Tag: "diabetes"

The Uneasy Case Against Salt: Part Two

The 2010 Dietary Guidelines for Americans was developed by the Department of Health and Human Services and the Department of Agriculture. They say that dietary sodium intake should be reduced to less than 2,300 milligrams per day for the general population, and to less than 1,500 milligrams per day for African Americans, people over 50, and people who have hypertension, diabetes, or chronic kidney disease. This blog has been critical of that determination since early 2009, with posts on the Salt Police, Rejoinder on Salt, The Other Side of the Salt Debate, and The Uneasy Case Against Salt.

The Centers for Disease Control asked the Institute of Medicine (IOM) to examine the literature on dietary sodium intake and its effect on health outcomes in the general U.S. population. The May 14, 2013, summary of the IOM consensus report concludes that there is no evidentiary basis for the conclusion that sodium intakes below 2,300 milligrams per day either “increase or decrease the risk of heart disease, stroke, or all-cause mortality in the general U.S. population.”

The committee did find some evidence suggesting that sodium intake levels in ranges from 1,500 to 2,300 mg/day may have adverse health consequences for those with diabetes, kidney disease, or cardiovascular disease.

Noting that there is evidence to support a “positive relationship between higher levels of sodium intake and risk of CVD” via the effect of salt intake on the blood pressure of people who have high blood pressure, the IOM calls for “more randomized controlled trials.” The press release for the report says that the report does not establish a health intake range for salt because “variability in the methodologies used among the studies would have precluded it.”

The Cost of Being Fat

In the past 30 years, the percentage of American adults who are obese has doubled, driving a sharp rise in such chronic conditions as diabetes, heart disease and hypertension.

The ramifications for health spending are significant. Annual health costs for obese individuals are more than $2,700 higher than for non-obese people. That adds up to about $190 billion every year. And many of these costs are borne by Medicare, which will spend a half-trillion dollars over the next decade on preventable hospital readmissions alone.

Ken Thorpe and Tommy Thompson in USA Today.

A Market for Chronic Care?

It’s not just sore throats and flu shots anymore. Walgreens today became the first retail store chain to expand its health care services to include diagnosing and treating patients for chronic conditions such as asthma, diabetes and high cholesterol…

Retail clinics generally appeal to consumers looking for convenience and cost savings. Costs are roughly 30 percent to 40 percent less than similar care at doctor’s offices and 80 percent cheaper than at an emergency room, according to a 2011 study published in the American Journal of Managed Care.

This is from Kaiser Health News.

Rising Cost of Diabetes, and Other Links

Should People Who Cause Their Own Illnesses Pay for Their Own Health Care?

David Friedman weighs in:

I recently came across a news story about a British legislator who proposed that patients suffering from life style illnesses, medical problems mainly due to behavioral choices such as being overweight, ought to have to pay for their own medicines rather than having them provided for free by the National Health Service. It is a proposal that I expect will provoke strong responses both against and for…

[I]t is not clear just how the logic of endogenous disability can be dealt with in a governmental system such as the National Health Service. There is a serious problem of lack of bright lines. Many sufferers from type 2 diabetes, an example mentioned in the news story, may have it because they choose to be greatly overweight, but presumably not all. Similarly in other cases.

Okay, commenters. What do you think?

The Secret of Ikaria

Ikaria, Greece, [is] a 99-square-mile island 30 miles off the coast of Turkey… [T]he island has 10 times as many siblings over the age of 90 compared with any other place in Europe…Ikarians also have less cancer, cardiovascular disease, depression and dementia than other parts of Europe, and men outlive women.

In addition to eating a healthy Mediterranean diet (fruits, vegetables, whole grains, beans, nuts, healthy fats and fish and seafood), there are other key habits and values embraced by the Ikaria inhabitants.

Dan Buettner, author of Blue Zones: Nine Lessons for Living Longer From the People Who’ve Lived the Longest, has seen those same habits in the other four Blue Zones: Sardinia, Italy; Nicoya Peninsula, Costa Rica; Loma Linda, Calif.; and Okinawa, Japan.

Janice Lloyd from USA Today.

The Cost of Drugs to Combat Normal Aging Exceeds the Cost of Drugs for Chronic Illnesses

The research suggests that cost and utilization of medications to treat conditions considered a normal part of aging, including those related to hormone replacement therapy, sexual dysfunction and mental alertness, are becoming so popular that they now rank third for cost impact only behind diabetes and cholesterol among commercially insured patients.

Researchers at Express Scripts in St. Louis looked at trends in prescriptions filled for aging medications among those commercially insured and found that in 2011 alone, per member cost for aging medications ($73.30) was 16 percent greater than the amount spent on both high blood pressure and heart disease medications ($62.80). The cost for diabetes medications was $81.12 and high cholesterol medications was $78.38.

Source: Health, Medical and Science Updates.

Ineffective Diet and Weight Loss, and Other Links

The Demonstration Projects Are Not Working

  • A paper in Health Affairs (subscription required) released last week found that even “aggressive” improvements in performance measures by accountable care organizations caring for diabetic patients would result in minimal cost savings — and “after the costs of performance improvement, such as additional tests or visits, are accounted for,” those minimal cost savings could become cost increases.
  • A recent analysis of North Carolina’s patient-centered medical home initiative found the program yielded no budgetary savings, contrary to expectations.
  • More broadly, the Congressional Budget Office noted earlier this year in a major report that most Medicare demonstration programs over the past several decades have NOT saved money.

Source: Chris Jacobs.

A Primitive Tribe Doesn’t Get Modern Diseases

Research on the [indigenous Tsimane of northern Bolivia] led to the finding in 2009 that cardiovascular disease is probably an ill of modern societies. Studies of the group also provided the most conclusive data supporting the idea that high levels of physical activity drastically reduce the risk of diabetes, obesity and hypertension.

There have been 42 studies with results published, and at least 33 more are under way. “This is the most productive research site in anthropology today,” Ray Hames, an anthropologist at the University of Nebraska-Lincoln, said.

Jean Friedman-Rudovsky in the NYT.