Yes folks, I’ve now launched the membership site, with information, a community forum and structured learning programmes for people with diabetes and their families.

Check it out right now at www.diabetesdietdoctor.com.

Yet another review (and papers in the same edition of the British Medical Journal) saying that self-monitoring in Type 2 diabetes is a waste of time and resources.

The review is by a Public Health doctor who summarises the “evidence” he has found by reading the papers and following their reference links. The papers show that in controlled trials, there is no benefit for self monitoring in terms of falls in HbA1C concentrations when compared with patients who were managed without taking their own blood glucose measurements.

This is not surprising because the HbA1c levels were not high in the first place, so any change could only be marginal.

In addition, in common with all other studies of this type, the approach to self monitoring was that only small changes were made to the tablets or to diet in response to the results of relatively few measurements.

Self monitoring is a potential life-saver in Type 2 diabetes when used intelligently. What is required is a period of intensive monitoring so that the person with diabetes learns exactly the effect of different amounts of different foods on their blood glucose levels and how to keep their fluctuations in blood glucose to a minimum. After this period, much less testing is needed because they know how and when to eat.

The complications of diabetes cost healthcare systems a huge amount of money, and this will go on increasing until people with diabetes take charge of their own condition and (mainly through reducing carbohydrate intake) get it under good control. Self monitoring is an essential part of that process, but education about what to do with the results is the key. Unfortunately, most diabetes professionals don’t seem to have grasped this yet.

The waste of time and resources is in doing these studies and publishing the results.

Read if you want, but don’t get discouraged.

And do go on testing, so you can learn how to improve your control.

Research, doi: ; doi: 10.1136/bmj.39526.674873.BE 10.1136/bmj.39534.571644.BE

http://www.bmj.com/cgi/content/abstract/bmj.39534.571644.BEv1

Interesting commentary in the Journal of the American Medical Association recently about how abnormal fat metabolism is the root cause of Type 2 diabetes. The author suggests that accumulation of fats in body cells causes insulin resistance and therefore Type 2 diabetes. The fats, he says get deposited in body cells because people eat too much, and he’s probably right, but he doesn’t address the question of what sort of eating too much is particularly bad for you. The current view seems to be that excess calories make you fat, and that since dietary fat contains 9 kcal per gram, this is worse than carbohydrate, which has about 4 kcal per gram, but in fact, what really cause fat to be laid down in cells is insulin, and this is only produced when you take in carbohydrate. So, the theory may be right, but the detail, as always is vital to the message.

 The report is by Unger, JAMA, March 12 2008, Vol 299, No 10, 1185-7.