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Letter from the Editor: Not Getting Caught Up in the Numbers and an Investigation into rhGH

Mar 14, 2011

Our first item, Predicting Diabetes: Using the Fasting Glucose, A1c, or OGTT, this week looks at the best way to diagnose diabetes and our last item, Millions Risk Early Death Due to Diabetes Diagnosed or Treated Improperly, discusses the risk of early death in patients not diagnosed and treated soon enough. These articles point to “administrative” problems we have in helping patients with diabetes. Most of our patients who are obese, hypertensive or hypercholesteremic are at risk for diabetes. In addition, a family history of diabetes increases the risk tremendously: this is why we have over 70 million Americans who have pre-diabetes. With all this evidence, we are spending time and money debating the best way to diagnose when our patients could benefit much more from simple food and physical activity advice. Often we spend so much time discussing the numbers that we give our patients a way out of taking action.

During a group office visit for diabetes patients last week I handed lab reports to all the attendees and they were able to see their FPG and A1c values. Some of the patients wondered why they were there because their A1c’s were either under 7 or their fasting readings were under 126mg/dl, and they felt fine. Rather than try to convince them that they had diabetes, I focused on describing simple things to “prevent” diabetes from occurring. So while the “experts” debate what diabetes is and the best way to diagnose it we can all help our patients by simply treating their pre-diabetes.

I was reviewing some articles on creative ways that people are trying to lose weight, replace fat with muscle or get the fat “vacuumed.” During this literature search my intern came across the idea of using Recombinant human growth hormone (rhGH) to get rid of the fat and build muscle and how it wasn’t just used by bodybuilders anymore. Although the cost to use rhGH is high, many people are trying it. Jenna Algozzine, PharmD Candidate, University of Florida College of Pharmacy, put together a feature on the legitimate and not-so legitimate uses of rhGH.


Many of you have helped patients avert diabetes disasters and we can all learn from them. (See our Safety and Error Prevention Topic page for a complete list.) If you have a “disaster averted” then send it in and if we use it in our Diabetes Clinical Mastery Series you will receive a Visa Gift Card worth $50.00. So far, we’ve sent out almost $1,000 worth of Gift Cards! Click here to let us know the details. (You can use your name or remain anonymous if you prefer.)

Announcements: March 13, 7PM ET on CNBC

Topics: One of the country’s largest health organizations conducts a groundbreaking study on how media can improve diabetes control. And, how hormones help and hinder diabetes. Sundays on CNBC at 7 PM ET, 6 PM CT, and 4 PM PT. Catch up on

TCOYD Conference and Health Fair, Tucson, Arizona, April 2, 2011

Join Special Guest Urban Miyares — Veteran, Entrepreneur, Motivational Speaker — for a full day event also including: state-of-the-art technologies and advances in diabetes care; afternoon workshops; and physical activities for everyone.

Please answer this week’s poll (in the right-hand column): After diet and exercise, and metformin, which do you prescribe next to treat prediabetes?

View last week’s poll results.

We can make a difference!

Check out this week’s “Test Your Diabetes Knowledge” question!

Dave Joffe, Editor-in-chief