Tag Archives: chronic disease

Drug Inserts as Legal Documents

From the annual meeting of the American Association for the Advancement of Science, Washington:

How many people read the package inserts on their prescription drugs? And how seriously do those who read them take the dire warnings about potential side effects?

courtesy of flickr user Horrgakx

In a session on “Chronic Illness Management and Cognitive Science: Translation Beyond Genes,” at the AAAS meeting, the presenters discussed how clinicians might improve patients’ management of chronic illness by better understanding how patients interpret their conditions. For example, some patients don’t truly believe they have a chronic disease (such as asthma), and consequently they are less likely to take their medications, said Dr. Ethan Halm of the University of Texas Southwestern Medical Center, Dallas.

 A member of the audience who identified himself as a psychologist made another interesting point about adherence and patient attitudes. He said that he has patients who read the drug inserts and decide not to take a medication because they are afraid of the severe side effects. Rather than tell someone about their concerns, they simply skip the medications.

Dr. Halm noted that the drug insert is a legal document, not a medical one. The drug insert has to list any conceivable thing that could possibly happen so that the drug company can cover itself.

Maybe medication adherence could be improved if doctors, nurses, nurse practitioners, or someone in the office reminded patients that drug inserts are legal documents, not medical encyclopedias, so they will keep taking their medications for chronic conditions and call if they experience side effects, rather than quit unnecessarily.

–Heidi Splete (on twitter @hsplete)

Leave a comment

Filed under IMNG, Uncategorized

China’s Diabetes Problem

China may be an economic superpower, but diabetes is taking away some of that wealth.  

 Approximately 13% of the country’s total medical expenditures—totaling 173.4 billion Renminbi, or $25 million (U.S.)—is spent on the condition, according to a new report from the Chinese Diabetes Society (CDS) and the International Diabetes Federation (IDF),

A public diabetes screening held in Shanghai / Photo courtesy of IDF

The report, based on preliminary data from a survey of 5,000 people at 12 sites, also documented that health expenditures for people in China who have had diabetes for 10 or more years are 460% higher than for those who have had the condition for just 1 to 2 years.

Of  the survey respondents with diabetes,  89% reported having health insurance. However, they spent 11% of their income on medical care — 9 times more than did those of the same age and sex who didn’t have diabetes.

The CDS/IDF survey is a followup to a study published earlier this year in the New England Journal of Medicine, which found that the prevalence of diabetes in China was 9.7% of the total population, or 92.4 million adults. Another 148.2 million adults in the country were found to have prediabetes,  the China National Diabetes and Metabolic Disorders Study Group reported. 

Diabetes threatens China’s prosperity, IDF executive director Ann Keeling said in September. “One in 10 people in China now has diabetes. They’re getting it in their 40’s and 50’s, the most productive years. In a generation, there will be cities full of sick people and a sick workforce. It has huge implications for competitiveness.”

The Chinese Ministry of Health recognizes the problem. This year it has introduced several new education and awareness programs, including a three-year project to train 100,000 community-level physicians across the country in diabetes prevention and treatment, a Web-based learning platform for diabetes training expected to attract over 400,000 subscribers a year, and a glucose management training program aimed at 1,000 community-based healthcare providers.

Also, BRIDGES, a $400,000 research project run by the IDF in the city of Tianjin, aims to translate a proven gestational diabetes care protocol into routine obstetric practice.

“Help is needed from both inside and outside the country to prevent and control diabetes in China,” CDS president Professor Linong Ji said in an IDF statement.

—Miriam E. Tucker (@MiriamETucker on Twitter)

Leave a comment

Filed under Cardiovascular Medicine, Endocrinology, Diabetes, and Metabolism, Family Medicine, IMNG, Internal Medicine, Obstetrics and Gynecology, Practice Trends, Primary care, Uncategorized

Diabetes Educators Fly Prevention Flag

Currently, 57 million Americans have elevated blood glucose levels that place them at risk for developing diabetes unless there is intervention. Who better than a diabetes educator to intervene? 

That’s the latest stance of the American Association of Diabetes Educators, which is now actively lobbying Congress and calling on private insurers to recognize that the services delivered by its members—which include counseling about nutrition, exercise, and the psychological aspects of lifestyle modification—can bring tangible benefits to those at risk for diabetes as well as those who already have it, AADE president Deborah Fillman said during the association’s annual meeting in San Antonio. 

Photo of Deborah Fillman, CDE by Lagniappe Studio/Courtesy of AADE

Specifically, AADE is asking Congress to further expand the Medicare Prescription Drug Improvement and Modernization Act of 2003 to include coverage for Diabetes Self-Management Education/Training (DSME/T) for people with pre-diabetes in addition to those with diabetes. 

The association cites data from a retroactive claims analysis of 250,000 Medicare beneficiaries showing an average cost savings of $135 per patient per month for those who completed a DSMT program, and an inpatient cost savings of $160 per patient per month. Other data have shown conclusively that lifestyle intervention such as that delivered by diabetes educators reduces the progression from pre-diabetes to diabetes. 

But with a shortage of specialized healthcare providers to meet the needs of the 24 million Americans who are already diagnosed with diabetes, how does AADE envision tackling pre-diabetes as well? “The first key is that we have the skill set to do it. The rest of it we’ll have to work on, including the reimbursement issue and increasing our numbers,” Ms. Fillman, a registered dietitian and a certified diabetes educator, told me. 

At the same time, she added, “We’re already doing behavior change. We already work with family members of people with diabetes. In many ways we’re already doing diabetes prevention. It’s just not recognized.” 

—Miriam E. Tucker (on Twitter @MiriamETucker)

Bookmark and Share

Leave a comment

Filed under Alternative and Complementary Medicine, Cardiovascular Medicine, Endocrinology, Diabetes, and Metabolism, Family Medicine, Geriatric Medicine, Health Policy, health reform, IMNG, Internal Medicine, Pediatrics, Primary care, Uncategorized

Will Noncommunicable Disease Become a Global Health Priority?

Dr. Jean Claude Mbanya photo courtesy of the International Diabetes Federation

On Feb. 24th at the first Global Noncommunicable Disease Network (NCDnet) Forum in Geneva, Dr. Jean Claude Mbanya delivered a key message of his International Diabetes Federation presidency: The world must awaken to the growing threat of noncommunicable disease. 

Launched by the World Health Organization in July 2009 , the NCDnet is a voluntary collaboration involving United Nations agencies, intergovernmental organizations, academia, and the business community. It aims to promote international partnerships for the prevention and control of NCDs. 

“The birth of NCDnet has led to greater recognition for the global epidemic of NCDs, but NCDnet needs money and people if it is to serve as a much needed resource and cannot run on goodwill alone,” Dr. Mbanya said in his speech at the forum. 

He noted that of the more than 2,000 employees at the WHO headquarters, there is just a single person dedicated specifically to diabetes, “a disease affecting 285 million people now and set to rise to 440 million in 20 years time.” According to the network’s newsletter, just 0.9% of the $22 billion spent by international aid agencies in low- and middle-income countries goes to NCDs, although they make up 60% of the total disease burden. 

As he did at the World Diabetes Congress in Montreal last October, Dr. Mbanya spoke of the need for a UN General Assembly Special Session on NCDs to raise global awareness. So far, 57 governments have signed on in support of such a session, which they are hoping will be held in 2011. He also called for NCD indicators to be included in revisions to the U.N. Millennium Development Goals, due to be reviewed in September. 

And he said that NCD medicines, such as generic glucose-lowering drugs and antihypertensives, should be funded just as drugs for HIV/AIDS currently are, along with support for delivery mechanisms and chronic disease education and care models. 

He acknowledged the enormity of the task: “Most cases of NCDs can be prevented, but wholesale NCD prevention will take vision and leadership of a type that we have never seen before. It will require changes in every aspect of our lives — taxation, food policy, advertising, and urban design. We will need to reevaluate the way we live if the human species is to survive.” 

-Miriam E. Tucker (@MiriamETucker on Twitter)

Bookmark and Share

2 Comments

Filed under Cardiovascular Medicine, Endocrinology, Diabetes, and Metabolism, Family Medicine, Health Policy, IMNG, Internal Medicine, Primary care

Cancer As Chronic Disease

Courtesy of Flicker user Mel B (creative commons)

Courtesy of Flicker user Mel B (creative commons)

from the annual meeting of the American Society of Clinical Oncology in Orlando

It’s a rare treat for the lone medical reporter to get together with others of our kind.  I had dinner tonight with the other EGMN reporters and editors covering ASCO.  We can’t help ourselves and we mostly talk shop.  There was a lot of great discussion.

My oncology mentor and editor of The Oncology Report, Jane MacNeil, brought up the idea of cancer as a chronic disease.  The idea was pretty thought changing for me.  I’ve been covering oncology for 3 years now and cut my teeth on patient/survivor care stories. The topic is still an important one to me.

Still, all of this time, as I’ve been thinking about the issues and problems of who cares for cancer survivors—some types of cancers with increasingly long survival—-it hadn’t occurred to me that it might be possible to start to think about cancer as a chronic disease.  I admit that for some types of cancers, the idea seems laughable but for other types…well, it seems kind of plausible.

So, I put it out there to all of you ASCO folks: can or will we start thinking of cancer as a chronic disease that is managed?

Also, I’d like to give a big shout out to some of my new Twitter friends that I found through #ASCO: @drsteventucker, @djsampson, @amarantoblook, @MaverickNY, @PharmacistScott, and of course my good buddy @MedReporter.

—Kerri Wachter (on Twitter: @knwachter)

Bookmark and Share

Leave a comment

Filed under Oncology