Not many would have missed news reports a few weeks ago claiming “Cure for type 2 diabetes”. This resulted in a lot of calls to our diabetes team asking for the “cure”. When 600kcal/day diet was mentioned and what it actually entailed most politely lost interest! So what is the hoopla about?
In the Counterpoint (Counteracting the Pancreas Inhibition by Triglyceride) study eleven people with type 2 diabetes went on a 600kcal/day diet (sound difficult!!!). Lots of the metabolic abnormalities in type 2 diabetes were corrected and at the end of the study volunteers were given advice about healthy eating with goal to avoid weight gain. Three months later only 3 out of 11 has blood glucose within the diabetic range. Thus in the early stages after diagnosis, type 2 diabetes is a reversible diagnosis. Of course a very low calorie diet is not easy and not for every one there- in fact maybe only a small proportion. But, I think diabetes teams should be poised to help the motivated patient(s) who refuse to take type 2 diabetes as a life sentence. In the long term gains for the individual and the society will be significant.
Further information can be accessed here
JAMA published a paper recently asking the question- should patients be given direct access to their test results. May not be ideal in case of radiology or pathology reports but in certain group of patients this will be very useful. In the U.K. both Renal Patient View and SCI-DC (Scottish Diabetes Database) give patients access to their test results and other info. Granted these are patients with chronic conditions in whom it works best.
In a study published in the NEJM, Warfarin, Insulin, anti-platelet agents and Oral diabetic medications were alone or in combination responsible for 67% of adverse drug reaction related hospitalizations among the elderly in the US. I don’t think its any different in the UK. Striving for tight glycemic control in the elderly is counterproductive as evidence by the above study. In most elderly symptom control and a sensible individualized glycemic target is essential. Primum non nocere.
The future of medicine is exciting and do watch the videos and be ready to be amazed.
Watching a TED video everyday inspires me. Ken Robinson’s talks about schools and creativity and more recently about the learning revolution are my favorites.
Anchoring, Availability and Attribution error are the major cognitive errors that doctors make, so say this insightful article by Jerome Groopman.
Dr Groopman’s book How Doctors Think is a great book, which, I think all medical students, well, all physicians must read.
Patients know best is delivering a new model of patient empowerment. I initially came across Mo, who is the brains behind PKB during the early part of this century when some of us had an interest in using our Palm Pilots and Compaq iPaq in hospitals for handover etc. Mo had written a very good book on that topic and I have heard him speak with great deal of enthusiasm about that topic. The tech has moved on and am not surprised Mo still is at the cutting edge of the intersection between medicine and IT.