Tuesday, March 23, 2004

diabetes educator

I've been in contact by email with a diabetes educator at one of the local hospitals. I wanted to check the person out before making an appointment, to make sure she wasn't hostile to the approach I am following. She replied that my approach was great if it worked for me, but then she said I should be aware that everyone eventually gets complications. I asked her if she had any evidence for that, as the approach I am following results in significantly lower average blood sugar than even the intensive therapy groups in the long-term studies that have been done (who had much lower rates of complications than people following the old recommendations). As the discussion continued, it became clear that she was dubious of the intensive approach I am taking. She doesn't want to promise anyone that if they work hard to keep their blood sugar in tight control they will be able to prevent complications, and I suspect she doesn't even suggest tight control as an option. She clearly feels caught between the endocrinologists, who are recommending tighter control of blood sugar, and local doctors who still tell their patients goals that are years out of date. It is a nasty position to be in--I'm sure the first thing diabetes educators get taught in their training is never to undercut the authority of the doctor.

Update: I contacted a diabetes educator at a different nearby hospital and she said they are required to teach the Amercian Diabetes Association guidelines in order to be eligible for insurance reimbursement. She also gave me the "diabetes is progressive and incurable" message: "Diabetes IS a progressive illness, so don't deem yourself a failure if what you do this year doesn't work as well next year." The evidence is very clear that the progression can be slowed way down, but the standard advice ignores that completely.

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