Close Concerns Weblog

Finally - a President who gets it. Invest now, save later!

Last night, President Obama discussed healthcare and healthcare reform at his fifth news conference. There’s a lot of discussion about politics and getting the reform bill through Congress, but aside from that, we’re so inspired to hear our president say this:

If we can get those people insured and instead of having a foot amputation, because of advanced diabetes, they're getting a nutritionist who's working with them, to make sure that they are keeping their diet where it needs to be, that's going to save us all money in the long-term."

 --President Barack Obama, July 22, 2009.

You know what? He gets it! We have to invest now in diabetes education and tools to keep us healthy – and happy – as we wait on a cure. By this method, we’ll save money, but more importantly we’ll save lives.

Also, here’s what he said about reform:

This is not just about the 47 million Americans who don't have any health insurance at all. Reform is about every American who has ever feared that they may lose their coverage, if they become too sick or lose their job or change their job.

Fantastic. And, thank you. Just, thank you.

Update: Sotomayor hearings

Today marks the final day of Sonia Sotomayor's confirmation hearing. The New York Times believes that the Senate will likely vote on Sotomayor by early August  and the Wall Street Journal just recently reported that the GOP will not filibuster Sotomayor. It seems like smooth sailing from here on out for Sotomayor. If confirmed, Sotomayor will not only be the first Latino female on the Supreme Court, but also the first Justice with type 1 diabetes.

We are particularly excited about having a Supreme Court Justice with diabetes as it should inevitably help raise awareness of diabetes.  In addition we expect it to be very important in waylaying many of the common misconceptions that the general public has about type 1 diabetes.  Also, for the 15,000 children diagnosed with type 1 diabetes each year in the US alone (and their parents), it will be encouraging and inspiring to know that they can live a full life despite having type 1 diabetes

From our latest issue of diaTribe

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Sonia Sotomayor is the first Supreme Court Justice nominee with type 1 diabetes. Jim Hirsch explains how he got involved in the White House's efforts to handle the fallout. Click here to continue. Click here to continue

Giveaway

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In diaTribe #16 we wrote extensively on the huge presence of continuous glucose monitors (CGM) at ADA in our conference pearls. This month, we’re excited to be able to give away one $500 credit for DexCom merchandise! This contest is open to everyone, regardless of whether they’re diaTribe readers already, so help us spread the word about CGM by forwarding this email! Click here to enter the giveaway.

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Howard Steinberg interviews Nick Jonas on dLifeTV this Sunday

Check out Nick Jonas and fellow diaTribe advisory board member Howard Steinberg (founder of dLife) who will be on dLife together this Sunday. Nick's pretty elusive so we were excited to hear that we'd really get to hear him riff about diabetes. Among other things, Howard said he acknowledged that sometimes diabetes can rob some of the joy. Boy, can it ... though we try to be super glass-half-full, it still is hard every day just to get back to 100 where everyone else starts! Members of dLife can catch a sneak peak here. See the show Sunday night on CNBC 7PM ET, 6PM CT, 4PM PT

Test-In Alert!

Forget a sit-in. We're joining the test-in to commemorate TuDiabetes and EsTuDiabetes reaching 14,000 members. Inspired by Kelly Rawlings (editor of Diabetic Living), the goal is to have 14,000 people test their blood glucose at the same time today - 4pm EST, July 14th.

Want to join in and help raise awareness of diabetes and the importance of testing blood glucose regularly? We certainly do!

Here's how to participate:

Test your blood sugar at 4pm EST / 8pm GMT on Tuesday, July 14. You can calculate your local time here.
1. Post your results on Diabetes Daily or at TuDiabetes.
   
   
   OR If you have a Twitter account, post the reading on Twitter (use the #14KPWD hashtag) and link back to: http://14kPWD.org.
   
   OR If you prefer, you can update your status on Facebook or other preferred social network, linking back to: http://14kPWD.org

Update: Every available member of our team (even those of us without diabetes!) participated in the test-in. Our results are listed below. Kelly was a little low at the test time, but after a snack is now at 82 mg/dL!

Kelly 68  (70 with her continuous glucose monitor)

Jeff 96

Nick 95

Mark 136

Tony 108

Eric 94

Kaku 95

Brendan 93

Dana 117

Be sure to check out our new issue of diaTribe here.

We are also now on twitter and facebook!

Tom Karla, Diabetes Dad, Gives Oh-So Valuable Advice to Parents at CWD Tenth Annual Friends for Life Meeting

"To parents, unless you have diabetes, you do not, will not, and cannot understand what your child with diabetes goes through .. everyday."

--Tom Karlya, Diabetes Dad, keynote presentation, July 9, Children with Diabetes Friends for Life meeting

Check out Diabetes Dad on dlife.com here.

Check out our new issue of diaTribe here.

Sanofi Reiterates its Insulin, Lantus, is safe. Novo Nordisk distances its products from the scare.

Both Sanofi Aventis and Novo Nordisk have been communicating with investors in the last few days, to address the backlash to four papers published in Diabetologia associating Sanofi-Aventis’ Lantus (long acting basal insulin) with increased cancer risk. Background to the controversy is here http://www.diabetologia-journal.org/cancer.html. 

Notably, all the major diabetes organizations, including the American Diabetes Association (ADA), the European Association for the Study of Diabetes (EASD), and the International Diabetes Federation (IDF), all suggest that patients not alter their insulin regimens. There have been a number of doctors that have pointed out weaknesses in the studies in Diabetologia, prompting Sanofi to term the studies “junk science.” 

Novo Nordisk emphasized on a conference call last Sunday night that it had taken great care in designing Levemir, its long acting insulin analog, to ensure that it had no mitogenic (cancer promoting) effects and stated that in vitro and in vivo scientific data, meta-analyses, and post-marketing pharmacovigilance studies all suggest Levemir is clean as far as cancer signals go.

We have spoken to a range of doctors over the last few days, all of whom have emphasized (along with Sanofi and Novo Nordisk) that patients should not of their own accord change their treatment plans, but should talk to their doctors carefully about their regimen. While it is still unclear what the medical community's response will be, we add that patients should always discuss with their doctors their potential cancer risks and their general treatment options.

One of our key diaTribe advisors, Dr. Steve Edelman, founder of Taking Care of Your Diabetes and a Professor at the University of California San Diego, stated that the reports associating Lantus with cancer were not “anything close to a proper scientific analysis.” Importantly, he urged patients to “stay focused on the most important issues with your health: blood sugar levels as close to goal as you can avoiding hypoglycemia and get your blood pressure and cholesterol levels in the correct range.”

Limited Recall of Levemir Insulin

Earlier this month, the FDA issued a limited recall for specific vials of insulin Levemir that may have been mishandled or stored incorrectly. The warning applies only to insulin from the following lots (the lot number should be listed on the bottle): XZF0036, XZF0037, and XZF0038. If you have insulin from these lots, you should not use it, and you should call Novo Nordisk at 1-800-727-6500 to find out how to dispose of the insulin. You can find the official recall here.

“Food Inc.” - How Income Levels Affect Diet and Diabetes

Diabetes and obesity therapy has always included a focus on the importance of diet and exercise, though success on this front for most people has been elusive (an oft-cited stat: two thirds of people in the US are overweight or obese, and the highest BMI segments continue to grow the fastest). At this year’s ADA, which ended Tuesday, we noticed a focus on lifestyle interventions that reaffirmed this trend (improved diets equal improved weight and glycemic control) and shared a common plea: improve your diets! However, as noted, behavioral changes have proven to be exceedingly difficult for Americans to adopt[1]. Historically, much of the blame has been placed on the patient, widely considered a consequence of their unwillingness to wean themselves off hamburgers and lumber off the sofa. We appreciate that the reality is more complex.

 Robert Kenner’s new politically charged film Food Inc., released yesterday in New York, Los Angeles, and San Francisco, puts forward ways in which the ability to make lifestyle changes is influenced by a higher power: a highly mechanized food industry that skews the system to bad calories - unhealthy, artery-clogging, obesity and insulin resistance inducing calories.

In this documentary, author Eric Schlosser (Fast Food Nation) characterizes the food industry as one that promotes a diet that frequently leads to serious health problems. For example, in a powerful scene at a youth health community group (in which topics including diet and exercise are discussed), the group is asked how many of them have a relative or close family friend with diabetes. Then, how many had two … then, how many had three. Seeing how many in the room knew at least three people with diabetes hit home the prevalence of type 2 diabetes in a way that all the usual statistics do not. The implication of the movie is that the families of most people in the class cannot afford healthier foods. In a follow-up segment, Schlosser asserts that the biggest predictor of obesity is income level and contends that these poor eating habits have contributed to the epidemic levels of diabetes.

We found Food Inc. to be an informative, albeit one-sided, commentary on the traditional food industry and its health consequences. We were happy to hear the mention, although brief, of the industry’s effect on the current diabetes and obesity epidemics as we think it will raise further visibility of the problems. While we think this film has an important message, we would have liked to have seen more explicit emphasis on the far-reaching effects our eating habits have on healthcare costs. Ideally, we would like to see much more focus on solutions – perhaps government programs that could subsidize healthy foods like fruits and vegetables, and introduce taxation of soft drinks and other unhealthy foods that contribute to obesity.

- by Tony Sheng, Mark Sorrentino, Jessica Swienckowski, and Kelly Close

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[1] Unfortunately, although we haven’t completed our review of all posters, there was really nothing that we saw that seemed incredibly likely to change adherence problems significantly

Medicare System Overhaul proposed

There’s a new (proposed) system in our nation, and this version includes sweeping changes in Medicare in order to reward and penalize various health care providers and organizations based on quality of care. Two bipartisan leading senators, Max Baucus (D-Mont.) and Charles E. Grassley (R-Iowa), believe the overhaul of the current system would create financial incentives for providers to coordinate care that is currently fragmented. Some of the components include recommendations to slow the growth of Medicare, hold doctors and hospitals more accountable, and to improve the quality of care of patients with chronic illnesses.

 

A five percent bonus would be received by family doctors and internists for Medicare patients for office visits and some “primary care services”. General surgeons in rural areas would also receive bonuses; Medicare payments to other specialists would probably be reduced. Some other components include the following proposals:

·         increasing Medicare payments to doctors exceeding ‘national standards’ of quality care (and penalties to those who do not meet minimum federal standards).

·         awarding bonuses to facilities or hospitals that provide superior care for certain selected other conditions like heart attacks and pneumonia.

·         physicians will also be encouraged to hire nurses for follow-up care once patients are discharged from the hospital disease relating to their chronic illness.

 

Generally we like the creative thinking though we would want to make sure that doctors didn’t become motivated to avoid patients with diabetes who need more care than average; we are also curious whether payments to specialists who care for people with diabetes would be reduced – that would definitely not be in all our collective best interests.

 

Increased drug spending in youth population

A recent Wall Street Journal article suggested the greatest increase in drug spending came from youth (aged 19 and below) – up about 5% over the past year. Although spending fell among seniors by one percent, total overall spending was still highest in the senior group, unsurprisingly. In 2008, health plans spent an average of $1,700 per senior compared to approximately $200 per youth. The report also mentioned diabetes drugs as the drivers for the increase among youth, linked to obesity among kids.