Personalize Diabetes Therapy, October 14, 2018

Personalize Diabetes Therapy, New EASD-ADA Guidelines Stress
by Miriam E. Tucker
October 08, 2018
 https://www.medscape.com/viewarticle/903090?nlid=125494_381&src=WNL_mdplsnews_181012_mscpedit_wir&uac=164666HZ&spon=17&impID=1767491&faf=1

        Personalized Diabetes Therapy, really what is this? Just baby toy to make a noise. How any treatment can be 'personalized' or 'not-personalized'? Every human body is unique. There are no one like any one else. So, the question is, should MD create special treatment for every patient under his care? Or should he treat every one with the same medicine and care?
       The statement is meaningless from the start. But it sound nice and passionate. Do really is the way to go?
       Why it is patient who must be treated but not the medical condition patient need to overcome? If attention will be pull on to the combat of Diabetes rather then person who carry it, then there is meaning and hope that finally patient will recovery, or at least less suffer. But it is not under attention of all Medical Care. Attention only to Show Case, Cooking Book Therapy.

The final version of the document, "Management of Hyperglycaemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)," was presented October 5 here at the European Association for the Study of Diabetes (EASD) 2018 Annual Meeting  and simultaneously published in both Diabetologia  and Diabetes Care.

Every year there are new guidance to address to diabetics treatment. What is new now?

Unchanged from June but in a major shift since the last ADA-EASD consensus report from 2015, this one recommends that the choice of second-line glucose-lowering agents after metformin be driven by new evidence from cardiovascular outcomes trials and by areas of medical need, including weight reduction and avoidance of hypoglycemia. And for injectables, it advises that glucagon-like peptide (GLP)-1 agonists are preferred over insulin.  

        Well, I used to be under this 'new' therapy since 2001, Metformin and SU, and Weight Loss. So, what is new now? It is different second line after Metformin and lifestyle modification (now it ia named : life style intervention).  Still there is the question. Why Metformin still First Line? It did not work last 20 years, if it ever worked at all. There are more and more diabetics type 2 diagnosed, and even kids as little as 3 years old can be diagnosed as diabetics type 2. Every one diabetic type 2 takes Metformin. And now there is the second line of treatment must be started.  Sorry, why do not stop medicine which does not work, and start to take another one? First line did fail. Push it asside, and start over with another medicine.
        There bigger fish to fry on the table now.  Just take closer look and try to see, how a new guidance provide 'personalized care'? Does anyone see the person in this guidance? Diabetic type 2 with special needs? I do not see myself or my needs to be addressed.
         First. what is it, "first line" therapy? Does it has meaning to anyone? We are human. Everyone of us unique. We come to ER, to clinic, and what next? MD takes blood sugar reading, 420 mg/dl, or 700 mg/dl. So, what is after? The next step, as it is recommended by ADA-EAS, to start weight loss. In stead to transfer diabetic type 2 into ICU, patient go home to modify his/her life. Hope, one will get home safely. I was discharged from ER from  hospital cross the street with sugar in urine 1000 mg/dl. Very high sugar reading. They did not say to me what was sugar in blood, and my meter does not take reading over 599 mg/dl. I was sent home. No test for ketones. I am diabetic type 2. According to ADA diabetics type 2 do not have ketones. Ketones  come after sugar is very high, so fat used as sourse of energy. Next stop is coma. If left untreated, it s Death.
       Next step is metformin.  It is interesting, as I read in many studies paper, Metformin reduce level of sugar in blood  up to A1c 1%. So, if right now A1c=9.4% then after Metformin it will be 8.4%. Say me, for how long it must be taken to get from 9.4% down to 8.4%? It is diabetes. If today one took one's way on diabetes highway, sugar will go up and up and up. So, what is the reason to take Metformin? Would this safe diabetic's type 2 life? Or Diabetic type 2 will die without any sign of recovery?
      This is first line which crossed my mind. With all presentations that diabetes type 2 treatment 'personalized' or 'client centered' there is always no attention to the client, diabetic type 2.
       Finally, injectaible. GLP-1 agonist increases insulin secretion from beta-cells and suppresses glucagon secretion from alpha-cells. As usual, it is nice to go organic. So, Victoza, Byetta, and all that kind of medicine, second generation medicine known as SU, provide diabetic type 2 with his/her own insulin, secreted by own beta-cells. Looks like good, is not it? It is bad. Really, it is very very bad. Because of this insulin is not the same which secreted by our system without any force. It is natural, yes, but this come with high cost: Beta Cells lost. Over the time there is nothing would be left. This is why diabetics type 2 live less then 10 years after being diagnosed with diabetes type 2. Only one way to safe our lives is, start to take insulin.
        Now there is one question which left: Why if we will need to take insulin later, do not start with Insulin as early as it is possible, right from the diagnose? Profit. We are too profitable for Medical Complex. Every one do know how costly diabetes type 2 is. Every one take big spoon from our sweet blood, politicians and medical care, governments and medial, you name, they are stand in line with Big Spoon ready. Our blood is sweet, every one is free to benefit from it.
comments by readers:

This is just a bundle of confusion. Even Doctor's are in confusion after practicing medicine for so many years.
First thing is first. Patients are in center of the treatment  Then price/age/culture/ and other medical comorbidities present with the patient  should be consider very seriously. No matter how good your meds are if charges $700/800 per month per one prescription how would person earning $2000 per month will afford. IN USA where profis is the only main goal in corporations and even in medical industry, more than 60% employees have no insurance to afford a care.
Medicare/medical rules are formulated in capitol buildings and people who write do not have any expericing of life living w/o insurance or live with minimum wage in USA.

In NYC my disability was terminated by SSA because of too high income. My man lost his job, so two of us lived on unemployment check, $1138 monthly. Only Insulin for me at that time cost $2000 monthly.  No any medical insurance we could afford. Without Insulin I started to skip into deep hole. It was at that time when my sugar was over $599 mg/dl. I went to community hospital. A lot of Barking Therapy. No insulin. No medicine. But I could have first line treatment, it is all the time first regardless how many times it is Rx: Metformin, SU, and lifestyle modifications.

YES!!!  Personalized Medicine !!  They should win the Nobel Prize,   I would never guess that one

 I was looking for Noble Prize winners. They are not on list yet. They should!!!!!!!!

SGLT2 BLOCKERS TOGETHER WITH GLP1 ANALOGS ARE SUPER COMBINATION- IF PATIENT CAN NOT PAY FOR IT THERE IS MUCH CHEAPER TREATMENT - E A T    L E S S and lose  important 15 kg of weight  !!!!!!

He is endo. This is why I do not like to go to endo. Well, now I do finally have good doctor, and she is endo. But first 10 years it was another. God, keep his soul under ground, and never let escape the Hell!
 

via Ravenvoron