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The NHS T2 Treatment Regime
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<blockquote data-quote="Daibell" data-source="post: 1433105" data-attributes="member: 21149"><p>Hi. This topic regularly comes up and I agree that's unacceptable the NHS so often gets it badly wrong with diabetes and I would include my surgery with that. There are many reasons as others have listed. The food and pharma lobby are very strong and there are many vested interests with 'snouts in the pot'. The food industry wants to sell carbs and the pharmas medication. GP training for diabetes is woeful. My new diabetes GP who had just come off the training course didn't know about late onset T1 for example. From posts on this forum you can see overweight T2s being given Gliclazide as the GP doesn't understand how this drug works. You see overweight T2s then having insulin added and wondering why it doesn't help. You see people being prescribed vanilla Metformin and having weeks of bowel problems and no help e.g. SR version from their surgery. I wonder how many GPs know that T2s have excess insulin and T1s too little (yes, a generalisation). The problem is that GPs are by definition generalists. They should not be diagnosing complex conditions as there are too many conditions and too many drugs. There is no way they can keep up. There should be more referrals to consultants but there aren't enough of them and the cost would be too high. I'm currently reading a good called 'Black Box Thinking' which compares the aircraft industry with the medical industry. The former measures failures, feeds back and hence has excellent control and few failures now. The medical industry refuses to accept measurement and feedback as good process so the speed of learning is very slow. It's interesting to se how slow Diabetes UK (not this site) has been in adopting changing knowledge and has largely ignored the posts on this forum preferring to follow the 'experts' who in turn have their research funded by food and pharmas. I don't see any way thru this failed scenario.</p></blockquote><p></p>
[QUOTE="Daibell, post: 1433105, member: 21149"] Hi. This topic regularly comes up and I agree that's unacceptable the NHS so often gets it badly wrong with diabetes and I would include my surgery with that. There are many reasons as others have listed. The food and pharma lobby are very strong and there are many vested interests with 'snouts in the pot'. The food industry wants to sell carbs and the pharmas medication. GP training for diabetes is woeful. My new diabetes GP who had just come off the training course didn't know about late onset T1 for example. From posts on this forum you can see overweight T2s being given Gliclazide as the GP doesn't understand how this drug works. You see overweight T2s then having insulin added and wondering why it doesn't help. You see people being prescribed vanilla Metformin and having weeks of bowel problems and no help e.g. SR version from their surgery. I wonder how many GPs know that T2s have excess insulin and T1s too little (yes, a generalisation). The problem is that GPs are by definition generalists. They should not be diagnosing complex conditions as there are too many conditions and too many drugs. There is no way they can keep up. There should be more referrals to consultants but there aren't enough of them and the cost would be too high. I'm currently reading a good called 'Black Box Thinking' which compares the aircraft industry with the medical industry. The former measures failures, feeds back and hence has excellent control and few failures now. The medical industry refuses to accept measurement and feedback as good process so the speed of learning is very slow. It's interesting to se how slow Diabetes UK (not this site) has been in adopting changing knowledge and has largely ignored the posts on this forum preferring to follow the 'experts' who in turn have their research funded by food and pharmas. I don't see any way thru this failed scenario. [/QUOTE]
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