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Legal and clinical meaning of "poorly controlled"
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<blockquote data-quote="Spiker" data-source="post: 817524" data-attributes="member: 102150"><p>Apologies first of all as this is a sort of cross post of <a href="http://www.diabetes.co.uk/forum/threads/poorly-controlled-our-fault.74656/" target="_blank">another thread</a> that ended up going off topic into people's perceptions - an interesting subject but not what I was looking to find out.</p><p></p><p>I'm trying to find out what the clinical meaning of "poorly controlled" diabetes is, whether or not it necessarily involves blame of the patient for their conduct (e.g. does it imply that the health problem is avoidable or reduceable by the patient). And from there, where does the "poorly controlled" diabetic stand in relation to litigation, in employment for example. <strong>Can they be held not to have taken 'reasonable measures' to cope with their condition, and thus fall outside Equality Act protection?</strong></p><p></p><p>Here are some clinical links</p><p></p><p><a href="http://en.wikipedia.org/wiki/Diabetes_management#Glycemic_control" target="_blank">http://en.wikipedia.org/wiki/Diabetes_management#Glycemic_control</a> (definition in last paragraph)</p><p></p><p>this study (for T2) gives an HBa1c based definition and says that those that are poorly controlled have "resistant diabetes"</p><p><a href="http://www.ncbi.nlm.nih.gov/pubmed/24567193" target="_blank">http://www.ncbi.nlm.nih.gov/pubmed/24567193</a></p><p></p><p>this study (also T2) <a href="http://www.cardiab.com/content/11/1/70" target="_blank">http://www.cardiab.com/content/11/1/70</a></p><p>also gives an HBa1c based definition, says that no predictors could be found to design interventions to improve control, and that the majority of "poorly controlled" diabetics were rated as having "very good or good" compliance with their care plan.</p><p></p><p>There's also a study from Jordan that does correlate poor control with poor compliance - particular with the recommended diet and exercise regime for T2s - only 15 of the poorly controlled T2s were eating their Eat Well Plate or whatever the Jordanian equivalent is. However this quick literature check suggests that the clinical meaning is just that BG and HBa1c are outside of target, and that (at least some of) the evidence shows that this is independent of the patients' compliance and behaviour.</p><p></p><p>Any views on that being the clinical definition? And what about the legal implications? Let's assuming we're talking about medicated diabetics, not diet-only.</p></blockquote><p></p>
[QUOTE="Spiker, post: 817524, member: 102150"] Apologies first of all as this is a sort of cross post of [URL='http://www.diabetes.co.uk/forum/threads/poorly-controlled-our-fault.74656/']another thread[/URL] that ended up going off topic into people's perceptions - an interesting subject but not what I was looking to find out. I'm trying to find out what the clinical meaning of "poorly controlled" diabetes is, whether or not it necessarily involves blame of the patient for their conduct (e.g. does it imply that the health problem is avoidable or reduceable by the patient). And from there, where does the "poorly controlled" diabetic stand in relation to litigation, in employment for example. [B]Can they be held not to have taken 'reasonable measures' to cope with their condition, and thus fall outside Equality Act protection?[/B] Here are some clinical links [URL]http://en.wikipedia.org/wiki/Diabetes_management#Glycemic_control[/URL] (definition in last paragraph) this study (for T2) gives an HBa1c based definition and says that those that are poorly controlled have "resistant diabetes" [URL]http://www.ncbi.nlm.nih.gov/pubmed/24567193[/URL] this study (also T2) [URL]http://www.cardiab.com/content/11/1/70[/URL] also gives an HBa1c based definition, says that no predictors could be found to design interventions to improve control, and that the majority of "poorly controlled" diabetics were rated as having "very good or good" compliance with their care plan. There's also a study from Jordan that does correlate poor control with poor compliance - particular with the recommended diet and exercise regime for T2s - only 15 of the poorly controlled T2s were eating their Eat Well Plate or whatever the Jordanian equivalent is. However this quick literature check suggests that the clinical meaning is just that BG and HBa1c are outside of target, and that (at least some of) the evidence shows that this is independent of the patients' compliance and behaviour. Any views on that being the clinical definition? And what about the legal implications? Let's assuming we're talking about medicated diabetics, not diet-only. [/QUOTE]
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