Tuesday, April 21, 2009

The Canadian Diabetes Association's Staggering Omissions

Some strange omissions over at the Canadian Diabetes Association (CDA).

The first strange omission was noted by my friend Dr. Arya Sharma who pointed out on his blog that despite bariatric surgery being a cure for nearly 80% of type 2 diabetics there's not a single mention of it on the CDA's website.

The second omission was noted by my friend Dr. Jeff Lipsitz, one of Canada's foremost sleep medicine experts, who noticed that despite the incredibly high percentage of type 2 diabetics who are obese and despite the incredibly high association of sleep apnea and obesity, that there was not one mention of sleep apnea screening or treatment in the CDA's 215 page 2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada

While some may not want surgery to cure their diabetes, certainly at least a mention of surgery on the CDA's website would be warranted given the 80% cure rate and the lack of public knowledge of that fact.

Regarding sleep apnea, the International Diabetes Association certainly thinks it's worth mentioning as they point out that estimates put nearly a quarter of all diabetics as having obstructive sleep apnea and therefore made this recommendation,

"the International Diabetes Federation Taskforce on Epidemiology and Prevention strongly recommends that health professionals working in both type 2 diabetes and sleep disordered breathing adopt clinical practices to ensure that a patient presenting with one condition is considered for the other."
So here we have the CDA with a cure that's not mentioned and a comorbid condition that's not being screened for. I wonder what's up with the CDA and these staggering oversights?

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  1. Theresa11:02 am

    I had gestational diabetes 15 years ago and was told at that time I have a higher risk of type 2 diabetes because of it.

    I attended a diabetes seminar last Thursday and it was a packed house. Imagine my surprise when I realized this was NOT for prevention at all! It was a TRADE show for every drug company to schlep their glucose monitors, drugs and for the pharmasists to gain market share with insulin prescriptions. Not one table in a huge hall had any information on prevention. The only table that had a positive slant was the CDA walk for a cure. There were brochures praising exercise.
    I left after the first guest speaker. She was a dietician who waved around the Canada food guide and said sugar is okay as long as you count it.

  2. Hi Theresa,

    Why would you be surprised? No one is going to get rich teaching people how to eat properly. There is a huge amount of money in selling drugs and also a huge amount of profit in manufacturing the foods that are contributing to both the obesity and type 2 diabetes problems.

    I maintain a site about using proper diet for reversing type 2 diabetes. There is not a rush of advertisers or financial supporters to help support the site. Even the organizations that say they are looking for answers to the problem will not work with me because I am critical of professional standards. Not because the diet recommendations do not work, (those who give me feedback are all very positive about good results) but because I am not supporting “professional practices” that are failing. As they continue promoting their professional practices the percentage of the population in the US and Canada keep increasing at alarming rates

    Dr. Freedhoff has a policy against advertising on this blog but I am betting he would have a similar situation.

    Toma Grubb

  3. From a patient perspective, the "cure" of surgery for type 2 diabetes is far riskier than current treatments in terms of potential loss of life and quality of life.
    While surgery appears to reverse diabetes in the short term, there is no guarantee of cure in the long-term. I do not wish to be pushed towards this particular cure -- with an A1C of less than 7.0 for most of the 15 years since I was diagnosed with diabetes, and less than 6.1 for the past 8 years, I am satisfied with the exercise, eating habits and medications I take. I would volunteer as a control for a long-term trial paired with someone who had bariatric surgery to "cure" diabetes at age 25, and see which of us in the long term has better health and quality of life. I weigh around 10% less than I did when I was diagnosed, and there are those who have had surgery who do not maintain a 10% weight loss.
    Each person has a different balance of factors to consider, but to frame surgery as a "cure" for type 2 diabetes is like saying amputation is a cure for athletes foot -- while technically true that the athletes foot will be gone, there are other far less invasive and life-impacting treatments out there for the same condition.
    I am well aware of the potential impacts of diabetes on health, but the impacts of bariatric surgery, even when successful, on health, are not necessarily trade-offs everyone views as worth taking.