In a presentation at the May 2012 American Association of Clinical Endocrinologist's (AACE) meeting (article here), investigators reported on findings that ~50% of non-obese "Type 2" diabetics were antibody positive and in fact had LADA (adult-onset Type 1 diabetes). In this study, they only tested for GAD and ICA, so some LADAs may have been missed (at the present time, being positive for any one of GAD, ICA, IA-2, zinc transporter, T reactive cell means the person has Type 1a diabetes). The scariest findings were that the average A1c was 10.2% and 80% already had diabetic complications. Simply treating these people with exogenous insulin would have averted many complications.
Here are some choice quotes:
Thanks to Natalie for alerting me to this article!
My first insulin pump trainer, who has Type 1 diabetes, went to her GP prior to diagnosis and told him her symptoms. He sent her to a psychiatrist. She remained undiagnosed and untreated, and went into DKA and a coma (thankfully, her boyfriend found her and got her to the hospital). Only then did she get appropriate treatment.
I was misdiagnosed as well. Only after going through a very difficult time of high BG numbers, losing weight, eating less, exercising more and nothing improving did I finally go to a specialist [endo.] and he did the blood work and came back with LADA and was put on Insulin right away--what a blessing it was. I am so thankful for the Insulin, I do 4 injections/day and my A1C is 5.6--yeah!!!
Here's a rather long recent article in the New Yorker about how inefficient our health care system is. It looks at how methods used to promote efficiency in other industries could be/are being applied to medicine. Interestingly the industry used as as example is the chain restaurant industry. In the context of the present discussion a standardized method would be applied to the treatment of the newly diagnosed to remedy what is obviously a problem. Bottom line too many Dr.s don't even know what the correct protocol is and there is no efficient method of disseminating this information to them.
Again and again, both researchers (including these researchers published in AACE) and doctors say that "antibody tests are too expensive" to be done on all newly diagnosed PWDs. But as Brian says, the test is $300. Since 80% of the LADAs in this study already had complications, and complications are extraordinarily expensive to treat/manage, I believe autoantibody testing is quite cost effective. Also, it's not just complications, it's DKA that can leave a person in ICU for a week (that has happened to at least one TuD member who was misdiagnosed as Type 2 and denied insulin). Unfortunately, there is not a "correct protocol" for diagnosing Type 1, which does lead to a lot of these problems.
Good article! It would be interesting to see how the sort of "new medicine" (or "new medical business?") approach would work in an endocrinology department? I agree about doctors approach to the protocol varying. For a long time, I'd just sort of sashay into the doctor's get an OK A1C and sashay out. Eventually, I had a GP who'd recommended the more modern insulins and/ or a pump but didn't really push it.
In a lot of the cases, it seems like the members (e.g. BSC...) are doing "ok" by the doctor's standards but have researched enough to get their own standard and want to make changes, whatever they might be, to get their results where they want them, in or close to a "normal" range, which should be the doctor's goal but they are so used to failure that they don't seem to bother?
I do agree that, at least in the case of T2, Dr.s "are so used to failure that they don't seem to bother" It is an article of faith that T2 is a degenerative disease and so when the patient degenerates no one is surprised. Patient apathy is also a huge factor.
The article does show what a mess our current system is. Change will have to come because the increase in cost's is unsustainable. It would seem the right kind of change could result in better care and decreased costs. A lot of this is really low hanging fruit if the correct mindset is adopted.
I agree with everything said. Let me add to your apathy statement BadMoon. Last time I saw my endo we were discussing my OCD (which he totally approves of), and he said that 90% of his patients who abandon their CGM do so because they find it annoying that it keeps alarming - they have their high alarm set for 200. I can't comprehend....
Perhaps what's needed is an OCD pill to take with your metformin:)
These would be anti OCD pills no?
LOL definately anti, for me at least ;0
Thanks for posting Melitta The article from the new Yorkr is well worth the read as well .Thanks BadmoonT2.