Questioning Diabetes Standards of Care

Hey, All — if you’ve got questions about life with diabetes, then you’ve come to the ideal place! That could be our weekly cardiovascular information column, Request D’Mine, hosted by veteran type 1 diabetes, diabetes author and clinical professional Wil Dubois.

Last week, Wil responds to your question about all those “standards” established by medical professionals about how we ought to be handling our diabetes therapy. No real surprise that Wil has any pointed remarks on this!

Dan, type 1 in Washington, writes: each time that I go to the doctor, they always say to me the insurance provider gets on them whenever they don’t put a type 1 diabetic on a statin and a blood pressure pill. However, as a patient, I do not take pills for prevention of illness unless I could find evidence, beyond a reasonable doubt, the pill is effective and not dangerous. That’s, I don’t have kidney disorder and that I don’t have cardiovascular disease. I don’t have elevated blood pressure. I have type 1 diabetes (35 years) and that is it. By the way, my A1C is always around 5.5.   My cholesterol is 200 and LDL is 125 and HDL 60.

Once I examine the research, there is only marginal improvement in taking a statin (which is, it takes 100 individuals to be treated to prevent 1 heart attack), if you believe the studies all done and paid for by the drug companies that make this stuff. Additionally, the Framingham Heart Study showed over half those who had a cardiac event had NORMAL cholesterol levels.

Why are people type 1 diabetics told that regardless of what, you need to take this? I’m tired of these doctors acting as if I have a disorder I don’t own and telling me about insurance companies and the way they get in trouble. And I am honest: I’d an innovative cholesterol assessment done that shmade my LDL is that the large fluffy kind (design A) and not the tiny dense LDL (pattern B). Even so, I get plagued every time that I see my general practitioner along with my endocrinologist.   Is all this really going on (insurance companies pressuring doctors to carpet bomb most type 1 diabetics with statins and blood pressure pills at the lack of clear cut research, replicated a couple of times, proving advantage)?   I’m tired of being treated for an illness I do not have by pills with demonstrate evidence they actually stop anything.   

Wil@Ask D’Mine replies: Confession: I am a heretic.

Needless to say, I wasn’t always a heretic. I was a True Believer. A believer at the standards of care. I believed that wiser folks than me, using scientific evidence, had carefully created diabetes therapy algorithms which could assure long life, joy and health. All I needed to do was follow the principles.

I am not sure when I began losing my diabetes maintenance faith. It arrived in baby steps. But I think the very first thing was baby ibuprofen. Once I was diagnosed, I had been placed to a statin, an ACE, and a baby aspirin. All standards of care. As soon as I began working in diabetes therapy, one of my jobs was to ensure those damned noncompliant diabetics took their statins, ACEs, and aspirins.

Like any good zealot, I strongly urged for your trio. I set a fantastic example by accepting myself, though I did not need them, and encouraged, cajoled, and silenced my own patients to do exactly the same. I created a cute visual help using a toy medieval armor place where sword had been diabetes meds, so the statin was the breastplate, the ACE was the protector, and the baby aspirin was the helmet.

And then one day the priests said, “Uh… never mind about that aspirin thing we’ve been pushing you for a long time. It out does not help. Our poor. But keep taking each of the other things we told you to choose.”

Along with the real Believer entertained his very first doubt.

Time, wind, and rain plantations hills. The more I worked at the area, the longer fallible I understood the priesthood was. The standards of care weren’t carved in stone. They have been created from Playdough. Each year they changed. Part of this was the truth that knowledge changes, but that which I came to understand was that there was more politics than science involved in establishing standards.  

Speaking of mathematics, I think I completely lost my faith when I was included in a college “scientific” study that allow me to see up close and personal badly conducted these investigations could be. The lead investigator conducted out of time, but needed a certain continuing volume of printed works for job safety in the dog-eat-dog academic universe. Exhausted and fearing occupational effects, this individual simply fudged the lost data.

I was really horrified. Appalled. Knowledge wasn’t the goal. Successful publication was.

Heresy EverywhereBut I half-heartily peddled the conventional drugs at work. It had been within my own job description, even though it was no more in my center. Ironically, I lasted taking them from habit than anything else. Subsequently, worn down and worn out myself, one day that I had a hissy fit and stopped taking all of my drugs — vitamins — except for my own insulin along with my thyroid pill.

Within days I felt 100% better. Ten years younger.

Officially, I am still supposed to advocate for the standards. I mention what the standards are, and the way they are made, but I don’t expend much energy.

Along with the drama armor is no more in my office.

Do the insurance companies irritate us because of our lackluster use of standards of care? That depends on how you define “hassle” Historically we receive three dimensional letters list their members who don’t appear to be toeing the line in regards to standards, but that’s about it.

On the other hand, the times they are a’changin’. These auto insurance companies which will not pay for test strips are beginning to place their money where the standards are. More importantly, docs have been bribed to make certain their diabetes sufferers meet the standards. In case their diabetes patients act, docs qualify for benefits. As in additional cold, hard cash incentives.

In the future, things look grimmer.

We’re in a significant state of turmoil in healthcare, and a model for the future which gets kicked around a lot is pay for functionality. Whether this model is broadly adopted, docs would not be compensated for what that they perform, but rather they’d be compensated for exactly what you do. They’ll be penalized if you don’t toe the line.

I am able to see a world where non-compliant diabetics like me and you will probably be discharged from care because doctors will not have the ability to be compensated for taking care of us. Regardless of how healthy we are.

Then what? Well, there may come a day after, so as to keep your healthcare coverage, you may have to fill out the prescriptions to the standards and create the copay. But in the solitude of your bathroom, nobody will know whether you take the pill flush it down the toilet.

Needless to say, I never said that, also certainly will deny stating it if asked. This column will probably self-destruct in five seconds.

Meanwhile, calmly and logically explain to your staff the way you feel, and request they quit hassling you. When they don’t, for now, you have the choice of searching around. Healthcare is still a consumer market. You’re the client.

Find someone who’s still promoting the sort of healthcare you want.

This isn’t a medical advice column. We are PWDs publicly and publicly sharing the wisdom of our collected experiences — our been-there-done-that knowledge in the trenches. But we’re not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are just a little portion of your total prescription. You still need the professional advice, therapy, and care of a licensed medical practitioner.


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This content is made for Diabetes Mine, a user health blog centered on the diabetes area. The content is not medically reviewed and doesn’t stick to Healthline’s editorial directions. To find out more about Healthline’s partnership with Diabetes Mine, please click here.

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