November 7, 2007

I Don’t Know...

I read Mr. Richard Kahn's comments on diabetes care and technology. I have seen the talk at ADA boards, at other boards and on the blogs.

Kudos to Mr. Kahn!

He’s going to single handedly take the heat of responsibility for the stupidest diabetes comment off Halle Berry. I am sure she will be pleased.

He did an outstanding job of focusing my support for diabetes advocacy. I will not renew my ADA membership. I will no longer recommended type 1 parents join ADA, which in the past I have done quite a bit, specifically to support Crystal Jackson's work with schools. Sorry Crystal, I love ya but the Richy is doing more harm than all your good.

Do me a favor Dick - take me off ADA’s emailing lists.

"I believe the sale of insulin pumps or continuous glucose monitors would soar if there were a long-term, randomized–controlled trial showing that either of these technologies really do benefit people with diabetes, and are worth the added cost."
In the context of the 15 pages, clearly the way he put this he doesn’t think either device is worthwhile. Oh it was eloquently done, oh so long winded (did I mention it is 15 pages?) and in ever so lofty sounding scientific terms, that the implication was both clear and plausibly deniable.

Dude, if you thought the studies were needed you would have ADA at the forefront of studies proving it. You don’t. Hell you don’t think type 2s should test. Says a lot.

Mr Kahn's ADA does allow adds in their magazines that talk about cures for diabetes and getting of medications, including insulin, without any distinction between type of diabetes. Says a lot.

"I think you can count on more attention being paid to technology that enables physicians to provide the evidence-based care that’s already available."
Rich does your underlining means you think we already have everything we need, so as a nation we can just skip any additional R&D? Type 2 pills are fine, so why look for cures for type 1? If so we don't much need ADA do we?

It is clear he’s all about the “evidence-based” care. Oh that sounds so like an insurance company letter that turns down a physicians prescription for a CGM. Bad physician tried to Rx something Dickypooh doesn't see as evidence based. But wait they are pediatric endocrinologist and your a PhD of Physiology maybe they have a better read on the evidence?

In a type 1 family the parents are the primary care givers. Every day. Every night. All Week. All Month. All Year. Evidence is measure every three months, we call it A1C.

"A technology that gets the 70% or so of people with diabetes who are not taking their medications as directed, to start taking their drugs like they should, would much more likely have greater benefit than another monitoring or insulin delivery device."

Right and this 70% - do they have any motivation to manage their care? Say Richy - does all the evidence-based studies based you this talk on show that patient motivation has any impact? Or are you shooting from the hip (and into your foot.)

Why monitor BG anyway, I mean other than that the definition of diabetes is based on the fasting BG.

"I concede that solutions that make the delivery of quality care more systematic are not as sexy as implantable closed loop islet factories, or new devices to make insulin delivery more convenient, but technology that improves systems of care are apt to save and improve more lives—and such technology will be amply rewarded in coming years."
I concede, I think you’re conceited. You use of the pejorative was very nicely done. Factories have a robber baron, eco disaster - last century vibe. Sounds a lot like; screw the type 1 people, it is a better investment to get the type 2 to take their pills - that he thinks any investment into type 1 technology is just flashy, beepy oh sorry "Sexy" video games for kids.

Well Richrd, I can tell you our kids, yes kids - two type 1 kids, have seen significantly better control with pumps as evidenced by lower and more stable A1Cs. I doubt it is possible for a T1 kid to maintain control in puberty without a pump.

But hey what do I know? I only live Type 1 diabetes care 24x7x365x2 and to be honest I didn’t even try to control T1 BG in puberty without the pump. Silly me! Pass the pills and get Halle on the line and oh - which kid should I give placebo insulin to?

At age nine the girl’s BG would shot all over the map, a stressful test in school could send her hypo in no time. A CGM that could predict a hypo based on rate of change would have helped in that classroom. But that just a kid in school - right Richard?

Even more it would track overnight rates and support basal rate fine tuning. Over night is crazy in puberty. Oh wait we don’t need to do that because we don’t need pumps. No pumps no need to track over night BG. We don’t track it and those spikes - well they just don’t happen if there is no evidence of them.

Here’s question for ya Richy; If BG spikes at night but there is no test strips or CGM to record it, in your world dose it impact A1C?

I guess not. In your world the ADA and a doctor will give us pills. Hell with T1 kids - lets get those adults taking their pills.

Maybe it is all a misunderstanding. Right, if so here a hint Rich, Don’t go in front of a group and say their work is misguided, don’t talk down the treatments that thousands of members of your organization use to keep their kids alive. It so makes you look stupid - I don’t know how much of an accomplishment that is. I don’t know Dick.


  1. Wonderfully said...I really hope he reads it...

  2. I let my membership lapse in the ADA this year too. I'm another Type 1

  3. Wow that's harsh! I presume it made you feel better?

    I sometimes think that the worst enemy a T1 child has is their "involved" parent.

    As you say, "Your diabetes may vary". So different strokes for different folks applies.