Outpatient Intensive Treatment program.
>
> OBJECTIVE: This study evaluated the Diabetes Outpatient Intensive Treatment
> (DOIT) program, a multiday group education and skills training experience
> combined with daily medical management, followed by case management over 6
> months. Using a randomized control design, the study explored how DOIT affected
> glycemic control and self-care behaviors over a short term. The impact of two
> additional factors on clinical outcomes were also examined (frequency of case
> management contacts and whether or not insulin was started during the program).
> RESEARCH DESIGN AND METHODS: Patients with type 1 and type 2 diabetes in poor
> glycemic control (A1c >8.5%) were randomly assigned to DOIT or a second
> condition, entitled EDUPOST, which was standard diabetes care with the addition
> of quarterly educational mailings. A total of 167 patients (78 EDUPOST, 89 DOIT)
> completed all baseline measures, including A1c and a questionnaire assessing
> diabetes-related self-care behaviors. At 6 months, 117 patients (52 EDUPOST, 65
> DOIT) returned to complete a follow-up A1c and the identical self-care
> questionnaire. RESULTS: At follow-up, DOIT evidenced a significantly greater
> drop in A1c than EDUPOST. DOIT patients also reported significantly more
> frequent blood glucose monitoring and greater attention to carbohydrate and fat
> contents (ACFC) of food compared with EDUPOST patients. An increase in ACFC over
> the 6-month period was associated with improved glycemic control among DOIT
> patients. Also, the frequency of nurse case manager follow-up contacts was
> positively linked to better A1c outcomes. The addition of insulin did not appear
> to be a significant contributor to glycemic change. CONCLUSIONS: DOIT appears to
> be effective in promoting better diabetes care and positively influencing
> glycemia and diabetes-related self-care behaviors. However, it demands
> significant time, commitment, and careful coordination with many health care
> professionals. The role of the nurse case manager in providing ongoing follow-up
> contact seems important.
>
> Till now I did not find anything on the long term effects of finger testing . If
> you do find something I would be interested
>
> hth
> Gys
.
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- I need proof of why Type 2s need to test test test
- From: Bastian
- Re: I need proof of why Type 2s need to test test test
- From: GysdeJongh
- I need proof of why Type 2s need to test test test
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