UK diabetes care basic, at best
Filed under: Type 1, Type 2, Daily News, Support, Care
British watchdog group The Healthcare Commission just gave diabetes care in the UK a lukewarm review. Its study of the facilities in which British diabetics receive care concludes that care levels overall are basic, at best. Most of the places (73%) surveyed in the study were rated "fair," meaning patients know what medications they are supposed to be on and when they should be taking them. They also know they should be getting annual checkups. Only five percent of facilities were rated "excellent by the Commission.The system is lacking, however, when it comes to anything beyond those most basic of services. Just like here in the US, most British people with diabetes are not receiving help with diabetes management. Studies suggest that regular consultations with a health "coach" on an individual basis could really improve patient outcomes. One reason they are helpful is because they get patients to come up with a care plan tailored for each person, making it more likely he/she will be able to stick with it.
Diabetes UK head of healthcare policy, Bridget Turner, agrees with the Commission's conclusions: "The NHS [National Health Service] has to focus more on...self-care. For people with diabetes, 95% of diabetes management is self-care."
To read more, click here or visit the Healthcare Commission's own web summary of the report.
Big savings today with IT based diabetes care
Filed under: Type 1, Type 2, Childhood, Adult Onset, Lifestyle, Research, Products, Support, Complications
Last month Bev addressed a news article that found high tech diabetes management did not equate to better diabetes care. Doctors felt that electronic care is only as good as the patient willing to participate beyond office visits. However, another service is trying to evolve the preconceived notions with a more developed system - and a bigger bang for the buck. How does $14.5 billion sound?
Information technology enabled diabetes management (ITDM) was found to be beneficial in avoiding diabetic complications - MILLIONS of cases. This is an overzealous finding - considering the word prevent is permanent and should probably be replaced with delayed. Even the DCCT knew that much. However, the study was conducted over a period exclusive to the program, and not the lifespan of diabetics in the study. However patient compliance did grow from less than 50% to approximately 80%. That would evoke a few halleluiahs from doctors. Another reason in support of ITDM is the fact that an electronic diabetes registry offers Medicare and other payers the ability to save quite a bit. Over 10 years, the overall net savings is estimated to be $14.5 billion. Does that figure include COLA - cost of long-term diabetes complications adjustment? The complications that did not occur in 2008 saved Medicare and payers $1.45 billion. Score! What is the inflation adjusted cost of those delayed complications occurring in 2013?
The headcount standing at 20 million diabetics, at a savings of $1.45 billion per year - I asked for clarification on that figure. The savings is speculative because the company is anticipating saving costs on preventing diabetic complications. That's optimistic but not entirely realistic.
Signs of kidney disease may also signal pre-diabetes risk
Researchers at the University of Buffalo recently found that a blood component once used to test for early-stage kidney problems may also help detect risk for the development of pre-diabetes.
Reporting in the July 2007 issue of Diabetic Care, the University of Buffalo researchers reported that elevated levels of cystatin C were linked to a much greater risk of progression to pre-diabetes. Currently, there are over 54 million Americans who have been diagnosed with pre-diabetes, which, if not addressed through proper diet and exercise, oftentimes results in the development of type 2 diabetes.
Lead researcher on the study, Richard P. Donahue, Ph.d., stated that "If further studied support our finding, testing for cystain C could become an important part of a standard physical examination. Preventative measures could be in place before glucose intolerance has a chance to develop and take its toll."
[RESEARCH] Cost effectiveness of self monitoring of blood glucose in patients with non-insulin treated type 2 diabetes: economic evaluation of data from the DiGEM trial
Objective To assess the cost effectiveness of self monitoring of blood glucose alone or with additional training in incorporating the results into self care, in addition to standardised usual care for patients with non-insulin treated type 2 diabetes.
Design Incremental cost utility analysis from a healthcare perspective. Data on resource use from the randomised controlled diabetes glycaemic education and monitoring (DiGEM) trial covered 12 months before baseline and 12 months of trial follow-up. Quality of life was measured at baseline and 12 months using the EuroQol EQ-5D questionnaire.
Setting Primary care in the United Kingdom.
Participants 453 patients with non-insulin treated type 2 diabetes.
Interventions Standardised usual care (control) compared with additional self monitoring of blood glucose alone (less intensive self monitoring) or with training in self interpretation of the results (more intensive self monitoring).
Main outcome measures Quality adjusted life years and healthcare costs (sterling in 2005-6 prices).
Results The average costs of intervention were £89 (113; $179) for standardised usual care, £181 for less intensive self monitoring, and £173 for more intensive self monitoring, showing an additional cost per patient of £92 (95% confidence interval £80 to £103) in the less intensive group and £84 (£73 to £96) in the more intensive group. No other significant cost difference was detected between the groups. An initial negative impact of self monitoring on quality of life occurred, averaging –0.027 (95% confidence interval–0.069 to 0.015) for the less intensive self monitoring group and –0.075 (–0.119 to –0.031) for the more intensive group.
Conclusions Self monitoring of blood glucose with or without additional training in incorporating the results into self care was associated with higher costs and lower quality of life in patients with non-insulin treated type 2 diabetes. In light of this, and no clinically significant differences in other outcomes, self monitoring of blood glucose is unlikely to be cost effective in addition to standardised usual care.
Trial registration Current Controlled Trials ISRCTN47464659.
Running over the same old ground: exercise and diabetes
Filed under: Type 2, Lifestyle, Exercise, Daily News
Oh yawn, I thought to myself this morning. Upon turning on National Public Radio, I immediately heard what seems to be yet another report on diabetics and exercise. According to the results of a new study, the majority of people with Type 2 diabetes or at risk for it fail to follow through on their doctors' advice to get moving and get some good old-fashioned exercise to ward off the disease - or at least slow its progress. The study comes courtesy of a team of researchers at the University of Colorado, Denver. It's a sizable study, involving over 22,000 patients. The results are being published in Diabetes Care (February 2007) and basically conclude that fewer than forty percent of those advised to get exercise actually do so. Moreover, those most at risk are in fact the least likely to heed exercise advice. Dr. Elaine Morrato, who led both this study and an earlier one on a similar topic, says "People should exercise more, that story is out. What we're saying is, 'Here's a high-risk population that can benefit from exercise, and they're even less likely to exercise.'" Now, I hate to be a grumpy naysayer, but (to use an exercise-related metaphor) isn't this just a case of running over the same old ground? Is this study really contributing anything new? According to the NPR report, Morrato goes on to say that the results are "very pessimistic," but that she does not know the answer to what is perhaps the real question: how to change peoples' behavior. We already know there is a T2 diabetes epidemic going on. We already know that obesity and inactivity are to blame. Instead of studying the issue over and over, from every conceivable angle, shouldn't researchers be focusing on how to stop this national health train wreck that we're seeing? Am I being unreasonable? You tell me.
Pennsylvania announces diabetes action plan partially funded by CDC
Filed under: Type 1, Type 2, Childhood, Adult Onset
Governer Ed Rendell is worried. An estimated eight percent of Pennsylvanians have diabetes. Nearly 800,000 people. We all know money talks, and what has caught the attention of state politicians is the tremendous cost to manage chronic diseases.
Governor Rendell recently shared that about 78 percent of the state's health care costs are linked to 20 percent of chronic diseased patients. The Governor has announced The Pennsylvania Diabetes Action Plan to improve how Pennsylvanians with chronic disease benefit from future health care.
In an effort to prepare Pennsylvania to educate the public about diabetes and diabetes prevention, and improve management of the disease to reduce complications, the Plan focuses on four key areas: surveillance, standards of care, health policy, and evaluation.
Truly a collaborative of care, more than 200 stakeholders, agencies, organizations and individuals contributed to the Pennsylvania Diabetes Action Plan. The plan was funded by the Centers for Disease Control and Prevention (CDC) and a state appropriation.
In 2005, potentially avoidable hospitalizations for diabetics in Pennsylvania cost nearly $730 million. Now that is a number even the Governor cannot ignore.
San Antonio registry to track diabetes impact
Filed under: Type 2, Daily News, Services, Care
Texas is turning to number-crunching in an effort to contain soaring Type 2 diabetes rates. San Antonio will be the first city there to operate a diabetes registry designed to improve both the cost and quality of diabetes care in the state. The Texas state legislature approved the initiative this past spring. The project, which will be administered by the local health department, has been given the extremely imaginative title of Diabetes Registry. (Hey, makes it easy to find in the phone book.) The registry will gather its statistics from labs that perform diabetes blood tests.The idea behind the project is not new: a similar scheme is already underway in New York City. Makes sense: before you decide how to cope with widespread Type 2 diabetes, you first need to assess exactly what the problems are. Who is missing out on care? Who are most likely to go undiagnosed? What could healthcare providers, teachers, or parents be doing differently?
Officials say that if the registry is successful in San Antonio, the registry may be extended throughout the entire state of Texas. Click here to read more on the community news site My San Antonio.
Insulin Dependent Diabetes Trust: A diabetes support charity
Filed under: Type 1, Type 2, Childhood, Adult Onset, Drugs, Research, Support, Care, Complications
Since 1994, the UK-based Insulin Dependent Diabetes Trust (IDDT) has supported people with diabetes and their caretakers. It is a charitable organization operating entirely on volunteer donations. IDDT is not influenced financially from the drug industry, all their donations are Big Pharma-Free.
IDDT has a wealth of information for type 1 and type 2 diabetics. Of special note is IDDT's comprehensive explanation of the GM 'Human' Insulin vs. Animal Insulin debate. Allie has written several posts addressing the issue. Since switching from synthetic to pork insulin, her blood pressure has dropped, her blood sugar control is better and her appetite has lessened. She has also gained tremendous insights from IDDT along the way.
Back in 1994, IDDT collected a load of feedback from people with diabetes and their caregivers on their experience with synthetic 'human' insulin. The top three complaints were loss of warning of hypos or functioning on automatic pilot; extreme tiredness/lethargy; and weight gain of 21 pounds or more. Whether you have researched this debate deeply or are just scratching the surface, IDDT is a good resource. They also award research grants, and their Dream Trust supports young people with diabetes in developing countries.
It's a crime the US only offers genetically modified human insulin. Other countries sell animal insulin. People with diabetes should have a choice of insulins, adverse reactions to synthetics are real.
Diabetes, athletes, and the technological revolution
Filed under: Type 1, Lifestyle, Drugs, Exercise, Products, Care
For athletes with type 1 diabetes, technological advances have opened up a whole new world. Tell your doctor you want to run a marathon? In past decades, the announcement might have been met with words of caution, even dismay. Exercise wasn't even part of the equation when it came to diabetes management. Being diagnosed with diabetes was a death knell for the careers of budding young athletes. Today, however, docs (well-informed ones, at least) are more likely to say, 'okay, let's come up with a plan.' Diabetes-related technology is a big reason for this shift in attitudes. An article just out in The New York Times. looks at the extent to which technology has made life easier for type 1 diabetics. Devices like digital meters and automated pumps are not cheap. But they are increasingly efficient, safe, and sleekly high-tech. Above all, they give athletes the tools they need to control blood sugar levels with absolute precision - the kind of precision that was impossible in the days of the urine-glucose test. The down-side, I guess you could say, is the mixed blessing of all that control: "We are essentially the CEOs of our own bodies," observes type 1 diabetic and long-distance cyclist Paul Southerland, "and we don't get a break from them."
Inspired by Diabetes global contest
Filed under: Type 1, Type 2, Childhood, Adult Onset, Diet, Lifestyle, Exercise, Fundraisers, Support, Care
Do you or a loved one have diabetes? Are you a healthcare professional caring for people with diabetes? Living with the disease or caring for a person with diabetes is an up and down journey. Inspired by Diabetes is a global campaign asking all those impacted by diabetes to share their story.
The campaign's Creative Expressions Competition just opened to the world on June 21, and is accepting creative entries through January 31, 2008. If you have a creative bent, tell your story through a short essay or narrative; up to three photographs; an original drawing/painting or musical score.
Entries will be judged across category, art type and age group, starting as young as age five. The Grand Prize Winner across each category will win a $5,000 donation to the charity of their choice, a trophy and a paid trip for two to the media announcement of the winners and the global exhibition. I wish I could tell you the exhibition is planned for an exotic location, but it hasn't been announced, yet!
Inspired by Diabetes, a collaboration between Eli Lilly and the International Diabetes Federation's Unite for Diabetes Initiative, is bringing those close to the disease together to try and raise awareness of the global burden of diabetes. All entrants will receive two blue circle pins, the global symbol of diabetes. I had never heard of the blue circle before, this is one pin I would like to sport. Perhaps the blue circle will become as powerful and recognizable as the beautiful pink ribbon for cancer awareness.