Transcript of #MDchat for December 14, 2010

Follow @MD_chat for Regular Updates

Twitter.com/MD_chat
MDchat.org
Moderated by Pual Moniz of Einstein Medial College - @EinsteinMed
(This Version Includes Retweets)

Welcome to #MDchat! Paul Moniz of @EinsteinMed will be

tweeting. Say Hi to Paul introduce yourselves! Here are
MD_Chat details: http://ow.ly/3pknf
For the next hour I'll be learning more about #Diabetes from
GailZahtz #physicians at #MDChat
thehealthmaven Have a great chat tonight Paul! #mdchat
Zonszein Clinical diabetologist in The Bronx #MDChat
Good evening everyone! We invited some friends tonight.
curbconsult #MDchat
@MD_Chat @EinsteinMed Hi, Paul! Congratulations on
RichmondDoc being the brave pioneer :) #mdchat
Hi, it's Dr. Elizabeth Walker - I do diabetes
prevention/control research at Einstein Coll. of Med. I'm Prof.
ElizabethWPHD of Medicine. #mdchat
Phil Baumann here - just saying hello to participants of
#MDchat and wishing @EinsteinMed good luck. I'll put up a
philbaumann transcript later. Cheers!
bfishgold @md_chat: hi paul. I am brian. #mdchat
Mark, family doc in #RVA, just home from a holiday party
where I felt very outnumbered in many ways; ready to feel
RichmondDoc more at home. #mdchat
Diabetic_Iz_Me Can Patients participate in the #MDChat about #diabetes?
@thehealthmaven @GailZahtz @RichmondDoc and all of
EinsteinMed #MDchat. Howdy! Go easy on me!
MD_Chat @Diabetic_Iz_Me Absolutely! #MDchat
 @EinsteinMed Looks like you've stacked the deck w/
supporters! Don't worry, we're all friends here. You'll do great.
RichmondDoc #mdchat
Hi #MDchat! Paul here. Q1: To what extent does low
insurance reimb. prevent you from delivering optimal care to
EinsteinMed your diabetic pts? #MDchat
@EinsteinMed Paul, you'll be great! We all have faith in you.
GailZahtz #MDChat
Is it a time factor or self-management skills? Do you have a
ElizabethWPHD team approach to diabetes care? #mdchat Q1
@EinsteinMed T1 I don't think it's so much insurance
reimbursement that makes it touch; rather, it's the nature of
RichmondDoc health care today #mdchat
Ellen, Social Worker, Parent of Young Adult w/type 1
#diabetes, Advocate for cure-focused research and prevention,
CureT1Diabetes VP @cwdfoundation #MDChat
RT @EinsteinMed: Hi #MDchat! Paul here. Q1: To what
extent does low insurance reimb. prevent you from delivering
RetiringDoctor optimal care to your diabetic pts? #MDchat
Q1 Big time: Insurance doesn't pay for prevention or
management of diabetes. We really need education for
Zonszein successful outcomes #MDChat
Mike Durbin, 26, Type 2 Diabetes/CHF since 12/08. Patient
mydiabeticheart blogger at http://www.mydiabeticheart.com. #MDchat
T1 Good diabetes care requires *time*--lots of face-to-face
time. The current reimbursement system doesn't value that
RichmondDoc face time. #mdchat
Cherise: Type 1.5/LADA,diabetes blogger, moderator of
Diabetic_Iz_Me #dsma (diabetes social media advocacy) #MDChat
T1 Diabetes might also be the most complex illness most
primary care docs face: labs, meds, counseling, teaching, etc:
RichmondDoc more time. #mdchat
 Q1 Our health care insurance loves to pay for tertiary
prevention (dialysis, amputations, etc) but not prevention
Zonszein #diabetes #mdchat
Fact: #CDC projects that if trends continue, 1 in 3 Americans
will have diabetes by 2050. http://ein.st/gJ270F Reaction?
EinsteinMed #MDchat
@RichmondDoc T1- What do you think are options to help
with diabetes care above the face time insurance won't
GailZahtz reimburse? #MDChat
quot;Q1: To what extent does low insurance reimb. prevent
you from delivering optimal care to your diabetic pts?
Diabetic_Iz_Me #MDchat”
RT @RichmondDoc: T1 Diabetes might also be the most
complex illness most primary care docs face: labs, meds,
DiabeticFury counseling, teaching, etc: more time. #mdchat
Do you know how to access diabetes education programs? Q1
ElizabethWPHD #mdchat
Lizmari: Type 2 Diabetes/PCOS/Hypothyroidism Patient.
lizzmariposa Advocate and casual blogger. #MDCHat
Q1 - The Japanese model seems to work well. If we paid based
RetiringDoctor on outcomes, we wouldn't have this mess. #mdchat
@GailZahtz I actually think there needs to be a fundamental
re-thinking of how we value time vs. amputations, dialysis,
RichmondDoc etc. #mdchat
We're using Q1, Q2 vs T1 T2 so as not to confuse type 1/2.
EinsteinMed #MDChat Thx.
RT @Zonszein: Q1 Our health care insurance loves to pay for
tertiary prevention (dialysis, amputations, etc) but not
RichmondDoc prevention #diabetes #mdchat
@RetiringDoctor I agree. Our reimbursement system needs to
Zonszein be changed. #diabetes #mdchat
 @RetiringDoctor T1- But isn't the insurance reimbursement
and time issue for prevention relevant to all diagnosis also?
GailZahtz #MDChat
RichmondDoc @EinsteinMed Gotcha! Force of habit... #mdchat
Q1. I do, even though I have no insurance. But I am well
educated enough now that a lot of what they share is not very
lizzmariposa realistic. #MDCHat
RT @RetiringDoctor: Q1 - The Japanese model seems to work
well. If we paid based on outcomes, we wouldn't have this
curbconsult mess. #mdchat
@EinsteinMed Woops, okay, force of habit also- I'm on Q1.
GailZahtz #MDChat
@RetiringDoctor Q1 the devil is in the details, though. What
RichmondDoc outcomes are worthwhile? Is A1c the right target? #mdchat
@richmonddoc @gailzahtz Absolutely it is all about
ElizabethWPHD prevention - primary and secondary. Q1 #mdchat
Q1 treatment of chronic diseases is very expensive, especially
Zonszein type 2 #diabetes #mdchat
@RetiringDoctor Q1 There was a JAMA study showing that
much of a physician's quality measures depends on the nature
RichmondDoc of doc's panel. #mdchat
RT @Zonszein: Q1 Big time: Insurance doesn't pay for
prevention or management of diabetes. We really need
CureT1Diabetes education for successful outcomes #MDChat
Q2: For those in primary care solo/small practice groups, how
EinsteinMed do you access services of CDEs, RDs? #MDchat
@ElizabethWPHD @richmonddoc I agree completely that
prevention is key. But we also all agree that reimbursements
GailZahtz don't support that #MDChat
Q2 From working in a small town, I can vouch for the fact that
it can be very, very hard to find good CDE/RD services for pts.
RichmondDoc #mdchat
 @RichmondDoc Q1 We don't treat A1c1, we treat patients and
Zonszein quality of life. #diabetes #mdchat
Q2 Usually simply referred to the hospital dietitians and
RichmondDoc hoped for the best... #mdchat
@GailZahtz I agree, but I think it's most relavent to diagnoses
like #diabetes where education (and time) is so important.
RetiringDoctor #MDchat
Q2 there is a scarcity of educators because of low
Zonszein reimbursement - all over the country. #diabetes #mdchat
@Zonszein Q1 Agreed--we treat patients. But the most
common quality measures currently used involved disease-
RichmondDoc focused measures (A1c) #mdchat
sorry I'm late.... will be lurking since i am NOT a DM
specialist.... although mny of my patients suffer from it.
hjluks #mdchat
Education classes I've been to, they didn't address carb
counting, and even gave people a high carb dinner, to boot. :/
lizzmariposa #MDCHat
“ @GailZahtz I agree, but I think it's most relavent to
diagnoses like #diabetes where education ( time) is so
Diabetic_Iz_Me important. #MDchat”
Q2a: @RichmonDoc and others...Any online resources that
EinsteinMed have helped you? Please share. #MDChat
I stopped going... They were at night, and at dinner time...
lizzmariposa *shrug* It didn't meet my needs. #MDCHat
As a pt, I'm curious as to (if you're a pcp) if you feel
comfortable treating T1 in what circumstance you advise a PT
JDRFQUEEN 2 see an Endo?#mdchat
http://j.mp/d5Z8gi ♻ @ColumbiaSurgery I'm in to.
healthgist Sorry for the late sign-in. #mdchat #mdchat
ColumbiaSurgery I'm in to. Sorry for the late sign-in. #mdchat #mdchat
 RT @RichmondDoc: T1 Good diabetes care requires *time*--
lots of face-to-face time. The current reimbursement system
DiabeticFury doesn't value that face time. #mdchat
lizzmariposa So, I feel a lot of the education stuff is broken, too. #MDCHat
A great resource to find a CDE is www.diabeteseducator.org.
ElizabethWPHD #mdchat Q2
agreed! “@Zonszein: Q2 there is a scarcity of educators
because of low reimbursement - all over the country.
Diabetic_Iz_Me #diabetes #mdchat”
@Zonszein Q2 (and still Q1) Think of this- kidney transplant
is covered 100%. Nutritionists often aren't covered at all.
GailZahtz #MDChat
@Zonszein Don't get me wrong: I don't endorse treating the
A1c. But it's easy to measure, attractive target for quality
RichmondDoc markers. #mdchat
@Diabetic_Iz_Me both diseases are costly. T1 is demanding
and not reimbursed, T2 is expensive b/c of complications #
Zonszein of patients #mdchat
RT @ElizabethWPHD: A great resource to find a CDE is www.
RichmondDoc diabeteseducator.org. #mdchat Q2 #mdchat
RT @GailZahtz: @Zonszein Q2 (and still Q1) Think of this-
kidney transplant is covered 100%. Nutritionists often aren't.
ColumbiaSurgery #mdchat
Lurking on #MDchat with interest - the subject tonight is
providing optimal care for diabetes patients in the US
a_singledrop healthcare system!
Q1/Q2: many difficulties result from the fact that our
reimbursement systems value high tech/high intensity care,
RichmondDoc not personal care. #mdchat
@RichmondDoc @Zonszein Does A1c correlate with risk of
hjluks post surgical infections? #mdchat
 RT @Zonszein: @Diabetic_Iz_Me both diseases are costly. T1
is demanding and not reimbursed, T2 is expensive b/c of
RichmondDoc complications # of patients #mdchat
@GailZahtz With or without reimbursement we must find a
way to prevent morbidity. Find a team to deliver care.
ElizabethWPHD #mdchat
@JDRFQUEEN All T1DM need to be followed by a diabetes
team. All T2DM should be followed by PCP w/assistance by
Zonszein educators. #mdchat
RT @RichmondDoc: Q1/Q2: many difficulties result from the
fact that our reimbursement systems value high tech/high
sarahlance intensity care, not personal care. #mdchat
Q1/2: I think team-based care w/ emphasis on self-care, pt
empowerment, and pt self-management is the best approach.
RichmondDoc But what $? #mdchat
@RichmondDoc treatment of T2DM is global cholesterol, BP
Zonszein glucose. Preventing CVD. #mdchat
Q3: Long-term behavioral modification is a challenge with
diabetes. What’s working in your practice to improve
EinsteinMed adherence? #MDChat
RT @EinsteinMed: Q3: Long-term behavioral modification is
a challenge with diabetes. What’s working in your practice to
MD_Chat improve adherence? #MDChat
RT @Zonszein: @RichmondDoc treatment of T2DM is global
EinsteinMed cholesterol, BP glucose. Preventing CVD. #mdchat
@ElizabethWPHD we must find a way #mdchat lt;-I agree. I
think some is going to have to come from non-face-time
GailZahtz communication and compliance
“Q3: Long-term behavioral modification is a challenge with
diabetes. What’s working in your practice to improve
Diabetic_Iz_Me adherence? #MDChat”
@GailZahtz This is unfortunate. Our healthcare system needs
Zonszein to change. #mdchat
Zonszein @RichmondDoc Agreed. #mdchat
“@Zonszein: @GailZahtz This is unfortunate. Our healthcare
Diabetic_Iz_Me system needs to change. #mdchat”
@hjluks I'm lurking too since I'm not a physician here for a
thehealthmaven show of support to MD's @EinsteinMed...#mdchat
RT @Zonszein: @JDRFQUEEN All T1DM need to be followed
by a diabetes team. All T2DM should be followed by PCP
RichmondDoc w/assistance by educators. #mdchat
@hjluks This is questionable. No good data in the literature.
Zonszein #mdchat
@EinstenMed Q2a - Sometimes we get network requests from
physicians looking for CDE's and RD's in their area. We help
ClearMedNetwork for free. #MDChat
Not an MD have seen @endogoddess success w teen diabetes
patients instant messages.http://www.youtube.com/watch?
mkmackey v=R8AZv5P1AYs #mdchat
Q3a: Examples of empowered e-patients or technology (like
EinsteinMed SMS) improving adherence? #MDchat
@Zonszein I think we're all in 100% agreement. I also think
we have to find ways around the healthcare system to increase
GailZahtz pt care #MDChat
@Zonszein @hjluks The presence of diabetes correlates with
risk of infection, can't find anything re: to the specific A1c
RichmondDoc level. #mdchat
Has anyone tried health educators using the telephone or text
ElizabethWPHD messages for promoting adherence to self-care? #mdchat Q3a
@Zonszein: Q1 Our health care insurance loves to pay for
tertiary prevention (dialysis amputations etc) but not
dorameulman prevention #mdchat Bullseye!
“@EinsteinMed: Q3a: Examples of empowered e-patients or
Diabetic_Iz_Me technology (like SMS) improving adherence? #MDchat”
 Q3: one way to increase pt adherence: make sure that patients
are empowered, setting goals, discussing Rx choices: work
RichmondDoc WITH pts. #mdchat
Q3 Clinical studies show that adherence to medications
produces best outcomes. Explain to pts why they need it, why
Zonszein to take them. #mdchat
@ElizabethWPHD @mkmackey's post a moment ago might
help answer that: text messages help improve Rx adherence.
RichmondDoc #mdchat
@EinsteinMed Q3 The studies show that compliance
increases 43% with pts who use #mHealth for compliance.
GailZahtz #MDChat
@ElizabethWPHD There is some early evidence that text
messages help w/ adherence and self-care in illnesses other
RichmondDoc than diabetes. #mdchat
9:35 Comprehensive diabetes resource link for those
interested: http://ein.st/hftqD3 #MDchat Suggested
EinsteinMed additions?
RT @EinsteinMed: 9:35 Comprehensive diabetes resource
link for those interested: http://ein.st/hftqD3 #MDchat
ElizabethWPHD Suggested additions?
Highly recommend brief book Motivational Interviewing in
Health Care 4 behavior change (purchased at ADA '09) http:
CureT1Diabetes //amzn.to/9n1drO #MDChat
@ElizabethWPHD Do you think like a text4baby for diabetes?
GailZahtz #MDChat
RT @EinsteinMed: 9:35 Comprehensive diabetes resource
link for those interested: http://ein.st/hftqD3 #MDchat
SuzannaNarducci Suggested additions?
From a patient point of view-be personable-talk to us in terms
Diabetic_Iz_Me we understand. #MDChat
 @ElizabethWPHD But I don't know specifically of a study
looking at diabetes self-care adherence (beyond Rx adherence)
RichmondDoc re: text msgs. #mdchat
Comprehensive diabetes resource link for those interested:
EinsteinMed http://ein.st/hftqD3 #MDchat Suggested additions?
So there are a lot of good websites in the link to promote
ElizabethWPHD adherence to self-care. http://ein.st/hftqD3 #MDchat
RT @EinsteinMed: Comprehensive diabetes resource link for
those interested: http://ein.st/hftqD3 #MDchat Suggested
RichmondDoc additions? #mdchat
As a 26 year old with Type 2 Diabetes and Congestive Heart
Failure, I'm curious as to how often doctors are seeing such
mydiabeticheart cases. #MDchat
RT @Diabetic_Iz_Me: From a patient point of view-be
GailZahtz personable-talk to us in terms we understand. #MDChat
@mydiabeticheart More and more common in younger and
Zonszein younger cases. #mdchat
Q4: With sharp increase in T2 cases, esp. amg teens/young
adults, are u seeing more liver dis., high chol. PCOS, kidney
EinsteinMed probs? #MDchat
RT @RichmondDoc: T1 Good diabetes care requires *time*--
lots of face-to-face time. The current reimbursement system
midwifeamy doesn't value that face time. #mdchat
Q4 quot;The new T2DM quot; is a more aggressive disease
with more organ damage (fatty liver, heart disease, etc) at a
Zonszein younger age. #mdchat #diabetes
Q4 in a general primary care family medicine practice, I'd say
yes. Not a huge increase for me, though suspect specialists see
RichmondDoc more #mdchat
Sobering Fact: US cost of diabetes is $220 billion a year and
EinsteinMed rising. http://ein.st/gAJuQg #MDChat
 Q4 certainly have needed to f/u teens w/ abnormal liver tests,
early signs insulin resistance, PCOS, etc. Getting more
RichmondDoc common. #mdchat
@richmonddoc There have been some promising studies with
ElizabethWPHD adolescents with diabetes and texting. #mdchat
RT @RetiringDoctor: Q1 - The Japanese model seems to work
well. If we paid based on outcomes, we wouldn't have this
westr mess. #mdchat
@RichmondDoc Q4 When i started, there were zero cases
w/T2DM in pediatrics. Now it's close to 1/2 of the clinic.
Zonszein #mdchat
(clarification: f/u = follow-up, for anyone following not used
RichmondDoc to medical shorthand) #mdchat
@mydiabeticheart Thanks for being here. How effectively do
EinsteinMed you feel you're being treated? #MDchat
Q4 When I started my practice, GDM was rare, now it can be
Zonszein more than 10% of pregnant patients. #diabetes #mdchat
@Zonszein Certainly not surprised to hear that. Get ready for
more and more: lots of little kids in practice gt;95% body wt
RichmondDoc for age. #mdchat
wow!“@Zonszein: @RichmondDoc Q4 When i started, there
were zero cases w/T2DM in pediatrics. Now it's close to 1/2 of
Diabetic_Iz_Me the clinic. #mdchat”
Q4 Since high incidence of #diabetes patients younger seems
likely new technologies might help adherence? #mdchat
mkmackey #mdchat
@RichmondDoc Unfortunately, this will be the work force of
this country and we need to keep them in good health.
Zonszein #mdchat
RT @Zonszein: @RichmondDoc Q4 When i started, there
were zero cases w/T2DM in pediatrics. Now it's close to 1/2 of
CureT1Diabetes the clinic. #mdchat
 (Just to extend the discussion: type 2 DM heart disease
increasingly important causes morbidity/mortality in
RichmondDoc developing nations) #mdchat
RT @mkmackey: Q4 Since high incidence of #diabetes
patients younger seems likely new technologies might help
GailZahtz adherence? #mdchat
Q5: WHO: By 2030 366 mil will have diabetes globally, 81% in
dev. co. What is best way for dev. nations to address
EinsteinMed epidemic? #MDChat
@mkmackey Technologies may help T1. Aggressive early
Zonszein detection and intervention helps T2. #diabetes #mdchat
@Zonszein The challenges in all this is that the issues of
obesity/diabetes/etc re-define the phrase quot;multifactorial
RichmondDoc causes quot;. #mdchat
RT @Zonszein: @mkmackey Technologies may help T1.
Aggressive early detection and intervention helps T2.
GailZahtz #diabetes #mdchat
We know we can prevent t2 diabetes in adults. See the
Diabetes Prevention Program. Obesity prevention is key.
ElizabethWPHD #mdchat
RT @EinsteinMed: Q5: WHO: By 2030 366 mil will have
diabetes globally, 81% in dev. co. What is best way for dev.
MD_Chat nations to address epidemic? #MDChat
@EinsteinMed Dude! Look at us! I didn't even know you were
about to change the topic, but it's like we're thinking w/ 1
RichmondDoc brain. #mdchat
@Zonszein Any idea what percentage of new diagnoses are
mydiabeticheart young type 2s with CHF? #MDchat
@RichmondDoc is a mindreader anticipating Q5. Next
EinsteinMed #MDchat host in the offing? @philbaumann take notice!
Q5: one way is to encourage retention of healthy traditional
lifestyles (meals, activity, etc) avoid Americaniaztion in these
RichmondDoc ways #mdchat
 @mydiabeticheart All in all, there is more vital organ damage
with cardiomyopathy due to fatty infiltration and vessel
Zonszein disease. #mdchat
@EinsteinMed You're welcome. Overall, my treatment has
mydiabeticheart been very effective. I've seen positive results. #MDchat
Q5 in the Dom Rep, we see lots of kids (and adults) leaving
traditional healthy/balanced meals and active lifestyles
RichmondDoc behind... #mdchat
Q5 ...in return for more TV, fast food, junk food and sedentary
life choices. It's likely only going to keep moving that
RichmondDoc direction. #mdchat
philbaumann @einsteinmed He sure is! @RichmondDoc #MDchat ;)
@mydiabeticheart Glad to hear it. We definitely appreciate the
EinsteinMed pt perspective on #MDchat
@RichmondDoc Q5 We had this conversation in 2 other chats
concluding that nutrition is an economic and social issue first
GailZahtz #MDChat
Global diabetes epidemic is alarming for developing world.
Prevention! Early awareness of obesity is key. I've seen it in
ElizabethWPHD Uganda. #mdchat Q5
@RichmondDoc increase gas prices, get more bicycles and
Zonszein more quot;slow food. quot; #mdchat
RT @GailZahtz: @RichmondDoc Q5 We had this conversation
in 2 other chats concluding that nutrition is an economic and
RichmondDoc social issue first #MDChat
Evening all, sorry I'm late. Q5: best way for dev. nations to
address DM epidemic? lt; lt; tax western food heavily -make it
sarasteinmd unaffordable #mdchat
RT @ColumbiaSurgery: RT @GailZahtz: @Zonszein Q2 (and
still Q1) Think of this- kidney transplant is covered 100%.
westr Nutritionists often aren't. #mdchat
 “@GailZahtz: @RichmondDoc Q5 We had this conversation in
2 other chats concluding nutrition is an economic and social
Diabetic_Iz_Me issue first #MDChat”
Fact: China, w/ 92 million diabetics, has overtaken India
(80M) with most cases of #diabetes. http://ein.st/ho21O8
EinsteinMed #MDChat
@Zonszein Yup. Also: more walking, safe places to that, etc.
Need culture to *actually* value health/wellness, not just lip
RichmondDoc srvc. #mdchat
@sarasteinmd glad you joined #obesity topic is your specialty
mkmackey #mdchat
Lurking T1DM pt here... cycling 4-5000mi a year and eating
well makes a huge diff. even as a T1. But I've never had a doc
diabeticcyclist suggest it #mdchat
RT @RichmondDoc: Q1/Q2: many difficulties result from the
fact that our reimbursement systems value high tech/high
westr intensity care, not personal care. #mdchat
RT @EinsteinMed: 9:35 Comprehensive diabetes resource
link for those interested: http://ein.st/hftqD3 #MDchat
rozzoepunk Suggested additions?
RT @sarasteinmd: Q5: best way for dev. nations to address
DM epidemic? lt; lt; tax western food heavily -make it
chukwumaonyeije unaffordable #mdchat
@RichmondDoc I found education needs to made to the
entire family, not to the patient alone. It's critical for
Zonszein prevention. #mdchat
@RichmondDoc Getting providers onboard that we can do
ElizabethWPHD something about lifestyle change is the first step. #mdchat
@mkmackey thanks, this is a great topic. I'd also like to see
GMA food against the law until someone can prove it's long
sarasteinmd term safety #mdchat
 RT @RichmondDoc: Q1/2: I think team-based care w/
emphasis on self-care, pt empowerment, and pt self-
westr management is the best approach. But what $? #mdchat
RT @sarasteinmd Q5: best way for dev. nations to address
DM epidemic? lt;tax western food heavily-make it
GailZahtz unaffordable #mdchat lt;=In w/a bang!
My prev docs focused on managing sugars when they get
hi/lo; never on the front end w/ exercise, proper meals
diabeticcyclist #mdchat
RT @CureT1Diabetes: Highly recommend brief book
Motivational Interviewing in Health Care 4 behavior change
kabid (purchased at ADA '09) http://amzn.to/9n1drO #MDChat
Empowering patients to ask their doctor for
ElizabethWPHD exercise/ftiness/nutrition plan would help. #mdchat
@Zonszein I'm asking if you put all new diagnoses on a pie
chart, what percentage would go to young type 2s with heart
mydiabeticheart disease? #MDchat
@ElizabethWPHD Agree: we need to work to affect that
change. Would be great if community other resources more
RichmondDoc avail to help. #mdchat
Lifestyle change is doable, however it requires a different
chukwumaonyeije approach than most allopathic medicine. #mdchat
Zonszein @mydiabeticheart Still low, but growing. #mdchat
“@ElizabethWPHD: Empowering patients to ask their doctor
Diabetic_Iz_Me for exercise/ftiness/nutrition plan would help. #mdchat”
RT @chukwumaonyeije: Lifestyle change is doable, however it
requires a different approach than most allopathic medicine.
hjluks #mdchat
I think we're nutritional catastrophes. Eat Less Move More
doesnt work when people are undernourished and ailing.
sarasteinmd #mdchat
 Re: Q5: Portion sizes/cheap cost of processed food a huge
issue in US and dev nations with their emerging
EinsteinMed working/middle classes. #MDchat
@chukwumaonyeije Agreed: will need to train new MDs
differently to focus on lifestyle change approaches, pt-
RichmondDoc centered care, etc. #mdchat
RT @Zonszein: Q1 Big time: Insurance doesn't pay for
prevention or management of diabetes. We really need
kabid education for successful outcomes #MDChat
@chukwumaonyeije Absolutely! It's small steps big rewards
EinsteinMed for behavior change. #mdchat
@OliviaKulbida46 You can have healthier selections at fast
Zonszein food restaurants. #mdchat
chukwumaonyeije @hjluks Evening Howard. Long time. #mdchat
RT @sarasteinmd: I think we're nutritional catastrophes. Eat
Less Move More doesnt work when people are
drpoppyBHRT undernourished and ailing. #mdchat
@EinsteinMed Q5 people eat farmer's breakfasts and high
cal/carb/fat meals, even as we spend all day at desks: reality
RichmondDoc check needed. #mdchat
@sarasteinmd If you go into a U.S. food pantry- where 20% of
the US food concerned need to go- you wouldn't like the food
GailZahtz options #MdChat
@Zonszein @OliviaKulbida46 like salmon, brown rice, kale
olive oil? Wouldnt that be a great fast food restaurant!!
sarasteinmd #mdchat
@sarasteinmd perhaps making quot;healthy quot; foods
JDRFQUEEN more affordable? #mdchat
nursingpins Thanks to @EinsteinMed for the information on #MDchat
Zonszein @sarasteinmd Fish tacos are great! #mdchat
@GailZahtz I'm sure I'd be sad. On the other hand, starvation
sarasteinmd isnt good either! #mdchat
 @RichmondDoc Not to mention better use of the tools
available. Self monitoring will revolutionize how we monitor
chukwumaonyeije lifestyle change #mdchat
Q6: Diabetics face increased risk of clinical depression. http:
EinsteinMed //ein.st/fjSBuv Do you screen for #depression? #MDChat
@JDRFQUEEN @sarasteinmd We need to make healthy
foods more affordable and get rid of food deserts where
RichmondDoc healthy foods unavailable. #mdchat
@JDRFQUEEN I tell ppl to toss their house plants and grow
sarasteinmd indoor vegetables in the containers. #mdchat
@sarasteinmd I agree anything is better than starvation. But
that's one example of how U.S. nutrition is an economic
GailZahtz social issue #MdChat
“@EinsteinMed: Q6: Diabetics face increased risk of clinical
depression. http://ein.st/fjSBuv Do you screen for
Diabetic_Iz_Me #depression? #MDChat”
RT @RichmondDoc: We need to make healthy foods more
affordable and get rid of food deserts where healthy foods
sarasteinmd unavailable. #mdchat
Loved this #Diabetes awareness video http://youtu.
mkmackey be/nkLHgK94Z0E #mdchat
RT @RichmondDoc: @JDRFQUEEN @sarasteinmd We need
to make healthy foods more affordable and get rid of food
chukwumaonyeije deserts ... #mdchat
Q6 Screening for depression can be helpful, esp w/ the 2-
question screening available. Often, becomes evident w/o
RichmondDoc screening needed. #mdchat
People with diabetes have twice the risk of depression than
people w/out. Screening can be simple but make a difference.
ElizabethWPHD #mdchat
EinsteinMed Depression Screening Tool: http://ein.st/gSbQgJ #MDChat
 Q6. Diabetes and depression go together hand in hand-these
days. A lot of PWDs (people with diabetes) battle with
Diabetic_Iz_Me depression. #MDChat
“@EinsteinMed: Depression Screening Tool: http://ein.
Diabetic_Iz_Me st/gSbQgJ #MDChat”
Q6: Mental health issues are very much a concern for those
living with diabetes. And there needs to be more attention
mydiabeticheart paid to that. #MDchat
@richmonddoc @elizabethwphd depressed #obese. Too
tired to cook or move dont care anyway. First the
sarasteinmd depression, then the details #mdchat
@Diabetic_Iz_Me Interventions are being evaluated for
ElizabethWPHD diabetes and depression. Promising results. Q6 #mdchat
Q6 @sarasteinmd wonderful idea to grow vegetables inside..
mkmackey now to just make that idea popular among teens #mdchat
@EinsteinMed Q6 even quicker: there is a 2-question screen
that helps determine need for the 9-question: http://tinyurl.
RichmondDoc com/2dk237c #mdchat
Just have to make sure the #depression meds arent making
sarasteinmd ppl MORE #obese. #mdchat
Q7: Which areas of research for T1 or T2 do you consider most
EinsteinMed promising? #mdchat
@mydiabeticheart I agree, Mike! If its that simple why don't
Diabetic_Iz_Me doctors screen for depression in PwD's? #MDChat
RT @EinsteinMed: @chukwumaonyeije Absolutely! It's small
chukwumaonyeije steps big rewards for behavior change. #mdchat
“@EinsteinMed: Q7: Which areas of research for T1 or T2 do
Diabetic_Iz_Me you consider most promising? #mdchat”
Q7 T2 early diagnosis and aggressive interventions are
Zonszein promising. Need studies with combination therapy. #mdchat
RT @Zonszein: @sarasteinmd Fish tacos are great! lt; lt;
Totally! Just need the kale to mitigate the mercury. Sigh.
sarasteinmd #mdchat
 Q7 T1DM, research in immunosuppression is promising.
Zonszein Technology may be helpful. #mdchat
@Zonszein Are too many prediabetics being undertreated?
EinsteinMed #MDchat
@ElizabethWPHD YaY! A lot of people with diabetes need
Diabetic_Iz_Me help with depression. #MDChat
@EinsteinMed @Zonszein Suspect we're not doing a good job
of intensive lifetstyle changes as we should be; ? benefit of
RichmondDoc early med Rx #mdchat
Q7 Both T1 2 have promising research. It all needs to be done.
ElizabethWPHD #mdchat
Q7 Islet transplant is approved at military several other
hospitals to replace insulin (Sorry, I know I'm not a doc- just
GailZahtz sayin') #MDChat
@EinsteinMed @Zonszein *if* we could actually establish
intensive, broad-based, family-focused lifestyle changes,
RichmondDoc maybe successful. #mdchat
@EinsteinMed Yes. This is where treatments are most
effective: lifestyle changes and sometimes with medications.
Zonszein #mdchat
@RichmondDoc Really great model of lifestyle change done in
YMCAs. People should look at that community model.
ElizabethWPHD #mdchat
@EinsteinMed f/u We are treating T2DM too much, too late
Zonszein without good outcomes. #mdchat
Q7, T1D : NIP (nutrition intervention to prevent d - DHA
clinical trial), encapsulated porcine islets, biohybrid artificial
CureT1Diabetes pancreas #MDChat
RT @ElizabethWPHD: @RichmondDoc Really great model of
lifestyle change done in YMCAs. People should look at that
RichmondDoc community model. #mdchat
@Zonszein What about cultural implications/challenges? Best
EinsteinMed way to address? #MDchat
Zonszein @RichmondDoc I agree. It's difficult to do. #mdchat
@Diabetic_Iz_Me That's just it, nothing about life with
mydiabeticheart diabetes is simple. It's a multifaceted disease. #MDchat
@GailZahtz The transplant programs have not been as
successful as expected, especially islet cell transplants.
Zonszein #mdchat
Q8: New study in Amer. Jour . of Med shows asthma/COPD
meds sharply increase risk of diabetes? Reaction? http://ein.
EinsteinMed st/fUrya4 #MDchat
Zonszein @RichmondDoc I agree. #mdchat
Truth! RT @mydiabeticheart: @Diabetic_Iz_Me That's just it,
nothing about life with diabetes is simple. It's a multifaceted
dimpleshudson disease. #MDchat
@Einsteinmed Interventions tailored to the person can be
done, telephone, text, websites, that is how you can get at
ElizabethWPHD multicultural. #mdchat
sarasteinmd @EinsteinMed all those roids #mdchat
@RichmondDoc @elizabethwphd what if the community can't
afford YMCA model? I'm not a doc but getting back to the
Diabetic_Iz_Me basics might work #MDChat
@Zonszein I know it's controversial- islet cell transplant. But
diabetes centers are still trying to finesse it to find a solution.
GailZahtz #MDChat
@EinsteinMed Translation is not enough. Ethnosensitivity
Zonszein and proper communication is important. #mdchat
Q6 Educational materials in various languages can be found at
ElizabethWPHD ndep.nih.gov. #mdchat
@dimpleshudson @mydiabeticheart @Diabetic_Iz_Me What
do you think a doc can do to *improve* diabetic care? What
chukwumaonyeije doesn't work? #mdchat
RT @Zonszein: @EinsteinMed Translation is not enough.
Ethnosensitivity and proper communication is important.
chukwumaonyeije #mdchat
 @EinsteinMed Study is a little unclear, though: if worse COPD
(on steroids), less activity, maybe more co-morbidities - gt;
RichmondDoc worse DM? #mdchat
@ElizabethWPHD I agree but a lot of physicians aren't
Diabetic_Iz_Me opened to using social media-websites, text or email #MDChat
Q7) I'm most excited about the Artificial Pancreas project.
JDRFQUEEN (type 1) #mdchat
@ElizabethWPHD The Y model is actually being paid for by
some insurers right now. Patients and docs should ask.
ElizabethWPHD #mdchat
@EinsteinMed Study shows association, not causation from
RichmondDoc my quick/brief read. #mdchat
RT @Zonszein: @EinsteinMed Translation (for education) is
not enough. Ethnosensitivity and proper communication is
blausengroup important. #mdchat
@Diabetic_Iz_Me @RichmondDoc @elizabethwphd If no Y
option, community-based simple options can work. Y is a nice
RichmondDoc central site, tho. #mdchat
Diabetic_Iz_Me @mydiabeticheart I agree! #MDChat
Q8 Rodent studies have shown that small particle pollutants
Zonszein can cause #diabetes #mdchat
Shoulder tap for final thoughts. The hour has flown by!
EinsteinMed #MDchat
@Diabetic_Iz_Me @ElizabethWPHD You bring up a good
point. The reluctance of docs to use text/web/media hinders
chukwumaonyeije progress #mdchat
Comprehensive diabetes resource links for those interested:
EinsteinMed http://ein.st/hftqD3 ndep.nih.gov #MDchat
@RichmondDoc @Diabetic_Iz_Me @elizabethwphd Just no
quot;challenges quot;.Last thing a person who struggles daily
sarasteinmd wants is to lose a contest #mdchat
 RT @RichmondDoc Really great model of lifestyle change
done in YMCAs. People should look at that community model.
dorameulman #mdchat
Final thought: As with many/most complicated chronic illness
pts benefit if they are empowered/center of care; teaching is
RichmondDoc critical #mdchat
@chukwumaonyeije do not rush appoint-we need the 15-20
min to talk make adjustments. help us become VIPs (very
Diabetic_Iz_Me informed patients) #MDChat
@ElizabethWPHD @chukwumaonyeije Empowering patients
to use the technology. Look for team support as CDEs can
EinsteinMed provide this. #mdchat
@Zonszein we're probably out of luck on that air pollution
angle causing #obesity. It might be true, not much
sarasteinmd intervention for that #mdchat
Gr8 conversation. Thx 2 #MDChat /@philbaumann for
allowing @EinsteinMed to host - and thx to all for drinking
EinsteinMed from our question firehose!
@Diabetic_Iz_Me Very good points. Also good to not limit
interaction / adjustments to office visits. Difficult but not
chukwumaonyeije impossible #mdchat
I really enjoyed #MDChat tonight! I think you all should have
Diabetic_Iz_Me more chats based #diabetes *wink*
Zonszein It's been fun. Thanks, @EinsteinMed #mdchat
@EinsteinMed Great job! Brave pioneer, handled a busy chat
w/ lots of questions very easily. Thanks for the hard work.
RichmondDoc #mdchat
That was AMAZING! Thank you @EinsteinMed for hosting.
Very good questions and the conversations were top-shelf!
MD_Chat #MDchat
EinsteinMed Yes, thanks @Einsteinmed #mdchat
 #Obesity =overfed,undernourished,medical condition, alterd
metab-genes- brain chem, nutrient deficiencies, food
sarasteinmd sensitivities #mdchat
@sarasteinmd Evening Dr. Stein. Enjoying your book on
Kindle and have recommended it to some patients/family as
chukwumaonyeije well. #mdchat
Connect patients with empowered groups- like the #Diabetes
Online Community, @TCOYD, @cwdiabetes - support from
CureT1Diabetes others who live #MDChat
Thank you, everyone who participated. Please thank Paul and
MD_Chat the rest of the @EinsteinMed staff. #MDchat
@chukwumaonyeije @Diabetic_Iz_Me Patients need doctors
who are willing to listen to concerns and work with us to
mydiabeticheart address them. #MDchat
@EinsteinMed Leave it to a Med School to be so well prepared
GailZahtz for a chat! Congratulations- well done. #MdChat
We will have a transcript of tonight's chat up shortly. Follow
this account for updates visit http://MDchat.org for more.
MD_Chat #MDchat
Thanks everyone. Have a great rest of week. Look forward to
EinsteinMed the next quot;pioneer quot;. #MDchat

curbconsult Great chat tonight! #mdchat

@chukwumaonyeije Cool! thx! starting Obesity Clinic in
Cleveland in March - we'll be highly wired for out of towners
sarasteinmd to participate! #mdchat
That was a very well-run #MDchat by @EinsteinMed! Thank
philbaumann you all indeed!
Thank you @MD_chat for allowing the non-physicians to
CureT1Diabetes participate in the #diabetes #MDChat tonight.
RT @CureT1Diabetes: Thank you @MD_chat for allowing the
non-physicians to participate in the #diabetes #MDChat
mydiabeticheart tonight. #MDchat
Follow @MD_chat for regular updates
Twitter.com/MD_chat
MDchat.org
PhilBaumann.com