New diabetes screening guidelines take one small step forward

I often feel like a libertarian when I’m writing these Reality Health Checks because they sound anti-government. When, in reality, I care so little for the abomination that is politics these days that I try to ignore it altogether. And the latest government pronouncement only strengthened my resolve.

I say this because when I read that the US Preventive Services Task Force (USPSTF) issued a new recommendation to screen overweight or obese adults ages 40-70 for abnormal glucose as part of a standard cardiovascular risk assessment, I first thought…

“Great, it’s about time!”

Until I analyzed the report a little further.

Back in 2008, the USPSTF recommended only screening people who had high blood pressure.

So this new recommendation is a step in the right direction. But it still falls short on so many levels.

First of all, the recommendation is considered Grade “B.”  According to the USPSTF, Grade B recommendations mean “There is high certainty that the net benefit is ‘moderate’ or there is ‘moderate’ certainty that the net benefit is moderate to substantial.” And “practitioners should either offer or provide this service.”

Say what?

When cardiovascular disease (CVD) is the leading cause of death in the United States, and diabetes is a life-threating disease that’s rising at an alarming rate…this is anything but a “moderate” problem.

More to the truth is that elected government officials are “moderately” doing what they can to protect the public’s health.

They’ve put more energy in harassing me for over two decades.

For years, they’ve told me more or less that I am a “quack” for my clinical practices — which are all proving true, by the way.

So you can see why I don’t care to participate in politics.

But it looks as though I’ve got the last laugh on this one — because in my practice I’ve been offering and providing these services since the first day I left organized medicine. I screen everyone for blood sugar disorders, not just those between 40-70 years. And not just those who are overweight.

But doing the blood work is the easy part. Knowing what to do with the results is the key. And this is where far too many mainstream physicians fall short.

To their credit, the USPSTF guideline goes on to say that for those individuals found to have an impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), clinicians are advised to either offer intensive behavioral-counseling interventions or refer them to programs.

The Task Force came to this conclusion after reviewing 6 new studies since 2008 that consistently showed intensive lifestyle modification such as improved nutrition and increased physical activity either prevented or delayed progressing onto diabetes.

They also found there wasn’t sufficient evidence that medications are as beneficial as behavioral interventions.

This was probably the most important take-away from this mandate, for two reasons…

No 1: It calls for major change in the way doctor’s treat their patients.

No 2: Diet and exercise are finally winning out over drugs.

Yay! I thought this day would never come!

But, I have to ask — is this really a new revelation? It should make perfect sense to all physicians to take these steps automatically.

The American Medical Association (AMA) also spoke out about the limitations in this study, saying “placing significantly less emphasis on the young as well as minority populations who are at high risk for undiagnosed diabetes will only create a greater barrier to reaching the 86 million American adults currently living with prediabetes who are at high risk of developing diabetes.”

Amen I say to that. The only thing I would add is thin people can get diabetes too, so I think everyone should be screened — just as I do in my office. And not just every 3 years.

Another roadblock for some people is how they will navigate the insurance process of how to pay for all of these services.

The good news is, many employers these days provide their own nutrition counseling and have gyms or offer reduced rates at health clubs as part of covered benefits. Private insurers are also getting on board and are reimbursing (at least partially) for these types of programs as well.

And as much as I loathe the Affordable Care Act, it does mandate that insurers cover services recommended as grade “A” or “B” by the USPSTF.

Unfortunately, as I said above, most physicians wouldn’t know where to begin with advice on nutrition and exercise. (I have a bad feeling the words “low fat” would get used FAR too often.)

So while conventional medicine and government health advice may have taken a baby step in the right direction, there’s still a long way to go. Stick with me and I’ll continue to give you the proven tips and techniques I’ve been recommending to my patients for years. Simple, effective, natural solutions that that can help you prevent diabetes — or even reverse it.

 

 

Resources:

http://www.medscape.com/viewarticle/853222

http://www.thecommunityguide.org/diabetes/supportingmaterials/RRcombineddietandpa.html

http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/screening-for-abnormal-blood-glucose-and-type-2-diabetes

http://www.endocrineweb.com/professional/type-2-diabetes/uspstf-recommends-diabetes-screening-adults-ages-40-70-who-are-overweig