Thoughts on why doctors often prescribe meds for T2 diabetes

[photognut]

I think the advice given to a Type 2 diabetic is appalling - my GP even told me I didn't need the testing strips as the HBA1C would give an accurate picture. The time that I stopped believing in my GP's practise was after two misdiagnoses resulting in Heart attack & Skin Cancer carcinoma that grew and grew finally ulcerating because 2 x Dr's thought it was a fleshy wart. This fuelled my Type A tenacious personality of fact finding to submit reasoned levels of arguments with GP's and consultants. Many people do not know how to research, let alone the ability to implement it.
I also have to agree with Andrew Colvin and NoCrbs4Me - you can show some people where the water is, it is their choice to drink it. Drinking it results in hard work, facing yourself, dealing with psychologically sensitive areas and addictions. A pill is easier to swallow nurturing and encouraging a false sense of security that everything is going to be ok.
My friend, over 20st in weight saw me lose 2st in two months going from a UK size 16 down to 12 jeans (Those UK size 8 Armani jeans are still in my cupboard and missing me) My friend wanted to adopt my diet, great!! I spent hours with her explaining portion size, calories etc. Every week, she proclaims I'm not losing weight, why?? After a trip to the seaside she said "you have to have Fish 'n' Chips, don't you?" my reply was "No you don't @ 1400 calories! plus whatever you had for breakfast, snacks and tea, you aren't going to lose weight!" I love my friend dearly, she is heading for some serious health problems, I have to accept this is her self destruct path, not mine.
There is a strange "Health Culture" going on..... A tongue in cheek comment;
The world is overpopulated and needs some form of natural culling - the ones who look after themselves won't be on the list, stay well peeps

 

[Totto]

@CatLadyNZ you seem to believe that actually doctors know how to treat diabetes type two.I find your trust in HCP rather cute. I however, haven't had as good experiences of GPs and other medical staff. As I said in my earlier post, the advice given to me was abysmal and I decided to more or less do the opposite and took my HbA1c down to 33 by going strict LCHF.

 

[ButtterflyLady]

@CatLadyNZ you seem to believe that actually doctors know how to treat diabetes type two.I find your trust in HCP rather cute. I however, haven't had as good experiences of GPs and other medical staff. As I said in my earlier post, the advice given to me was abysmal and I decided to more or less do the opposite and took my HbA1c down to 33 by going strict LCHF.

Thanks for the patronising tone. I believe some doctors know how to treat it, and some don't. I don't claim to know that all doctors are ****, like some people here seem to do.

 

[chri5]

Thanks for the patronising tone. I believe some doctors know how to treat it, and some don't. I don't claim to know that all doctors are ****, like some people here seem to do.

Totally agree with this point, whist it is painfully obvious that some people have had a raw deal with their GP I have to say that mine has been very good indeed. When you have a bad experience with someone/something it is understandably easy to class all others in that profession as the same..... easy but unfair and unrealistic.

 

[Totto]

Thanks for the patronising tone. I believe some doctors know how to treat it, and some don't. I don't claim to know that all doctors are ****, like some people here seem to do.

Oh, I don't think all doctors are ****, far from it. Only I still haven't met one that has a sensible approach to diabetes T2 or basic knowledge about thyroid matters. If you follow the advice given by most GPs you are likely to end up on increasingly stronger medication and possibly insulin eventually. If we disregard their advice (don't test eat plenty of carbs etc), in particular regarding testing BG and thus take responsibility for our own health and adjust carb intake accordingly I'm sure many of us will be able to live with no or few tablets to a good old age and with limited, if any, diabetes complications. Don't you think it would have been a good idea if T2 were encouraged to test BG instead of actively discouraged? I think so anyway.

Tonsillitis and asthma and such most doctors seem able to handle well.

 

[AndBreathe]

So is Financial Conduct Authority Guidance, but I've yet to see a financial institution turn around to the FCA and say "Well it's only a guideline". As NICE is a legislatively created body that feeds into the department of Health, regardless of whether they produce "Guidelines" or "Legislation" it will be seen as the DoH point of view and followed accordingly by many.

Regarding the FSA and Guidelines,..... I have known companies take the approach you quote, Tim; i.e. It's a Guideline, not a Rule, but it didn't stop the £18.something million fine levied against them for interpreting the guideline differently from the then FSA at the moment the inspection was undertaken, as opposed to the day the underlining issue under critique was executed.

 

[mojo37]

Hello. Although I have changed my diet and exercise since diagnosis and lost some weight ( not all I need to) I was very glad the doctor prescribed metformin for me as it gave me an additional boost by reducing my appetite.

It certainly hasn't reduced mine lol

 

[Fayefaye1429]

I do have to say there are good doctors out there and pants ones. May I ask is the health system knowledge and approach better in some countries? I e what differs

 

[ButtterflyLady]

Oh, I don't think all doctors are ****, far from it. Only I still haven't met one that has a sensible approach to diabetes T2 or basic knowledge about thyroid matters. If you follow the advice given by most GPs you are likely to end up on increasingly stronger medication and possibly insulin eventually. If we disregard their advice (don't test eat plenty of carbs etc), in particular regarding testing BG and thus take responsibility for our own health and adjust carb intake accordingly I'm sure many of us will be able to live with no or few tablets to a good old age and with limited, if any, diabetes complications. Don't you think it would have been a good idea if T2 were encouraged to test BG instead of actively discouraged? I think so anyway.

Tonsillitis and asthma and such most doctors seem able to handle well.

There are doctors who encourage their patients to do home testing. You just haven't met them.

 

[ButtterflyLady]

I do have to say there are good doctors out there and pants ones. May I ask is the health system knowledge and approach better in some countries? I e what differs

Yes, I believe the approach to diabetes is different in other countries. But as the guidelines posted above show, UK doctors are not being told to give everyone drugs from the start and to discourage home BG testing. The doctors who take this approach are not implementing the guidelines correctly.

 

[Totto]

There are doctors who encourage their patients to do home testing. You just haven't met them.

No, I haven't and they are few and far between.

Could you please make list a of those you have met who do encourage their patients to monitor BG?

 

[ButtterflyLady]

No, I haven't and they are few and far between.

Could you please make list a of those you have met who do encourage their patients to monitor BG?

Could you please lighten up? Seriously, there is no reason for you to be so persistent with me about this issue. Plenty of other people on this site have said their doctor encouraged them to monitor their BG. People have different experiences, that is life.

 

[Pipp]

When I was first diagnosed T2, 10 years ago, it was the practice nurse that told me. I was given a meter, as many test strips as I needed and a precription for Metformin. I was told not to worry, it could be managed with medication even though it was a progressive disease, as long as I stuck to the NHS diet of plenty of carbs at every meal, and took the tablets I would be fine.
About 3 years ago the advice changed, suddenly was told that no need to test BG anymore. The words used, I have heard so many others say were exactly the same as they were told. 'The only thing you get from testing is sore fingers'. This has been from several different GP surgeries. I was vain enough at the time I was told to stop testing to believe it was because I had done such a wonderful job on 'reversing' my diabetes. I had been having non-diabetic readings for over a year. Yet still they kept me on Metformin.
In UK GPs receive extra payment for testing for and identifying chronic conditions such as diabetes. Then they get extra payment for monitoring and prescibing to those patients. My thoughts on why they prescribe meds? Financial benefit is one reason. Another is that they cannot/will not consider alternatives for newly diagnosed, because it takes too much time. Also, not all patients are willing to take responsibility for their own health and try dietary changes first.

 

[ButtterflyLady]

When I was first diagnosed T2, 10 years ago, it was the practice nurse that told me. I was given a meter, as many test strips as I needed and a precription for Metformin. I was told not to worry, it could be managed with medication even though it was a progressive disease, as long as I stuck to the NHS diet of plenty of carbs at every meal, and took the tablets I would be fine.
About 3 years ago the advice changed, suddenly was told that no need to test BG anymore. The words used, I have heard so many others say were exactly the same as they were told. 'The only thing you get from testing is sore fingers'. This has been from several different GP surgeries. I was vain enough at the time I was told to stop testing to believe it was because I had done such a wonderful job on 'reversing' my diabetes. I had been having non-diabetic readings for over a year. Yet still they kept me on Metformin.
In UK GPs receive extra payment for testing for and identifying chronic conditions such as diabetes. Then they get extra payment for monitoring and prescibing to those patients. My thoughts on why they prescribe meds? Financial benefit is one reason. Another is that they cannot/will not consider alternatives for newly diagnosed, because it takes too much time. Also, not all patients are willing to take responsibility for their own health and try dietary changes first.

Do they get extra payment for prescribing? I haven't seen any evidence of that but I have an open mind about it so if anyone can provide a link to something that confirms their payments are linked to prescribing I would be interested to see it.

The NICE guidelines have been posted above, and they tell doctors to only start prescribing Metformin if the person can't reduce their HbA1c through diet and exercise. This implies about a 3 month window where people can demonstrate they don't need Metformin. So, if doctors/nurses are prescribing Metformin from the day of diagnosis, then they are not following the guidelines.

Similarly, home BG testing is encouraged by the guidelines, because it is part of the person's education about diabetes. Granted, the guidelines don't encourage testing 8 times a day forever, they seem to imply more limited testing and only at the start, because it is part of education. It is also encouraged for when the person is sick with something else. If a doctor or nurse is telling a person they should not test BG at all, then they are not following the guidelines.

 

[Pipp]

Exactly, they don't follow guidelines, just the parts that suit them.
Of course, there is a ray of hope. Southport GP who posts on here is one.

 

[Anaelena]

The reason the most GPs continue to work to government guidelines, however good or bad they are, is predominantly down to liability. If you veer off piste, as a practice you run the risk of censure. The result ? The practice undergoes sever scrutiny and potentially you are struck off and law suits ensue. That's the main reason for sticking to official guidelines. When the low carb studies are complete and a part of the NICE guidelines for treating T2, it will be recommended.

Being married to a a cardiologist in the states I find that this is all to true .

 

[phoenix]

In UK GPs receive extra payment for testing for and identifying chronic conditions such as diabetes. Then they get extra payment for monitoring and prescibing to those patients. My thoughts on why they prescribe meds? Financial benefit is one reason. Another is that they cannot/will not consider alternatives for newly diagnosed, because it takes too much time. Also, not all patients are willing to take responsibility for their own health and try dietary changes first.

I don't think that it is nearly as 'simple' as payment for the prescription of drugs.
The framework for payment is horribly complicated and has changed over the years As far as I can see, there is a set of standards and each practice that is registered has targets for the percentage of patients being managed in accordance with each standard. The percentage required varies according to the make up of the practice (age profile, type of area the practice is in etc). Not all practices belong to the scheme , I've never been able to find out how that works out.

The present set of indicators can be found in the PDF linked on this page They don't include targets for prescription.of medications for glucose lowering. The targets are to do with the percentage of patients with HbA1cs or cholesterol levels or blood pressure levels within certain bands. There is a target for the prescription of an ACE or ARB if you have diabetes with kidney disease and another for the percentage of people with diabetes who have a flu jab. There are targets for documented foot examination and referral of newly diagnosed patients for structured education. There are others on smoking cessation advice


In the future it looks as if the scope of the indicators may change completely (perhaps @donnellysdogs knows more) I end up on the NICE site when I try to look at the framework for 2015-16
Here is what seems to be the 'future' framework for diabetes .http://publications.nice.org.uk/diabetes-in-adults-quality-standard-qs6/list-of-statements.

 

[Pipp]

I don't think that it is nearly as 'simple' as payment for the prescription of drugs.
The framework for payment is horribly complicated and has changed over the years As far as I can see, there is a set of standards and each practice that is registered has targets for the percentage of patients being managed in accordance with each standard. The percentage required varies according to the make up of the practice (age profile, type of area the practice is in etc). Not all practices belong to the scheme , I've never been able to find out how that works out.

The present set of indicators can be found in the PDF linked on this page They don't include targets for prescription.of medications for glucose lowering. The targets are to do with the percentage of patients with HbA1cs or cholesterol levels or blood pressure levels within certain bands. There is a target for the prescription of an ACE or ARB if you have diabetes with kidney disease and another for the percentage of people with diabetes who have a flu jab. There are targets for documented foot examination and referral of newly diagnosed patients for structured education. There are others on smoking cessation advice


In the future it looks as if the scope of the indicators may change completely (perhaps @donnellysdogs knows more) I end up on the NICE site when I try to look at the framework for 2015-16
Here is what seems to be the 'future' framework for diabetes .http://publications.nice.org.uk/diabetes-in-adults-quality-standard-qs6/list-of-statements.

I did not say it was simple. It really is not as simple as looking at any NICE guidelines for any condition either. The Clinical Commisioning Groups in each area are interpreting those guidelines as they feel relevant to the medical parctitioners in their area. So we have different interpretations in different areas. This is already evident in the devolved services in Scotland and Wales, and is becoming so in various areas in England, and one reason why treatments and prescriptions are different in the different areas. The GPs are not really allowed to make decisions on protocol. They have no choice but to follow the directives from CCGs. They do have the targets set on monitoring and prescribing for T2 diabetics in my area though. It could be different where others live.

 

[Daibell]

I see this "buffer/insurance as a problem, not a solution. Many Type 2's newly diagnosed are sent away to lose some weight and take these tablets, come back in 3 months. They are not told how Metformin works. They assume it is a miracle drug that will allow them to continue eating carbs/sugar. For them, it is a way to carry on much as normal. Some of these people arrive on this forum to ask why the Metformin isn't helping them, why they see spikes after eating. They honestly believe the tablets should be stopping this happening.

If only they were told by the GP that Metformin doesn't work that way, that it is mainly an appetite suppressant and also works on the liver to help reduce liver dumps, to a limited extent, and that carbs are the problem.

I believe prescribing Metformin to newly diagnosed should be accompanied by a full description of how it works, to what extent, and more importantly, what it doesn't do. Otherwise, I see it as the start of a slippery path for many.

I agree.Metformin is a useful drug but no miracle cure. I wish I'd known that when my diabetes GP first diagnosed me with sky high blood sugar and started me on Meformin with no information or support.

 

[Totto]

There are doctors who encourage their patients to do home testing. You just haven't met them.

http://www.diabetes.co.uk/forum/threads/have-you-been-told-not-to-test-your-blood-sugars.66574/