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Saturday 22 September 2012

The reason for the NHS failure in controlling diabetes in the UK !

This post on from a diabetic doctor. Nothing illustrates better why NHS Doctors like him are responsible for the gruesome NHS audit statistics for diabetics in the UK.

This sort of attitude and advice creates the HbA1c numbers from the NHS audits.

Results for England. The National Diabetes Audit 2010-2011
Percentage of registered Type 1patients in England
HbA1c >= 6.5% (48 mmol/mol) = 92.6%
HbA1c >   7.5% (58 mmol/mol) = 71.3%
HbA1c > 10.0% (86 mmol/mol) = 18.1%

Percentage of registered Type 2 patients in England
HbA1c >= 6.5% (48 mmol/mol = 72.5%
HbA1c > 7.5% (58 mmol/mol) = 32.6%
HbA1c >10.0% (86 mmol/mol) = 6.8%

These results are very similar to those obtained in previous NHS audits over the past 5 - 6 years.

Thank the Lord he has recently retired !

"by david252 
Hi guys, 

I don't want to pull rank here but I have had diabetes for 34 years - yes type 1 - but have also been (recently retired on ill health :( ) a GP for 20 years with a special interest in diabetes (including type 2).

The debate over home blood glucose testing in type 2 is not really a debate, I just didn't want to appear arrogant. It is pretty well accepted by most health care professionals with an interest in diabetes including NICE and my consultant colleagues in endocrinology, that home BG measurement in type 2 diabetes has a very limited role to play and with the occasional exception (there are always exceptions in medicine) is of very little value and hence is not encouraged.

I fully accept that type 2 DMs need to CHO count as much as type 1's but there is no need to test. Whilst there is some merit in what has been said about learning which foods will raise your blood sugars rapidly, all you really need to do is look at the glycaemic index of foods. A food with a low glycaemic index is absorbed slowly and will not spike your blood sugars, whereas the reverse is true for foods with high glycaemic indices. This holds true for everybody - type 1, type 2 and people without diabetes. There are stories of soldiers feigning DM to get out of the army by drinking tea with a lot of sugar in - their blood sugars would spike above the renal threshold and they would present with glycosuria - same for everybody. The key in diabetes (both types - although pumpers may get away with this) is to avoid high GI foods, or take them as part of a meal with lots of low GI foods, hence delaying their absorption. The focus from health care professionals over recent years has been on giving this sort of specific, detailed dietary education rather than on home BG monitoring.

My point is, you don't need a finger prick to tell you this (which in any case would take a lot of trial and error to pinpoint which foods were causing the elevation), you just need to know which foods have fast absorption rates (ie high glycaemic indices) - your GP should have access to a local primary care based type 2 DM specialised education group, usually led by dieticians, that he/she can refer you to for this type of advanced patient education (its obviously not for everybody) - alternatively you can always google it!

As far as HbA1c's are concerned, there are a few but rare conditions that will cause inaccuracies (usually conditions which increase the rate of turnover of red blood cells) but these are rare and often inherited, so you and your doctor would probably be aware of them."

by Pneu
"David.. you have antagonised people because you have not read the original post properly.. the OP clearly stated his readings were +2 hour post meal.. he stated he had checked the meter(S) for accuracy.. one can assume this is with control solution.. the difference between his average reading on the meter and the lab HbA1c is VAST around 4 mmol/l average.. I suspect he probably has the wrong persons lab results.. you then go on to make sweeping generalisations about type II diabetics and show frankly the sort 'I know best' attitude the infuriates members on this forum... the sort of thing they here week in week out... the NHS approach is the only approach despite the fact that it is years behind the rest of the world..

We welcome all contributors here but you are going to get pretty short shift unless you can defend what most would see as an antagonistic starting position... 

To be blunt it comes across as "your type II your going to get bad readings because that's what you have to expect"



Anonymous said...

Eddie.. you miss the point where he really losses it later in the thread!


Anonymous said...

david252 wrote

"My point is, you don't need a finger prick to tell you this."
"I don't want to pull rank here but I have ... been (recently retired on ill health ) a GP for 20 years."

Quite frankly I didn't need a prick to tell me any of that NHS nonsense.
And the arrogance of the man, thinking he COULD pull rank !
Good to see a mod with some sense !


Anonymous said...

I would think that Dr. David has been retired due to mental health problems. Delusions of grandeur as to his rank on a diabetic forum is a clue.