Re: The fight against Diabetes

On Jul 23, 12:52 am, "johnniemccoy@" <johnniemc...@xxxxxxxxxxxxxxxxx>
wrote:
"glass318" <glass...@xxxxxxxxx> wrote in message

news:1185169311.108261.64300@xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx



On Jul 22, 10:35 pm, Alan S <loralgtweightandca...@xxxxxxxxx> wrote:
On Sun, 22 Jul 2007 18:09:00 -0700, Wingmask

<mugtechnic...@xxxxxxxxx> wrote:

What percentage of your patients are in poor control of their diabetes?

Thank you WM; you have totally surprised me with that
excellent question.

May I add to it?

For the "doctor": First, define poor control please.

Cheers, Alan, T2, Australia.
d&e, metformin 1500mg, ezetrol 10mg
Everything in Moderation - Except Laughter.
--http://loraltraveloz.blogspot.com/
latest: Mossman Gorge in the Daintree
Rainforesthttp://loraldiabetes.blogspot.com/
latest: Self-Testing and Type 2 Management

Well, I guess you guys look at Daibetes from your individual
perspectives. That is expected. I look at it from a practioner's
perspective. I have about 800 Diabetic patients so its bread and
butter for me. I wish I had a magic wand so I could come here claiming
to have a panacea for all Diabetes-related troubles. Nope. I come here
neither to make up numbers or to please you with fictitious numbers.

For those of you (Susan et al) making fun of my practice's A1C average
below 8, I ask you to go to your physician's office and randomly
select 50 to 100 Diabetic patients and calculate the A1C. You'll be in
for a big surprise. When we started our practice 3 yrs ago, our
average A1C was 10.5. I even saw patients with starting A1Cs as high
as 22 .

Having said that, I would also like you guys to step out of your
comfort zone and face the national reality that, of about 20 million
Americans living with diabetes, a whopping 34% are poorly controlled
(for the guy who wanted to know, poorly controlled in HEDIS lingo is
A1C > 9%). If you take only medicaid patients, a mind boggling 50%
have A1Cs of more than 9%! It is very naive to think that the average
medical practice has an A1C below 7. That is the ultimate goal but we
are legions from there. About 20% of Diabetics don't even get the
minimum 2 A1C checks per year!

I think HEDIS data is great for those who want to evaluate medical
practices and their performance: Scroll to page 32:
http://www.ncqa.org/communications/sohc2006/sohc_2006.pdf

Some of my patients cannot even afford the healthy foods that I
recommend to them. You are fortunate to have scaled Maslow's hierarchy
to a point where you have a clear enough mind to think critically
about the disease but I urge you to look at the bigger picture. If you
already have your A1C below 6, you are doing great but you are a
sideshow. You may want to join hands with the medical community to get
more people to that goal because we are struggling. The data does not
lie.

For those quoting ADA or AACE or whomever's standards, kudos for
knowing the standards and striving to get there. Most physicians know
the standards but how do we get our patients there? Show me a
physician with an average patient A1C of less than 7 (no biased
Hollywood-based concierge practices---real world mix of
commercial,self-pay,medicare and mediacid patients).

For those who want to give me classes in studies showing the effects
of percentage rises in A1C on DM complications, please hold that for
when I'm recertifying with the ABIM. DCCT, UKPDS, etc, etc. The data
is there but data does not save your body parts from being burried all
over the place.

I'll give you a better one: For every 1 percent reduction in blood
glucose levels (HbA1c blood tests), the risk of developing eye, kidney/
ESRD and nerve disease is reduced by 40 percent (
http://diabetes.niddk.nih.gov/dm/pubs/statistics/index.htm#5)

I am just being realistic. If patients with Diabetes see the
establishment as their enemy, woe betides us all in the war on
Diabetes. Its OK to be skeptical but some of your arguments sound more
like turf protection a la 'I have the lowest A1C so who the heck are
you to teach me anything?'

Come to think about it, I'm here to stay.

I can't wait to see what it is you're selling.

John- Hide quoted text -

- Show quoted text -

lol. NADA, RIEN, NOTHING! Not a salesman. WOuld be a terrible one 'cos
judging from these exchanges, I would piss customers off by not
telling them what they want to hear. Anyway, to bed I go.

.

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