Friday, April 1, 2011

Sherlock Strikes Again

Seriously, I wish this was an April Fool's joke.

But sadly, it's not.

This is the one where we get to once again explore how stupid and worthless some medical and health studies are, in exploring questions that don't actually need to be explored.

I've ranted and raved about this concern of mine before, touching on studies that have found "Sedentary behavior linked to high blood sugar" and "Active Self-care Improves Blood Sugar Control." That March 31, 2007 post was entitled No Shit, Sherlock and I ended up recycling it last summer, but now it comes to this again as a new mind-boggling study has been spearheaded by inquiring minds in the Diabetes Research Community. Apparently, Sherlock Strikes Again.

Oh, and here's a shout-out to DiabetesMine that has a great look today at another stupid waste of a study, this one also over in Europe.

Side note: What is it about this time of year? Is this the Season of Senseless Studies, a time when we see just how money can be wasted exploring issues that simply don't need exploring because they're known to anyone with a brain??

But, on to this new study that a Reuters news story gave the headline: "Counting carbs may help with type 1 diabetes." Here's the first part of the story describing the study and its findings...

Tallying the number of carbohydrates in the diet may be helpful to people using an insulin pump to treat type 1 diabetes, a small study suggests.
The study, of 61 adults on insulin pump therapy, found that those who learned to count carbs had a small reduction in weight and waist size after 6 months.
They also reported gains in quality of life and -- at least for those who consistently counted their carbs with each meal -- an improvement in blood sugar levels.
The findings, published online by the ADA journal Diabetes Care and scheduled to appear in the April print issue, do not prove that carb counting is the answer for people with type 1 diabetes.

The actual study can be found here, entitled "Effects of Carbohydrate Counting on Glucose Control and Quality of Life Over 24 Weeks in Adult Patients With Type 1 Diabetes on Continuous Subcutaneous Insulin Infusion." (a.k.a insulin pumping therapy)

In the intro to this study where it discusses the objective, the researchers note this: "Few studies have assessed the efficacy of carbohydrate counting in type 1 diabetes, and none have validated its efficacy in patients who are treated with (insulin pumps). The aim of our study was to test the effect of carbohydrate counting on glycemic control and quality of life in adult patients with type 1 diabetes who are (on pump therapy)."

Conclusion: Among adult patients with type 1 diabetes treated with CSII, carbohydrate counting is safe and improves quality of life, reduces BMI and waist circumference, and, in per-protocol analysis, reduces HbA1c."

(Sigh...)

Um, really. Really!? I honestly don't even know where to begin ranting about this one.

The rocket scientists listed on this research study all appear to hail from Italy, and it's unclear from the abstract I'm able to read for free how this all came to be published in the ADA's most recent journal. or what the pressing question on this whole carb counting concept might be over there in Italy. Maybe it has something to do with pasta and how you can never seem to carb count correctly or dose accurately... Who the heck knows.

I may be guessing here, but maybe the reason why there've been few studies on this is because everyone who knows this already. Carb counting is the whole basis for how an insulin pump works - you get a steady basal rate that acts as you're long-acting during the day, and then you take a bolus whenever needed for FOOD or higher-than-normal BGs. The same concept applies to Multiple Daily Injections, when you're doing the same with syringes rather than a piece of technology.

I mean, seriously. If you aren't calculating carbs correctly, then you aren't dosing insulin accurately and therefore YOUR BLOOD SUGARS ARE OFF. The next logical extension of that is when you're BGs are Low or High based on incorrect carb counting and bolusing, then at least you're immediate quality of life is diminished and you're A1c is likely to be higher based on higher BGs building up over time.

As I've written before, but never seem to get a solid answer for my question: Why The Fructose are we wasting time and energy on stupid studies that simply reinforce what isn't disputed and what we already know? My mind has melted from the confusion about why this was even given attention in the first place. I get that sometimes people just need to be able to justify their beliefs with actual study-based research. But seriously. What a complete waste of time and money that could have been focused on something more productive.

For example, this very same issue of Diabetes Care includes details on another study that actually seems worthwhile. That one has the title: "Protection From Retinopathy and Other Complications in Patients With Type 1 Diabetes of Extreme Duration - The Joslin 50-Year Medalist Study." Those leading this study are from the U.S., largely in Massachusetts, and it's findings show that, "The Medalist population is likely enriched for protective factors against complications. These factors might prove useful to the general population with diabetes if they can be used to induce protection against long-term complications. Specific AGE combinations were strongly associated with complications, indicating a link between AGE formation or processing with development of diabetic vasculopathy."

To me, as a layman Type 1 diabetic without any scientific or medical background, this latter study seems to have some merit while the first does not. But, whatever.

All I know how to say, in closing, is: "No, Shit, Sherlock. Thanks for playing, Captain Obvious."

Now, I need to go do a blood test to see if dinner carb counting was anywhere near accurate and if my Scientific Wild Ass Guessing has led to a Higher BG and that's the reason I feel tired and crappy... Because, you know, THAT HAPPENS.

And I don't even need a study to prove it.

6 comments:

Sandy said...

Omg that is crazy funny. People people.....

newtothis said...

This reminds me of an old Beatle Baily comic strip. It was two cels.

First cel:

A sidewalk runs through an elaborate iron-work, tall fenced area. Inside are trees, water fountains and bird baths. A service man is feeding birds in this area. Outside the fence is a sign which reads: Bird Sanctuary.

Second cel:

One service man explains to his confused companion: There were a surplus of funds. If they didn't find a way to use them, their budget would be cut next year.

S

tomswife said...

Research, doctors, insurance companies, hospitals,

so many have become part of the money making machine

Quite a few of my relatives are now university professors -- they are all about research (with big grants from corporations) and very little about teaching students

its enough to make a person sick - OOPS -- enough to make a person upset with the way our system works

until "we" can figure out a way to copy the way a pancreas works, carb counting is the answer

a crappy way to live, but the only way to live

keep at it, you are doing a great job....

Tom's Wife

Jamie said...

As a student attempting to become a RD, CDE, I can give you some background on this...

This, while seemingly stupid to those of who've been doing this for years, is actually very valuable because it provides EVIDENCE for jerk-butt insurance companies.

Without EVIDENCE, an RD cannot be paid by the insurance company bc then the insurance company can claim that there's no evidence that what the RD does actually changes the patient's outcome. Blech.

Also, would you like the article? I can email it to you.

~Jamie

The Chocolate Cheerio said...

Unfortunately, I agree with Jamie. I always smirk when I read things like this, but there are also a lot of silly insurance companies who don't necessarily provide coverage for things like diabetes education training. Why? Partly because they're trying to cut corners... and partly because they can get away with it without this type of data. I don't know much about carb counting research (and I would've thought this study/other similar studies in populations diverse in age/nationality/ethnicity/etc would've appeared prior to now...), but hopefully this article that appears silly to those of us lucky to know enough to laugh about it will help those living with T1 who don't.

Lilly said...

So, this study was big news to WHO? What a waste of time!