Diabetic care: Deciding what is necessary vs. unnecessary

Diabetic care: Deciding what is necessary vs. unnecessary

Overtreated by Shannon Brownlee

There is a lot of care to manage when you are a diabetic.  You have to see your doctor or endocrinologist regularly and get your A1c test (to show your average blood sugar over the last couple months).  You have to get your eyes checked once a year for problems in the retina.  Your doctor also wants to keep tabs on your weight, blood pressure, the condition of your feet, and labs such as cholesterol to ensure you are in good health and to minimize the risk of various complications of diabetes, such as the risk of going blind or having a heart attack.

But how much of this care is really necessary?

I read an eye-opening book recently about the state of our health care here in the United States: Overtreated by Shannon Brownlee.  Not only are we wrong when we think our health care is the best in the world, we are massively overpaying for health care that gives us not one iota better health than the care other developed countries offer -- and can actually at times put us at more risk.

The issue is that doctors and the pharmaceutical companies are constantly subjecting us to unnecessary, expensive and often risky medical procedures and medicines, while ignoring the need for other care that can actually make a difference (such as counseling diabetics on how to improve their health via diet and exercise).  Doctors and hospitals order unnecessary tests and prescribe unnecessary medicine because they get paid more for doing so or because they have connections to the drug companies, and patients often demand these things because of the many advertising campaigns that (successfully) attempt to intervene in the traditional doctor-patient relationship.

While many things about diabetes care are completely necessary, the book makes me think about things that are often overlooked by many doctors, such as ensuring that diabetics know the importance of diet and exercise.  And it also makes me wonder about things such as the increasingly stricter expectations for cholesterol (which leads to more and more people being on statins, despite recent studies indicating that they may not actually reduce the risk of heart attack).  As the book points out, most medical studies are funded by the drug companies -- and of course, they have incentive to find in favor of their products.  In fact, the book cites more than one instance of the drug companies withholding information about dangerous side effects.

So how do you know what parts of your care are necessary or unnecessary?  One of the messages of the book is how important it is to have a primary care doctor whom you can trust.  I'd say to start there, but also to question everything -- why do you need this test or drug, how likely is it to help, and what are the risks and side effects?  Use common sense, and don't be too quick to jump on the bandwagon whenever your doctor recommends a new drug, test, or procedure.