27 November 2010

More Prognostications About Diabetes - 3

This is part three of prognostications. There are no predictions in this one.  This is about another medical insurance company setting up a pilot program with the Medical Clinic of North Texas (MCNT). Aetna is saying this is a year-long initiative and will include adding a part-time bilingual diabetic educator. Claiming this pilot program strengthens Aetna's efforts to reduce disparities in health care, it also will develop and deliver culturally appropriate care for its members.

While this is a noble idea, what took them so long. While approximately 5000 persons will be involved in this pilot program, the program will use 17 distinct measures. They are generalized as improving levels of diabetic control, such as medication compliance, blood pressure, blood sugar and cholesterol rates, eye and foot screening rates, as well as other measures of quality health care, such as reducing avoidable inpatient and emergency room stays.

This sounds to me like a model for establishing criteria for claims denial in the future and not improved health care or even preventative health care. I can only hope that this is untrue and that these are not the motives.

The pilot program is located in Dallas, Texas. The patients and staff will be provided bilingual, and culturally correct educational information. The racial and ethnic data has been gathered and will be used to determine if the targeted interventions will improve the lives of the patients with diabetes.

Aetna says they will make an effort to see that all its members receive quality health care irregardless of the race or ethnicity. They also say they are committed to getting past the disparities in health care for minorities to lead to better health care for these populations.

Now I would challenge all medical insurance companies to be more open and actually do more all their members.

This is the final part in this series.

26 November 2010

More Prognostications About Diabetes - 2

This is part two of prognostications. I vented a little with the last one so I'll try to stay with the positive on this one. When dealing with Type 2 diabetes, overweight/obesity is normally part of the discussion as it will be this time. One of the largest concerns by some in the insurance industry is the overweight/obesity from youngsters to the elderly.

While I am surprised by some in the insurance industry, they actually are starting to realize that if they can step in and do some preventative actions, the amount of money that can be saved is very substantial. By working with the medical community and encouraging them to intervene and to work with the people of all ages to encourage them to lose weight, later health problems will be reduced.

What surprised me is a few doctors are actually doing this and actually testing many more people for diabetes. If the medical community can succeed with this, many people will be able to prevent onset of diabetes or delay it for many years. When there is over two-thirds of US adults and 17 percent of children that are overweight/obese and still rising, this means that diabetes and prediabetes will continue to rise.

The authors quote studies showing if a person increases in body weight by 11 to 16 pounds of they are doubling their risk of Type 2 diabetes and an increase of body weight by 17 to 24 pounds triples their risk. Since diabetes generally follows the course from obesity, to prediabetes, and then diabetes, many feel that the place to start is before prediabetes.

The United Health Group offers four solutions. Three of the solutions involve intervention strategies and the other is a medication and care compliance program. Interventions would involve lifestyle to include public health and more extensive use of wellness programs, community-based intervention programs, and public-private partnerships for lifestyle intervention.

This is where I have to say, not well done. They are looking to unproven and unreliable public health and community-based programs which also are notoriously unreliable. There are a few community-based programs that are successful because of the strong people operating them. I have to ask why the UHG is unwilling to work wit the medical community and pay the doctors to do the intervention? Also in some areas of the country there are strong nurse groups that are capable to this work.

This is the second part of three parts.

25 November 2010

More Prognostications About Diabetes - 1

Everyone this fall and because this is Diabetes Awareness Month is making forecasts for the potential size of the Type 2 diabetes epidemic. I doubt that the predictions are accurate, but this still leaves a lot of people that will develop diabetes. We don't even want to think of the costs this will generate.

A study by United Health Group (UHG) predicts a $3.35 trillion cost over the next ten years. Ouch!, and Double ouch! At least the the study did have some positives and hopefully some of them will happen.

When I read about the health industry (at stated by United Health Group) needing to become proactive in preventative care – you could have knocked me over. This goes against their past philosophies by 180 degrees and even what they practice today that I have to wonder “up who's are they blowing smoke”? If they had said that they would deny claims for people overweight, I might have believed them, no way, in the past they have said and done what they wanted to without regard to the benefit of their consumers or policy holders.

Now I have to speculate about why. Is it because of the Affordable Care Act that has the insurance industry saying things it would not otherwise even consider? Or are there actually enlightened people at the helms of some of the companies? Or is this a form of advertising to get new clients and then stick it to them? I will let you decide what is driving the insurance industry after you have read the articles.

According to the report, UHG has been quietly tackling some preventive measures, but on the peripheries. I say if they are really serious, they should be more vocal and up front about it. They should openly challenge others in the insurance industry to participate and get out in the open about their efforts.

Read about the new article here and the full 60 page report here.

This is the first part of at least two parts.

24 November 2010

B Vitamins Helps Slow Alzheimers

Thanks to fellow blogger Diabetic Guy, I have found the courage to do more research about alzheimer's disease. Yes, I have written a few blogs about this, but when something as insidious as this scares the daylights out of me with the link to diabetes, it is depressing.

Now in the last few months several studies are giving me hope that there may be measures that can slow the progression of alzheimer's and maybe even slow the onset of alzheimer's. This is the B vitamins, B6 and B12, plus folic acid. Granted this will need more studies to determine how helpful this will be, but the discovery of this was surprising even to the researchers. No one expected a 50 percent slow down in the progression of alzheimer's.

The B vitamins, folic acid, B6 and B12 are protecting the brain and controlling the substance homocysteine in the blood. High levels of this substance are in direct correlation with the speed of brain shrinkage and alzheimer's progression.

All the researchers involved urge caution until more trials are completed because scientists are aware that high levels of the B vitamins can cause health problems which may offset the good. B vitamins are found naturally in meat, fish, eggs, and green vegetable which are all good for those of us with diabetes. B12 is also found in milk and some fortified cereals which may not be beneficial for some because of the levels of carbohydrates which many cannot tolerate well.

Many people that have been on Metformin may already be taking vitamin B12 and others are on B12 for anemia. Therefore, it is wise to consult your doctor before taking increased doses of the B vitamins. Rebecca Wood, the chief executive of the Alzheimer's Research Trust urges caution about the findings.

While these findings are very encouraging, we should wait for more research before overdoing vitamin B consumption. This will determine the correct amounts for best results and give doctors a clearer path to help diabetes patients avoid or slow the progression of alzheimer's.

Read about alzheimer's and B vitamins here and here. Read related blogs here and here.

23 November 2010

The Future of Health Care Reform

When I wrote this on October 16, 2010, I wasn't sure of what was coming next. I thought I knew, but not this. This insertion in the New England Journal of Medicine has no place being given space. This author cries fowl because the GOP now can block, de-fund, and generally make the ACA (Affordable Care Act) generally ineffective.

Congress cannot presently repeal the ACA, but it can now pick and chose the parts that may get support. While I don't like many parts of the ACA, I can support other parts. I do not like that our medical insurance industry is being so greedy and determined to reap their profits before they are regulated and this needs to stop. The other problems are that many of the insurance companies will be slowly forced out of business so that people will demand universal care insurance from the government. There is no balance in what is happening.

There are issues in all this, but a respected medical journal is not the place for politics. This is more appropriate for blogs and other places. That the NEJM chooses to air the political furor of its members degrades it's place in medical journals and should be on the boycott list by the medical community and research community. Will this happen?
I doubt it, but there are other medical journals that have recently gained traction and this position may lose this journal some respect.

While the author tries to present his arguments fairly, it is easy for me to see where this is heading and this is the reason I am so against this in a medical journal.

22 November 2010

Diabetics Underusing Statins

Oh really??? While I would like to get my hands on this study and see if this is really correct, I do have to wonder who paid for the study? If a study finds something like this being underused, it may not be a good thing.

Just because roughly a third of eligible patients with Type 2 diabetes do not receive a statin, does not mean that they should. I am taking a statin because I have cardiovascular problems that make it necessary. Two friends with Type 2, are not on statins and have no problems with cholesterol or triglycerides. When we read this, they had a good laugh.

They both expressed the desire to remain off medications if at all possible. One has been talked to about taking statins, but has refused and the other has not been talked to. Both are still controlling their diabetes with exercise and nutrition and are not on any other medications.

While many patients with Type 2 diabetes are at risk for cardiovascular problems, I sincerely wonder if statins are the answer if lipid tests are normal. If cholesterol tests show an increase, then it should be watched and statins may be appropriate. Giving someone statins just because they have diabetes and qualify does not seem right.

This article lists no standards for normal cholesterol levels or where statins should be considered and without the full text, I am hesitant to criticize too much more. Just seems like this could be bad advice.