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diabetes 24-7

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31 December 2005

Happy 2006!

24 December 2005

Dissapointing News...

Today, response from noted academics in the field of medical research to South Korea's top human cloning scientist Hwang Woo-suk who had apologised and resigned when it was found that he had fabricated results in his stem-cell research. Here is the original story from the BBC reported on 20 May 2005, which Hwang has since retracted.

On 15 December, it was found that at least nine of 11 stem cell colonies used in a landmark research paper by Dr Hwang Woo-suk were faked. Dr Hwang's paper had been hailed as a breakthrough, opening the possibility of cures for degenerative diseases such as diabetes and Parkinson's.

Although some see him as a National Hero, others like Professor Malcolm Alison of the Centre for Diabetes and Metabolic Medicine, Institute for Cell and Molecular Science in London feels that Hwang is "washed up, a scientist's credibility relies on his integrity."

22 December 2005

Merry Christmas, Happy Holidays from London

Let's all find ways to work harder at finding and funding the cure for diabetes in 2006!

20 December 2005

Who is the leader of the Sugar Police in NYC?

NYC Department of Health requires clinical laboratories to report A1C (levels of blood sugar for diabetes) test results.
Who has been leading the sugar police in New York City (all boroughs)? It is Thomas R. Frieden, MD, MPH, Commissioner of the New York City Department of Health and Mental Hygiene since January 2002.(NYC DoH is one of the world's oldest and largest public health agencies, the Department has a budget of $1.5 billion and a staff of 6,000.)

Frieden implemented the smoking ban in the Manhattan, and has now decided that diabetes self-management is his next big cause for the welfare of public health. His work ethic and philosophies about public health are indeed honourable. But this new odd outreach programme for diabetes seems way off-the-charts for how far Constitutional boundaries are being pushed. Is this about finding the undiagnosed? Sort of, but it is also about checking on people with diabetes to see how their blood glucose control is being maintained. What is most disturbing is that Friedman doesn't feel that patient consent is necessary! C'mon - what has happened to the the radical, rebellious American voice. Does diabetes exclude you from putting up a fight for your rights! It is not as if the Department of Health is paying for your healthcare in return for the information. That would be a different story altogether!

Is this an infrigement on patient rights? Probably. What is the logic behind this? The following power point presentation states the reasons in 10+ slides: 1.) epidemic proportions of diabetes; 2.) annual cost to the City = 8.3 billion and 3.) public healthcare interventions will lessen the severity of the two former - population and cost.

Why doesn't the programme have a name? I find this strange! Why didn't Frieden's staff write a normal run-of-the-mill Press Release for public information. The New York Times story seems to be one of a handful of (non)official news sources of information. I spent an hour on the Department of Health's website and found nothing officially written about the Board's approval of the "programme" (which occured one week ago). I think there are a lot of questions that no one is asking. Is this new policy in keeping with Amendment XIV in the Constitution? It is so easy to allow healthcare to be the one area for the State (here the State of New York) to demand private information from it citizens. What's next? Was there or is there an AIDS programme like this? Even the American Diabetes Association is keeping quiet.

There is opposition:
Those opposed to the plan, including the Association of American Physicians and Surgeons, the National Lawyers Guild and the National Libertarian Party, express concern that the registry could lead to higher insurance premiums for patients or denial of life, health or car insurance coverage.
See story by Henry Goldman, Bloomberg News "New York City to Register, Monitor 500,000 Diabetics (Update2)"

The way I see it, this is a Constitutional issue that needs to be addressed by the United States Supreme Court.

19 December 2005

Do you know who developed the Insulin Pump? Professor John C. Pickup

I remember the day I finally got an appointment to see an endocrinologist at Guys Hospital here in London. I had recently moved from Rome and left behind a wonderful doctor, Professor Geremia B. Bolli of the University of Perugia, Italy. I wasn't going to accept second rate in London and so, I waited 9 months to be assigned to a doctor at Guys.
What is interesting is I knew that there had been a team at Guy's who developed the insulin pump in the late 1970's /early 80's. And I knew that Guys, and Kings College Hospitals (all teaching hospitals), were by reputation, the best in clinical standards and research. So imagine my surprise when the the doctor I had been assigned to nearly a year ago, Professor John C. Pickup, sent me an email after reading my blog post about the Animas (makers of insulin pumps) acquisition by Johnson & Johnson (see Post 16/12/2005):
Elizabeth, I think your blog is great! Please continue. There is a lot I could comment on, but I will restrain myself a bit. I didn't know about J&J - this is fascinating for me as the inventor of the insulin pump.
Now that is what I call a story...
In 1976, John Pickup, now Professor of Diabetes and Metabolism, Guy's, King's and St Thomas' School of Medicine, London, started developing the first Continuous Subcutaneous Insulin Infusion (CSII) in December 1976 as a research fellow. Today, he is a very passionate advocate for the use of pump therapy as "best" and has written many important published papers, definitive textbooks on the subject as well as address the House of Commons on the subject of diabetes and why pumps should be made more accessible here in the UK.
Professor Pickup is a hero. No one at Guys ever financially benefitted from the development of the pump; they didn't patent it back then in the 70's. Hard to believe...
It is not very English at all to do this sort of thing...but I think Professor Pickup deserves a round of applause, especially from each and everyone of us who is wearing a pump today! Next year, I hope Prof. Pickup will accept my request for an interview so we can learn more about what was going on in those laboratories at Guys Hospital in the 1970's and what he thinks about the future.



Guys Hospital, built in 1721 and founded by Sir Thomas Guy

18 December 2005

What Does Diabetes Look Like?

This seems to be a reasonable question. I used the internet to better understand how the world sees diabetes. I used three very simple values:

1. Googled “diabetes looks like….”
2. Googled “I see diabetes…” or “ seeing diabetes”
3. Googled (in images) “people with diabetes”

This is what I found…

First “What does/do diabetes/diabetics look like”, was picked up on a teen Australian chat-room for young people with diabetes called Reality Check. The conversation went like this:
"I have had, when explaining my T1 when asked about my health: "But you don't have bad diabetes like 'so & so' has - she has to wear some machine thing on her tummy to give her insulin? I explained it was one and the same but I choose to inject, not pump. The response was: "Oh, I thought you had the other better type of diabetes." Better? Many people have been puzzled when they find out I have diabetes, I have had on quite a few occasions "but you dont look like a diabetic"!!! Sigh!
For "seeing diabetes", I found the following exact excerpts:
"We're seeing diabetes diagnosed much earlier in life than ever before,"
"We are seeing diabetes patients in their 40's having heart attack"
"seeing diabetes as “no big deal."
"If you're used to seeing diabetes as an enemy that complicates your already-too-complex life"
"Seeing diabetes cured"

Lastly, on people with diabetes in Google images, I found the following:






What do you think diabetes looks like? What do you see?

16 December 2005

Johnson & Johnson to Acquire Animas, maker of Insulin Pumps, for $518 million

Johnson & Johnson (J&J) had already owned over 8% of Animas, and is said to have been in discussion with Animas for months due to their desire to further define their niche in the diabetes market, and more specifically gear up to compete with future market developments such as Medtronic's Guardian® RT Continuous Glucose Monitoring System as well as the high-tech implant future that doctors and scientists say is coming.

Currently, Animas Corporation designs, develops, and markets the following:

External insulin pumps (principally in the United States.)
Diabetes Management software for patients and their healthcare team
GlucoWatch a noninvasive continuous glucose monitor, worn on the patient’s wrist, which provides blood glucose readings every twenty minutes
Diabetes Pump supplies (disposable cartridges and infusion sets, pump batteries, various clothing supplies, etc.
In Development
Next generation insulin pumps and other pieces of new technology for the pump such as their micro-pump, micro-needles, microwatch, and long-term implantable continuous glucose sensor.

Johnson and Johnson develops, and markets 100's of over-the-counter medicines, diagnostic equipment, medicines and food products. This includes the entire range of Lifescan products for diabetes, as well as Splenda Brand Sweetner and Benecol -- both of which are marketed heavily towards the diabetic/pre-diabetic or insulin-resistant market in the United States and here in the UK too. This is likely to make Animas a real player in the global diabetes focused market with the strength of J&J's strategic know-how and world-wide marketing and sales force.

My opinion about Animas is neutral since, as a European resident, I have had very little exposure to the product. Would love to hear any insight about Animas. Also, what are the pros and the cons of an American Fortune-500 taking over a piece of diagnostic equipment for people with diabetes (insulin dependent). Could it spell over-usage or equal better care for millions of people who will be more successful with a pump then without.

15 December 2005

Is aspartame safe? Sugar vs. sugar substitutes!

Is aspartame safe? For British Liberal Democrat MP Roger Williams the answer is NO, as he has called for a ban on the artificial sweetener aspartame which is used in over 6000 food, drink and other medicinal products. Aspartame makes these products taste better without the added calories from sugar! This includes diet sodas, low sugar fruit drinks, sugar-free gums, reduced fat foods, children’s cough syrups, vitamins and other off-the-shelf medications. Just take a look in your kitchen cabinets, and fridge and then check out your medicine cabinet to see how many products you may have in your household with Aspartame. I counted about 25 in my household.

MP (that’s Member of Parliament for all you non-British citizens out there) Roger Williams called for the ban as a result of new concerns raised by a study conducted in Italy this year. The study, conducted by the European Ramazzini Foundation, showed that aspartame:

"administered at varying levels in feed causes a statistically significant increase of lymphomas-leukemias and malignant tumors of the kidneys in female rats and malignant tumors of peripheral nerves in male rats"

According to MP Williams, aspartame is consumed by every 1 in 15 people worldwide, most of whom are children. I am under the impression that this is the most valuable piece of information that led the MP to his emergency action, and for us too. If there is a question about its safety, and children are the largest group of consumers -- then what are we doing?
I love Aspartame, it allows me to sweeten my coffee, and enjoy some foods that I would normally don’t eat without increasing my bolus insulin. But now, there is a new dilemma – what is worse, sugar substitutes or sugar!

The public health minister, Caroline Flint, responded that it was indeed a serious issue, but added that evidence for its safety had been reviewed many times by regulators around the world including the FDA, WHO and the UN. She also added that artificial sweeteners were useful in their help to control obesity. MP Williams maintains that regulators around the world had failed in protecting the public and that it should never have gotten a license. He blames President Reagan and Donald Rumsfeld (then on Reagan's transition team)who began the approval process for aspartame on President Reagan's Inauguration Day in 1981.

Question: How would your diabetes diet be affected by it being pulled off the market? What do you think? Are you feeling cautious or do you feel confident in the European Food Safety Authority or the FDA

14 December 2005

Daily self-care and long-term treatment goals: Is there a gap?

Following up on yesterday’s post regarding the noncompliant pregnant woman, I thought it would be of some use to talk about the issue of patient motivation. So, as we digest the idea that Alzheimers is Diabetes Type 3, let’s ponder something else as well.

I found a pretty typical (has been performed pretty regularly over the past 20 years) study that was administered at the University Hospital of Basel, Switzerland in June of this year. The study, What are Disease perceptions and subjective treatment goals of insulin treated diabetic patients, was conducted to learn more about patient perceptions, concerns and treatment goals with diabetes. The sample was small, at 60 for “no insulin pump” Type 1’s, 42 insulin pumpers (Type 1) and 22 insulin dependent Type 2’s. The objective was to try and figure out what is most restricting or concerning to IDDM patients.

The authors at the outset, reflected today’s diabetes clinical care with the statement,

….patient empowerment and self management can increase their satisfaction and quality of life. [3,4} as well as metabolic control. Therefore, diabetes care is moving towards more patient centered care. Individual tailoring of the treatment goals to the patients’ own goal potentiates this autonomy.

That’s fine.

What they sussed out is this:
Disease perception
When asked open-ended questions about primary concerns patients were more concerned about the loss of freedom in their lives and QOL issues. Closed-ended questions produced responses that were more focussed on long-term issues such as fearing complications and major hypoglycemic episodes.

Treatment Goals
The main response for both Types was good blood glucose control and preventing complications.

In the end, the study speculates, “that for many patients, glucose control as a goal has become too detached from the original long-term goal.”

Doctors know that good to great metabolic control will be likely to give a person a reasonably high QOL without complications. This statement is absolutely true, and I can’t tell you how many times I have read variations of it in my lifetime. My question is this – at what cost to a person’s personal life? Why are QOL variables defined only in the long-term net and not in present time?

I remember interviewing a Type 2 insulin dependent woman for research and she told me that if she really did everything her doctor told her to do – she would have no time for living.

That statement has stuck with me for a long time.

13 December 2005

Where has the Hippocratic Oath Gone to? Read this!

Red State Moron is obviously an Obstetrician. Read this post from 10th December....(click on title above to see link)

I have sympathy about Red State Moron's ethical dilemma about the "non-compliant" diabetic woman who is 24 months pregnant. I think the concerns are valid. But I am also sympathetic to the woman with diabetes. Where is her Physician (GP), Diabetologist or Endocrinologist? Why is she out there drowning on her own? What is her medical history? Why isn't "Red Moron" collaborating with other specialists?

She refuses to engage with her diabetes management. She refuses to see a therapist, and all our attempts to connect with her are also refused.

Something is clearly wrong. Normally it is difficult to be rational with a A1c of 12 - has this been considered? Along with the obvious issues of patient denial, I think the healthcare system has failed her completely.

Additionally, there is something off about the comments made to this post. Are these really medical professionals? Did I miss something in the Hippocratic oath?

Not to teach medicine to other people.
To practice and prescribe to the best of my ability for the good of my patients, and to try to avoid harming them.
To avoid violating the morals of my community.
To keep confidential what I learn about my patients.
To keep the good of the patient as the highest priority.
To avoid attempting to do things that other specialists can do better.


There seems to be something numb and diseased about this chat the doctors(?) are having. I love the comparison of the cocaine addict to the diabetic --- that is priceless! Scroll down a bit to read this:

Interesting, and difficult dilemma. to play the devil's advocate, what would be your options if you had clear evidence a patient was, say, a daily cocaine abuser and 24 weeks along? The risks to the baby, while in specifics may be different, are the same in the long haul. I don't envy you in this situation; good luck.
Written by Aggravated DocSurg

or
When my patients refuses to follow my advice, the important thing for me is to document her refusal. Apart from that, she is an autonomous human being and is by law (at least in my country) entitled to do whatever she wants. As for doing a C-section on a diabetic in 24th week of pregnancy after the kind of intrauterine environment you have described; I would not do that. There are worse things than dying.
Written by My Opera

Can someone call a doctor...?

Cool Websites!

Diabetes 24/7 has been linked to two other very cool websites, Check them out -- you may just stumble across the information or idea you are looking for!
Diabetes OC: A website that brings all the Diabetes Online Community together... Vote for your favorite diabetes blog here!

Next, ChronicBabe lists a range of sites on their Canival of Compassion: A fantastic range of websites from ladies who are challenged by a chronic illness. Check out Livabetes! Scroll down a bit to see me - a diabetes diva...

These are all from the states -- next time something from Europe.

Keep blogging!

12 December 2005

The Undiagnosed

Micro-encapsulated Islets of Langerhans-the cells that produce insulin

Another newsday, another story discussing the problem of diabetes undiagnosed.

One of the BBC's major health stories today discussed a recent study where they actually tested 500 people and found 13 that were undiagnosed with diabetes. Statistically this means that there are approximately 1 million + in the UK with diabetes that do not know it. Most of these people are 40+ and will be diagnosed with Type 2 diabetes.

I found this story (and all the other stories published bi-monthly across the world on how many millions of people are walking around with diabetes undiagnosed) absolutely staggering for the following reasons:

How difficult is it for any doctor or specialist (ie, cardiologist or pediatrician) to find glucose in the blood with routine blood (or even urine tests)? I also find it very hard to believe that a person with undiagnosed diabetes is living a tolerable or "good" life. I intimately know how I feel when my blood sugar spikes - an unconscious state in consciousness.

And then there are the eyes.

Eye exams are pretty routine, especially when you are having trouble with your eyesight. It is difficult to ignore. Shouldn't ophthalmologists, Diabetes Clinics and related organizations be working together? I am sure that most eye doctors can spot swollen blood vessels almost immediately! See the photo of a diabetic eye with retinopathy.

Last on my list is heart disease. Often doctors will use the loss of toes, feet or legs to diabetes as a scare tactic to control blood sugars. However, for me the greatest scare is not being able live to see my daughter graduate from University because of heart failure. I haven't been able to find any studies, but I would bet that a very high percentage of those who die from heart disease also have diabetes. Perhaps many of these people have family who have no idea!

A diseased diabetic heart with atherosclerosis - see black density in cut
When my five year old and I tumbled on the floor in a pile of exhausted laughter, and my pump hit her on the nose, she got very angry. I asked her why. She told me "I hate that thing!" in a voice only a 5 year old can carry. I think she feels this way about her grandfather's diabetes as well. The only thing she doesn't realize is that the pump (insulin) keeps me alive!

If diabetes has become the modern epidemic and routine blood and urine tests would and will help to find the millions of undiagnosed then why aren't governments, politicians, opinion leaders in the medical field and all the savvy pharmaceutical lobbyists doing something to give everybody a better chance?

10 December 2005

糖尿病 = Diabetes in Chinese


Why should we care? I will give you a few statistics to consider:

The current population of China is 1,306,313,812. The population of the United States as of today is 297,846,405. Western Europe is around 457,030,418.

There are 14.8 diagnosed persons in the United States, and NIDDK estimates that about 6.2 are undiagnosed. There are roughly 33 million people with diabetes in Europe (combined EU and non EU states.)

The diabetes population in China is set at around 50 million and is set to double by the year 2035. See International Diabetes Federation. Even these numbers are disputed by a group of clinical researchers in Beijing who completed a study that concluded:
Three out of every four diabetes patients are undiagnosed, indicative of a lack of population-based screening programmmes and a relatively rapid and recent increase in incidence of diabetes. These results indicate that diabetes has become a major public health problem in China and underscore the need for national strategies aimed at prevention and treatment of diabetes.

The IDF also tells us in a more recent report that it is estimated that 330 million people worldwide will have diabetes by 2025, and that more than 60 percent of those affected will be in Asia Pacific. See press release.

Why should we care in the western world? Because China is and will continue to challenge the Western world as an economic super-power. Because, the number of people in Asia (Including India) diagnosed with diabetes will almost be that of the total poulation of the United States by 2040. If the Business world(some parents are raising their children to speak Chinese!) is already standing up and taken notice of China and is beginning to build bridges -- why aren't we in the field of Healthcare and Medicine doing the same thing. It occurs to me that we have this incredible technology that allows us to break down some of the barriers, and yet we are still somewhat xenophobic in our taste for learning about other cultures. We all may have a lot to learn.

I hope this discussion continues.

09 December 2005

NICE: England's Clinical Guidelines: Diabetes Management

Today seemed to be a rather slow news day up to this point (1 PM in New York: 6 PM here in London) so rather then link a piece of International news -- I thought it may be interesting to talk about the National Health Service (NHS) in the United Kingdom, and the UK perspective on pump therapy. At first glance, this may seem to be all about Type 1, and in some ways it is. However, the ADA (American Diabetes Association) mentions on their site that there is an increase of Type 2's using the pump. This is not the case over here in the U.K. nor in Continental Europe, but I would love to hear any feedback on T2 pump users in the States.

Back to the NHS and N.I.C.E Guidelines. NICE stands for the National Institute for Clinical Excellence and every UK GP or Specialist (endocrinologist) working for the NHS must adhere to these guidelines when assessing a patient. The Guidelines for pump therapy, after conducting a study in 2002-2003, concluded that:

The Appraisal Committee considered that the evidence from clinical trials comparing CSII (sub-cutaneous insulin infusion) therapy with MDI (multiple dose insulin) therapy showed that - on the basis of the outcomes measured - either CSII therapy is no more effective than MDI therapy or if CSII is more effective, then at best the difference between the two therapies is small.
and...
The Committee's view was that the proportion of people with type 1 diabetes who would be appropriate for, and would take up, insulin pump therapy, would be of the order of 1-2% of the total. For this small group of people for whom CSII therapy could make a large difference, the following conditions would have to apply for the therapy to be considered cost effective. The diabetes would have to be poorly controlled, as measured by achievement of accepted levels of HbA1c, using MDI therapy (including a sufficiently long use of insulin glargine, where appropriate, to determine its effectiveness. CSII therapy should provide significantly better control than MDI therapy (with the use of insulin glargine, where appropriate) and prevent the occurrence of disabling hypoglycaemic events.
The Committee considered that for this specific group of patients (1%) the increase in utility would be of the order of 0.035 or more. On this basis, at a net cost of £1100 per year to the NHS, CSII would be likely to be cost effective.
(NHS budget would increase by 3.5 million for 1% and 7 million for 2% in sterling).

This means that for 1-2% of the total diabetic population (Type 1's only), the above conditions must be met. Not only that, but consider that poor control is a requirement for assessment! That would seem to make for a very tricky patient review; pregnancy and young children are also put under the same strict guidelines.

For all of you in Los Angeles, New York and anywhere in between -- is healthcare in the US more advanced? I believe it is! Take pity on your poorer cousins here in Europe! And for those of us here in the United Kingdom, let's try to change the current practice! The proposal for review on the Guideline is slated for February 2006. Just over 2 months away.

08 December 2005

Development of Oral Insulin Looming Closer?

India: Pre-Clinical Trial for Administering Oral Insulin Completed
Transgene Biotek, one of the first biotech research companies in India, announced yesterday the development of an oral insulin to be administered via drops. Now that the company has completed pre-clinical trials, they will initiate steps to move into the next stage of Clinical Trials - Stage 1 in Europe and India.

I find this information important as I belive most people who are insulin-dependent would probably rather take a few drops orally than inhale a powder...

We all may want to keep our eye on this company!

Diabetes Divas? Just an Idea!

After reading the latest post on Diabetes Mine, and then experiencing the ChronicBabe website, it occured to me...why not Diabetes Divas?

I wrote to Jenni the creator of ChronicBabe and told her that I have often felt like a chronic babe! Full of zest for life, wanting to participate in any and every avenue of life that appealed to me without limitations! Inside, I knew that I might be slightly hindered by diabetes, but that it was up to me to let go of the doubts that might prevent me from achieiving! It is all a state of mind!

Absolutely don't want to alienate any male readers...but for all the women reading out there -- what do you say?

Love to hear from you...

07 December 2005

Diabetes-Stories

A New Website

As a resident of London, England, I was shocked and delighted to see that one of the most emotive websites regarding diabetes has been launched from the United Kingdom. The "diabetes-stories" website has former study participants/patients talk about their lives with diabetes from diagnosis to present-time, and has arranged the stories chronologically so we can see just how far we have come in the last 70 years! There are photos, text and audio interviews.

The website is based out of the Oxford Centre for Diabetes, Endocrinology and Metabolism and is funded by the Wellcome Trust.

Welcome to Diabetes 24/7


Diabetes 24/7 will reflect the notion that somewhere in the world – every hour of everyday – there is something newsworthy about diabetes: a new healthcare programme, a lasting transplant, a new drug, a successful study …as well as failures and provoking stories like this one!

The range of topics will cover:

Doctor and patient news and views
Diabetes Reports and statistics, such as world diabetes populations by country!
Science and pharmaceutical developments


Replacing one conceptual world view with another
In general, there is a negative world view about diabetes. Perhaps the key lies in its definition – a chronic complication vs. a serious illness. This eludes me! I am unsure as to whether it is perpetuated by patients, doctors or the media. People with diabetes have a great responsibility towards this – especially those of us in the western world. It is time to look at the real issues surrounding diabetes. It is time to educate populations. It is time for discussions about better care in places like New Delhi, Beijing, Nairobi, London and Rome! Diabetes is often perceived as a self-imposed disability for people who aren’t disciplined. Quite simply, diabetes is a chronic disease caused by little or no production of insulin which kills millions annually. It chooses no favorites – it can strike a poor child in Africa, the wife of an American Icon, or or an impoverished grandmother in Pakistan. And yes, there are two types of diabetes–Type 1’s and Type 2’s–and for me this is only important for the patient and the healthcare specialist to concentrate on together. Essentially, the differences in type are slight as the outcomes are often the same.

Diabetes 24/7 is also a dual concept in name. For all of you with diabetes reading today, you know more astutely than anyone how diabetes truly is 24 hours a day - 7 days a week. Perhaps, with better knowledge and global education and acceptance, we can change that.