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Is There An Error In Determining The Degree Of Diabetes?
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<blockquote data-quote="kitedoc" data-source="post: 1865113" data-attributes="member: 468714"><p>Thank you [USER=406242]@pollensa[/USER], and please excuse my belated response. Whilst the lab scientists and doctors might explain the differing standards (figures) for diabetes diagnosis from time to time and country to country as due to continual researching of laboratory error range and new techniques of measurement, I tend to call this activity "changing the position of the goal posts'.</p><p>And I am cynical. In Australia the upper limit for safe mercury levels in tuna has increased as consumers become more aware of the risks and tuna sales have fallen. Political, food industry and other interests can be well served by these manipulations.</p><p>Lowering of some of the cut-off levels for diabetes /pre-diabetes in certain countries seems counter-intuitive in this regard yet the health professions, drug companies, diet and food industry benefit from an increase in numbers of newly diagnosed diabetics.</p><p>Where diagnostic levels have perhaps not budged much, the expense of newly diagnosed diabetics to Government-run health schemes is at least stabilised for the time being. Am I too cynical ??</p><p>I agree that NZ has at least clarified who is 'in' and who is 'out', rather than a person being left on the edge. And one can argue that an error range for the test could possibly place one person in and another out if the first argues for the upper error limit as the result to be used and the latter, argues for the lower extreme of the range.</p><p>Also who is to say that the test repeated the next week is not going to be different enough to change the diagnosis.?</p><p>Absolute figures, ranges, fancy predictions and statistics do not, cannot apply fully to human beings, only perhaps trends apply over time and other variables. Clinicians use a numbered scale to assess and person's level of pain. Pain is an experience which cannot be reduced to a linear scale yet concrete thinking rules the day!</p><p>There is not only the fear, worry about being diagnosed in or out of diabetes, there may be some financial benefits or disadvantages to health consumers and then the monitoring or diagnosis by HBA1C is still a crude measure. It is the best we have at the moment but again it has cut offs and by itself provides an average over 3 months, an average of BSLs and an average only on potential damage caused.</p><p>And we know that for some that diabetes is reversed, at least for a while. Do the health professions think this is a game of rounders, cricket etc? My premise is that trends, using whatever is the most effective, least interventive, and most economical form of assessment and use of a continuum paradigm better informs management of diabetes.(apologies for repetition of part of last post here).</p><p>Clinicians need to be trained to not think in absolutes, nor have Government try to enforce this. In Australia a GP can be fined for pre-emptively prescribing a diabetes medication to reduce insulin resistance for a person who under the guidelines (read cut-offs) is diagnosed as pre-diabetes rather than diabetes. Despite the fact that in one case a pre-diabetic women achieved pregnancy only by being prescribed such a medication before conception.</p><p>Health professional training from under-graduate upward needs to include health care consumers who can argue the case for modifying the 'cut off' paradigm. Sadly some doctors still think of healthcare consumers/patients as passive, unintelligent or too under-qualified to discuss things with. The exceptions amongst the profession are to be highly valued. </p><p>You have given me added umphh (so descriptive a word, and with no cut-offs attached) to add this to the Health Literacy projects I am working on with a Healthcare Consumer group here in Adelaide. If a change can occur through small group effort, anything is possible. If you see a future newspaper article on Adelaide showing protestors dressed in long trousers and slacks, holding banners labelled " Say NO to cut-offs", "Trends send the right message", "Managing diabetes is not cricket" I will be there.</p><p>Best Wishes - May the Trends always be in your favour, and those that appear not, May they be amendable always to change.</p></blockquote><p></p>
[QUOTE="kitedoc, post: 1865113, member: 468714"] Thank you [USER=406242]@pollensa[/USER], and please excuse my belated response. Whilst the lab scientists and doctors might explain the differing standards (figures) for diabetes diagnosis from time to time and country to country as due to continual researching of laboratory error range and new techniques of measurement, I tend to call this activity "changing the position of the goal posts'. And I am cynical. In Australia the upper limit for safe mercury levels in tuna has increased as consumers become more aware of the risks and tuna sales have fallen. Political, food industry and other interests can be well served by these manipulations. Lowering of some of the cut-off levels for diabetes /pre-diabetes in certain countries seems counter-intuitive in this regard yet the health professions, drug companies, diet and food industry benefit from an increase in numbers of newly diagnosed diabetics. Where diagnostic levels have perhaps not budged much, the expense of newly diagnosed diabetics to Government-run health schemes is at least stabilised for the time being. Am I too cynical ?? I agree that NZ has at least clarified who is 'in' and who is 'out', rather than a person being left on the edge. And one can argue that an error range for the test could possibly place one person in and another out if the first argues for the upper error limit as the result to be used and the latter, argues for the lower extreme of the range. Also who is to say that the test repeated the next week is not going to be different enough to change the diagnosis.? Absolute figures, ranges, fancy predictions and statistics do not, cannot apply fully to human beings, only perhaps trends apply over time and other variables. Clinicians use a numbered scale to assess and person's level of pain. Pain is an experience which cannot be reduced to a linear scale yet concrete thinking rules the day! There is not only the fear, worry about being diagnosed in or out of diabetes, there may be some financial benefits or disadvantages to health consumers and then the monitoring or diagnosis by HBA1C is still a crude measure. It is the best we have at the moment but again it has cut offs and by itself provides an average over 3 months, an average of BSLs and an average only on potential damage caused. And we know that for some that diabetes is reversed, at least for a while. Do the health professions think this is a game of rounders, cricket etc? My premise is that trends, using whatever is the most effective, least interventive, and most economical form of assessment and use of a continuum paradigm better informs management of diabetes.(apologies for repetition of part of last post here). Clinicians need to be trained to not think in absolutes, nor have Government try to enforce this. In Australia a GP can be fined for pre-emptively prescribing a diabetes medication to reduce insulin resistance for a person who under the guidelines (read cut-offs) is diagnosed as pre-diabetes rather than diabetes. Despite the fact that in one case a pre-diabetic women achieved pregnancy only by being prescribed such a medication before conception. Health professional training from under-graduate upward needs to include health care consumers who can argue the case for modifying the 'cut off' paradigm. Sadly some doctors still think of healthcare consumers/patients as passive, unintelligent or too under-qualified to discuss things with. The exceptions amongst the profession are to be highly valued. You have given me added umphh (so descriptive a word, and with no cut-offs attached) to add this to the Health Literacy projects I am working on with a Healthcare Consumer group here in Adelaide. If a change can occur through small group effort, anything is possible. If you see a future newspaper article on Adelaide showing protestors dressed in long trousers and slacks, holding banners labelled " Say NO to cut-offs", "Trends send the right message", "Managing diabetes is not cricket" I will be there. Best Wishes - May the Trends always be in your favour, and those that appear not, May they be amendable always to change. [/QUOTE]
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