Patient, Heal Thyself?

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I’ve often half-jokingly said I needed to go to medical school just so I could tell if my docs were doing what they were supposed to do. Several years ago, my (former) primary care provider (PCP) told me my blood pressure was a bit elevated, but still "just fine."

"No," I responded. "I have diabetes. It needs to be lower."

He was not happy with me correcting him and, at a later visit, we got into a shouting match when he told me that insulin pumps were dangerous and my endocrinologist was an idiot, so I fired him—the PCP, that is; not the endo. Just in time, it turns out, because when I needed surgery for a bone infection in my foot shortly after that, my podiatrist’s office mistakenly called him instead of my new PCP, and he refused to give permission for treatment.

But I digress (although it was good to vent, thank you).

Do you know what your blood pressure is—and is supposed to be? How about your lipids? Kidney function? Average blood glucose? Have you had a dilated eye exam lately? How about a liver function test, especially if you take certain medicines?

As people with diabetes, these are all things we need to be aware of and not fully depend on our health-care team to take care of for us—because the reality is that they probably won’t.

I was surfing around over the weekend, trying to see what was going on at this year’s American Diabetes Association’s Scientific Sessions. What I found that caught my attention, however, were a couple of news releases from last year’s meeting. One was a call for a new commitment to diabetes care in America. That one was immediately—and ironically—followed by another release saying that doctors are failing to intensify needed treatment in people with diabetes.

The first release called for an “ideal” scenario, in which everybody receives optimal care for their diabetes, achieving an HbA1c level of 7% or lower and blood pressure of lower than 130/80 mm Hg.

And the second release detailed research studies showing that physicians were overwhelmingly dragging their collective feet when it came to treatment for high blood pressure and blood glucose levels.

  • In one study, “regimens were intensified in only 26% of visits where elevated blood pressure was documented.” There was, however, good news for minority groups: They were 10% more likely to have treatment intensified.
  • In another study, docs intensified treatment for blood pressure in only 12% of visits. The physicians in this study, by the way, were part of an academically affiliated outpatient center. They were also less likely to intensify blood pressure treatment if the patient had high blood glucose levels or a history of coronary heart disease, or if they were also seeing a cardiologist.
  • A research study that looked at “clinical inertia” in prescribing oral antidiabetes drugs found that by the time people were prescribed their first drug, their average HbA1c was 8.4%. That included 33% who were at or below the ADA recommended level of 7%. “Unfortunately,” said the study’s author, “this included 67% who were well above the goal at A1C levels of 9.5%.” It would be another seven months or so before a second drug was added—at which point the average HbA1c was 8.5%, with 67% of the individuals with levels approaching 10%.

I think that this research underscores the necessity for us to advocate for our care. We all need to learn what preventive measures need to be taken and how often. We need to know what our blood pressure, lipid, and HbA1c levels and so on need to be. If you don’t know the answers, you can find them in this article from the archives by clicking here.

If our doctors are noncompliant, then we need to stand up for ourselves and demand better care. If that doctor won’t walk the walk, then find one who will.

Ironically, an item on the news just caught my attention: It said that only one-third of people with diabetes have HbA1c levels in optimal ranges. And I do believe it blamed the people with diabetes, when the research I’ve just written about says doctors aren’t doing their jobs.

Yep. It’s time to stand up for ourselves. Be loud. Be adamant. After all, it’s our lives. Literally.

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