11 September 2013

Are Laws Needed to Control Diabetes?

With the ever growing population of people developing diabetes, some are turning to legal remedies for stopping the tide and the role that law can play in serving as an effective health tool. Honestly, I had never thought legal remedies would be applied, but the more I read about this study the more I realized that some of the most useful legal remedies are not even mentioned in the press release. When the American Diabetes Association has legal tools available to use against discrimination, why should there not be other legal tools available.

I may be criticized for this, but without legal remedies to force doctors to become current in their knowledge, prevention, and diagnosis of diabetes, patients will continue to bang their heads against the wall. Doctors are the first line of defense and as long as they continue to ignore diabetes, this diabetes epidemic will continue. If stiff legal penalties are required to bring doctors into the twenty-first century, so be it.

The law can be a critical tool for health improvement as long as it does not jeopardize our freedom rights. Assessments reported in a new study published in the American Journal of Preventive Medicine indicates that federal, state, and local laws give only partial support to guidelines and evidence-based interventions relevant to diabetes prevention and control. Bold is my emphasis.

It is sad indeed that nearly 26 million people in the US have the disease and about one-fourth are not aware they have diabetes. Facing about 30 percent (about 1 in 3 people) having diabetes by 2050, it is time for action. Risk factors for type 2 diabetes include limited access to nutritious food, limited opportunity for physical activity, socio-economic conditions, and genetic disposition. While many well-crafted guidelines and recommendations for diabetes intervention exist, the incidence and prevalence of diabetes continues to escalate.

Lead author, Anthony D. Moulton, PhD, Laboratory Science, Policy and Practice Program Office, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, states, "Laws, including statutes, ordinances, and government agency rules and regulations, can support interventions to prevent and control disease in various ways."

Dr. Moulton continues, "Laws can help shape environments to reduce exposure to some type 2 diabetes risk factors and encourage preventive behaviors, and laws can authorize or require provision of prevention-oriented information designed to change the behaviors and cultural norms that affect risk."

Investigators analyzed the laws further to determine whether they contained provisions that require, incentivize, or encourage healthcare providers, insurers, employers, schools, child care centers, restaurants, government agencies, and others, to take action consistent with a given guideline.
Investigators concluded that:
  • Implementation of guidelines for evidence-based interventions for diabetes prevention and control is incomplete
  • Many opportunities exist for exploring uses of law to improve adoption”

Dr. Moulton's conclusion is also worth quoting, "Laws that are demonstrated to be effective, designed to support proven public health and clinical interventions, and well implemented can give crucial support to strategies that address public health priorities and to wider adoption of evidence-based guidelines. Law is a key tool for scaling and sustaining effective interventions at the national level. Public health practitioners and policymakers nationally can intensify their exploration and evidence-based application of law to help slow and potentially reverse the accelerating threat posed by the diabetes epidemic."

Dr. Moulton does not state this, but I think until doctors educate themselves about diabetes and step up to the challenge, we will not achieve any reduction in the diabetes epidemic. Doctors that make statements, such as – “Watch what you eat, your blood sugar is a little high,” or “Curb your sugar intake,” should be penalized for not making a diagnosis or giving a complete description of what the blood glucose readings mean for the patient. ONLY then will we see a possible slowing of the number of diabetes cases. The 15 minute office visit or less, will do nothing to slow the diabetes epidemic and blaming the patient needs to end.


  1. Although I really despise (HATE) the term "control" used in reference to diabetes, that's a separate topic. The question of whether laws are needed to manage diabetes (which applies to developing the disease, as well as ongoing maintenance once patients are diagnosed) is a different conversation. The U.S. stands out for its legal system which has actually perpetuated and encouraged the development of type 2 diabetes, a food industry, for example, which has few restrictions of any kind (one which China is trying to emulate; the recent move to acquire Smithfield Foods is a sign the country really WANTS to industrialize its food production, yet the track record on industrialization of agriculture isn't one of complete success, and health has generally suffered population-wide as a result).

    Laws can help or harm, but I concur that laws, by themselves, aren't likely to move the needle in one direction or another; the issue is far more complex. In the end, I think a complex problem like diabetes deserves a discussion of approaches on things that might help or hurt, and any kind of discussion is better than none at all, but using simple terms is not a solution, its merely a the first part of discussion.

  2. Scott, Thanks for some points I had not considered. Another article is here - http://www.medicalnewstoday.com/releases/265925.php

    I had some time to think on this topic, but would like to discuss your points. I will not be available until later because of doctor appointments.