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A New Meta-Study is Released

March 14, 2012

The findings of a new study on women’s health were released on February 28 of this year. This meta-analysis* was conducted by an Ontario-based team that took six years, 60 researchers, and $4.3 million to complete.

Unfortunately, it’s not receiving much air time.The lack of attention to the study has some serious consequences, according to TheStar.com:

That means too many women who suffer heart attacks will be misdiagnosed. Unlike men, they don’t typically experience chest pains or numbness. The most common symptoms of cardiac arrest in women are nausea, vomiting, shortness of breath and intense fatigue.

It means too many expectant mothers will undergo C-sections for low-risk births and unnecessary episiotomies for vaginal deliveries.

It means too many medical practitioners will ignore the strong connection between poverty and chronic ailments, such as obesity, hypertension, diabetes, arthritis and obstructive lung disease, which lead to foreshortened lives. (emphasis mine)

The author of the article thinks the reason for the lack of widespread dissemination is the use of jargon. And while the study itself has a high incidence of jargon, the “highlights document” for each segment is written in every day language.

Let’s take the chapter on diabetes, shall we?

Diabetes differentially affects certain populations — in terms of both incidence and complications. For example, low-income populations have a higher risk of developing diabetes and have worse outcomes once they have it. The risk of diabetes is also higher in certain immigrants and ethnic groups, such as those of South Asian, African, Hispanic and Aboriginal descent. Canadians living in rural regions have higher rates of diabetes; evidence indicates that rural residents have worse access to care, lower incomes, and are more likely to have behavioural risk factors for developing diabetes and other chronic conditions. (PDF)

Even in the easy to read summary, the report states things not many people want to hear. Certainly not people who make a profit from the suffering of the people who have the disease (especially anybody who makes money off of weight loss, and that includes doctors who offer weight loss surgery or push diet pills).

The report also has a chart which shows the prevalence of diabetes by age group (20 and over, referring mostly to type 2 diabetes) and gender. In ages 20-44, women and men are about equal for the incidence of diabetes:  2.7% and 2.6% of the population, respectfully. Incidence for ages 45-64  jumps dramatically to 9.6% and 12.7%, respectfully. At 65-74, the incidences jump dramatically again to 20% and 25.9%, respectfully, over double the rate for the previous age group, which was well over double the rate for the first age group. In the over 75 age group, the incidence slows down just as dramatically to 22% and 27.2%, respectively.

Now, I’m no doctor, and only an amateur researcher, but seeing this data leads me to wonder why there is so great a jump. Most people would say, “Look at all the fatties!” but the summary even states that poverty and genetics puts more people at risk for having the disease.

Later in the chapter, the authors state:

Income matters when it comes to diabetes prevalence and complications. Lower-income groups share a disproportionate burden of diabetes and suffer more diabetes complications. In fact, socioeconomic status was a strong and inverse risk factor for virtually all diabetes complications that we studied, including CVD and renal disease. Income-related gradients were steeper in men with respect to hyper- or hypoglycemic emergencies, amputations and end-stage renal disease requiring dialysis.

In Ontario, lower-income groups with diabetes have worse outcomes despite greater use of primary care services suggesting missed opportunities for intervention. Evidence suggests that lower-income groups need more frequent and more intensive interactions with a health care team to achieve improvements in diabetes control. Rates of specialist visits were unaffected by socioeconomic status; however, this may reflect problems accessing these services, given the greater burden of complications among lower-income groups. Moreover, we found that men living in the lowest-income neighbourhoods were more likely to not receive primary or specialist care within a two-year period than men living in the highest-income neighbourhoods (8.0% versus 5.6%, respectively), suggesting that they have problems accessing care or a preference for not seeking care as it is currently offered. Changes in services and focused outreach could help to address this problem.

Complications like amputation (which ad campaigns keep trying to convince us is the inevitable outcome of diabetes) are more prevalent in lower-income groups than higher-income groups.

Wow. So it isn’t the “fatty supersizing all his fast food meals” like certain ad campaigns from certain cities would like us to believe.

This whole study is chock full of information like this, but it is a bit difficult to get through at 1,800 pages. I hope that enough word spreads, though, that somebody will take it on and bring it into the vernacular. That way we can begin appropriately mining the data, not only for the myths it’s busting about obesity and the role it plays in chronic disease (please note,  this study is NOT pro-obesity), but also for the great information on how diseases are different in men and women. For example, the symptoms of heart attack in women are much different from the symptoms of heart attack in men: women don’t generally experience chest pains or numbness. Instead, the common symptoms for heart attack in women are nausea, vomiting, shortness of breath, and intense fatigue.

*Meta-analysis is a study which gathers and analyzes multiple studies on any individual given subject.

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3 Comments leave one →
  1. vesta44 permalink
    March 14, 2012 2:06 pm

    It’s funny you should post this today. I just read an article on MedPage Today (here) that said they’re talking about lowering the threshold for diagnosing pre-diabetes. The current threshhold is an HbA1c of 6.0 (fasting blood glucose of 136), however, some groups have it as low as 5.5 (fasting BG of 118). Well, now they want to make it an across-the-board diagnostic standard of at least 5.7 ( fasting BG of 126) for pre-diabetes, and anything over 6.5 is full-blown diabetes (fasting BG of 154). All of which I find funny as hell (and not in a good way, might I add). My fasting BG is usually around 99, which gives me an A1c of less than 5.0, but my ex-doctor insisted I was going to become diabetic any day now because I’m fat. My husband has type 2 diabetes and has had for 18 years now. His doctor is happy if he keeps his A1c under 7 (fasting BG of 172).
    Supposedly it’s cost-effective to diagnose diabetes earlier and treat it sooner (cost effective for who – the pharmaceutical companies who are making/selling all those drugs to treat it?). But how much good does it do to diagnose diabetes if people can’t afford/don’t have the health insurance it takes to pay for the treatment and follow-up care? And I’m sure insurance companies are going to be just ecstatic over having more people diagnosed with diabetes, and having to pay for that care. Treating diabetes is not an inexpensive proposition, and diagnosing it earlier and earlier isn’t going to save people from the complications of diabetes if they can’t afford to treat the diabetes to begin with.

    • bronwenofhindscroft permalink
      March 14, 2012 9:34 pm

      Back when I was working for the “Evil Insurance Company” (EIC for short), I had a doctor who called me pre-diabetic because my fasting BG was 105. She said that it *used* to be 110, but they’d changed it to anything under 100, and used that as her excuse to put me on metformin the first time.

      While metformin helps some women with PCOS, it turned out the formulation she gave me (the extended release tabs) gave me mini-migraines (all the symptoms, only pain that I could, just barely, work through.

      Although my fasting BG has stayed the same, I’ve never had any other doctor be concerned that I was pre-diabetic. Not even the ones who really tried to shame me into losing weight. :/

      After quitting the EIC, I was without insurance for a few years. It was a good thing I wasn’t really diabetic or pre-diabetic, because I couldn’t have afforded the metformin, much less the quarterly doctors visits to make sure all my levels were staying under control.

  2. Robert Wright permalink
    March 19, 2012 1:56 pm

    I wonder if age correlates strongly with diabetes simply because it took decades of high refined carbohydrate/sugar consumption for these people’s pancreas to throw up a white flag and say “SCREW THIS I’M OUT!”

    This may mean that many individuals simply develop insulin resistance/hyperinsulemia gradually over time and that it may take decades for the effects to be seen (though it scares me to think what may be happening over these decades to people with prediabetes who eat a high carb diet for decades; many of them probably just keel over from heart attacks

    Diabetic women on a low-fat, high carb “balanced” diet in the Women’s Health Initiative trial (~$700 million with 50k women) had worse blood glucose than even women in the comparison group (who were eating their normal diets). This means eating high fruits and whole grains can potentially screw up your blood sugar more than hot dogs, beer…whatever the comparison group were eating.

    “diabetic women had an increase in glucose that was 7.9 ± 20.3 mg/dL greater in the DM-I than in the DM-C group (P for interaction <0.001)."

    Shikany, James M, et al. (2010). “Effects of a low-fat dietary intervention on glucose, insulin, and insulin resistance in the Women's Health Initiative (WHI) Dietary Modification trial.” American Society for Nutrition, May 11, 2011, doi: 10.3945/ajcn.110.010843. Retrieved from: http://www.ajcn.org/content/early/2011/05/11/ajcn.110.010843.abstract .

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