Sunday, December 09, 2007
Shortly after writing my comment on the USA Today "Diabetes revolution" article, I had cause to re-visit a report by the US National Committee for Quality Assurance.
It's worth browsing through. Although it is specifically about the USA, I doubt that other Western nations, such as mine, are significantly different:
THE STATE OF HEALTH CARE QUALITY 2007
Scroll down to page 35 for some details on diabetes.
• Almost 2 in 3 Americans living with diabetes will die from heart disease or stroke.
• For every 1 percent reduction in blood sugar level (HbA1c), the risk of developing eye disease, nerve disease and kidney disease is reduced by 40 percent.
• Every 10 millimeters of mercury reduction in systolic blood pressure in diabetics results in a 12 percent reduction in diabetic complications.
• In the U.S., diabetes accounts for almost 45 percent of new cases of kidney failure.
• About 65 percent of people with diabetes have mild to severe forms of nervous system damage. Long-term effects include impaired sensation in the feet and hands, carpal tunnel syndrome and other nerve problems.
• Diabetics are more likely to die from acute illness such as pneumonia or influenza than those who do not have diabetes.
• Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness annually.
That doesn't sound much like a revolution in diabetes to me. More reports are available here: NCQA Newsroom
I won't quote it because I don't want to infringe copyright. So I'll wait while you slip away and read it.
Back already? :-)
I wouldn't get too excited just yet. Have another look at those graphs that are at the top and on the left sidebar again. I hope I'll be forgiven for copying those. They may have changed the curve but the changes are rather un-dramatic.
The graph at the top shows diagnosis numbers tripling over a 25 year span. Despite changes in diagnostic criteria and populations that is still a giant increase at a time when we were being told by all dietary authorities that fat is evil and starch was good for us.
The other charts show:
o Lower extremity amputations are exactly where they were,after a terrible peak in the '90s.
o Eye damage has dropped from 26% to 21%; still terribly high and hardly encouraging considering much of that drop could be related to improvements in eye treatment such as laser surgery over that time.
o The chronic kidney disease rate increased by 40% over that 25 years despite coming down from a peak in the '90s.
Despite all the feel-good words in the report, I have difficulty accepting the up-beat tone. The only thing I get out of it is the thought that they should be studying what changed in the mid-90s in diet and lifestyle in the American population.
I can think of a few things that may, or may not, be significant. Think about these for a while, and maybe you can add some of your own.
1. There has been almost no change in the dietary advice pushed by the major professional medical advisory bodies.
2. The diagnostic criteria change has led to earlier treatmentfor many.
3. Low-carb diets, whether you like them or hate them, led to a new awareness of the dangers of excess carbs in diet and may have had an effect on the consumption of carbs as a proportion of the Standard American (or Australian) Diet (SAD), particularly of those diagnosed with type 2 diabetes.
4. Home testing meters became much more available and easier to use.
5. The internet has empowered patients of all afflictions to gain knowledge to add to their doctor's advice.
Just thoughts. But I'm not rushing out to celebrate the 'revolution' in diabetes just yet.