We'd all be better off.
No, this isn't another "I hate Bill Gates" diatribe. It's just that until someone who has the kind of moola Mr. Gates has, combined with an engineering frame of mind, gets diabetes, we are never going to see the studies funded that we NEED to have funded to make official the findings those of us who have normal health with diabetes have learned anecdotally.
It all comes down to hard cash. Right now almost all the money researching diabetes is coming from drug companies, and the only thing the drug companies research is, surprise, surprise, how wonderful their drugs are.
The truth is there is no pharmaceutical drug besides insulin that reliably lowers A1c more than 1% in ALL people with diabetes. And the average American with Diabetes, according to NHANES III has an A1c near 10%.
But you would not know that if you reviewed the various publications exploring "evidence based medicine" like the latest AACE practice recommendations (just published this week) which make it sound as if the only treatment for diabetes is pharmaceutical drugs. And for Type 2 diabetes these "evidence based" recommendations recommend doctors ONLY use oral drugs and a high carb/low fat diet until people's A1cs are high enough to have taken out their kidneys, retinas, and nerves.
So clearly what we need is for someone to fund research that collects some serious "evidence" about something OTHER than oral drugs!
It's not going to be coming from government--which is who USED to fund this research until the Republicans added a clause to the Constitution that said that American business had the right to do whatever it could in defense of its profits, including cutting all taxes that sent funds to non-industry funded medical research.
So folks like Mr. Gates are our only hope. If Mr. Gates should end up diagnosed with Diabetes--like so many of use who diet, exercise and still end up with abnormally high blood sugars--and decides he would like to do something to help the millions of us who don't have his resources--here are a few projects he might like to fund:
1. A twenty year study examining the impact of maintaining truly normal blood sugars on the progress of diabetic complications in people with Type 2. Think of this as UKPDS on steroids.
Participants in one arm of this study--at least 10,000 of them--will maintain blood sugars of 5.5% or less, using carb restriction, exercise, metformin, and both basal and bolus insulin where needed. Whatever it takes! Participants will be advised to cut their carbohydrate intake down to the level which produces blood sugars after meals that do not go over 140 mg/dl--the level associated with the beginning incidence of microvascular complications.
The control group for this study will be the entire diabetic population of a randomly chosen county treated with the standard treatments.
Participants will test blood sugars fasting and 1.5 hours after every meal and upload readings from their blood sugar meters monthly. They will be given a CGMS and long-use sensor once a year and instructed how to use it, uploading the data and detailed information about the food they eat and the drugs they take to verify their blood sugar patterns.
2. A ten year study testing the safety and efficacy of very low carb dieting for people with Type 2 diabetes.
All participants at the beginning of the study will be freshly diagnosed and will have been screened so that there are NO people with any early diabetes complications in either group. Again, we want 10,000 or so participants in each arm.
The control group is people given the standard dietary advice given diabetics, which is still, sadly, a diet of at least 125 g of carbs a day but usually much higher and a fat intake of under 30% of total calories.
The test group will limit their carbohydrate intake to 100 grams a day or less. Triglycerides, HDL, LDL, blood pressure, microvascular complications, thickness of carotid arteries and other cardiac health tests etc will be monitored every three months to track development of early complications.
Various expensive prizes will be offered every three months to participants to keep motivating them to participate. It is amazing what people will do for the chance of winning an iPod! At the end of 20 years one lucky person who stuck with the study gets a Maserati or a world cruise--something along those lines. Bill can afford it.
This study is particularly important. Despite the fact that a whole series of short term dietary studies have established the superiority of low carb dieting for people with diabetes, every single review of their data concludes "caution is required as we still do not know the long term effects of this diet" and then goes on to suggest they are probably bad. This study would answer that.
Both these studies would cost a lot of money because they would require large populations to be followed for many years. But "a lot of money" when you are discussing medical studies is something like $30M over ten years, which is lunch money for Microsoft Bill.
For now, this is our only hope of seeing ANY research that doesn't "prove" that oral drug A makes a tiny but not clinically significant (as opposed to statistically significant) change in the diabetes patient's health as it makes its lemming-like way over the cliff!
Don't YOU hope Bill joins "the club no one wants to join?"
Copyright Janet Ruhl 2007. If you are NOT reading this on http://diabetesupdate.blogspot.com the content has been STOLEN.
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