The theme for this week is "Manage Your Healthcare Team". 
For me, and for many others with Type 2 diabetes, this is a laugh. Team? What team? I have a primary care physician who handles everything from soup to nuts, including my diabetes care. She'll refer me to specialists and labs as needed, but she doesn't have any direct correspondence with my ophthalmologist (for whose checkup I am long overdue), and I've never had a CDE or an endo.

Except for the lack of CDE, this is pretty standard for Type 2s who are not on insulin. In fact, I don't think I know a single Type 2 who is not on insulin who has an endo -- unless he or she needs an endo for some other, non-d-related medical issue. CDEs for Type 2 are a pretty hit-or-miss proposition, depending on when we were diagnosed, who pays for our healthcare (insurance, Medicaid, Medicare, other?), and the community in which we live. Diagnosed in 2002, I was never referred to a CDE or a Registered Dietician. My Other Half, diagnosed in 2007 out of the same practice, was prescribed a ten-session course of consults with a CDE.

My biggest beef with primary care physicians being the primary point of contact between a patient and his (or her) diabetes care is that most family physicians and general practitioners are not up-to-date on standards of care for diabetes management, and do not have the time to keep up on that along with all of the other first-point-of-contact medical issues that their specialty requires. My mother's PCP, for example, has never asked her to self-monitor, even once a day. Her peers, who were diagnosed later, all test. My Other Half's T2 aunt who is on insulin tests before meals. His T2 father tests once or twice a day on a regular schedule (fasting and/or retiring), while the T2 aunt who is not on insulin was told to test "three times a week, always on the same three fingers".

The end result of this is that not only are most T2s responsible for following doctors' orders, but -- if we want to be protect our health -- we need to be following up on what is going on in the fields of diabetes research and management, and standards of care, and we need to pass that information on to our doctors and CDEs. For most of us, this goes about as far as reading the dLife News headlines and scanning Reuters Health or Yahoo Health on a semiregular basis. Unfortunately, that which makes the general health news headlines can be truncated or skewed, based on preliminary results or small sample sizes, alarmist, or extremist. If you're unsure about how to critically evaluate a health news release, head over to Health News Review for some tips.

The next layer of depth is the realm of publications aimed at professionals. Many of those publications have online abstracts that are available for free, if you are willing to register for them. Two of the major online "news feeds" aimed at doctors treating patients with diabetes are Diabetes in Control and Endocrine Today. These online weeklies are narrowly focused -- but when I see the same Reuters Health releases on Diabetes in Control that I see on Yahoo Health, I have to look a bit askance, and peel back the next layer, into medical jourals such as The Lancet, the New England Journal of Medicine (NEJM), and the Journal of the American Medical Association (JAMA) and into conference abstracts from events such as the ADA Scientific Sessions and the annual EASD conference. If that does not give me enough information to critically assess the news, I'll try to find more information in the NEJM CME sessions (where I can read entire articles), or I'll look at even more esoteric research over on BioMed Central or PLoS One...

Peeling back the layers gives me the best likelihood of being able to analyze the research or findings and put them into a theoretical and/or practical context. From here, I can print out the chain of "evidence" as far as free subscriptions will take me, note how far along the research has gone, the strengths and shortcomings of the published analyses, and where further pursuit may be required regarding my own health. I can do this not just for diabetes and the rest of the metabolic syndrome, but also for medical topics of personal interest to my doctor. All of these go with me to my doctor appointments (along with my log book), and depending on the time, we'll either discuss the basics of the articles as I pass them to her, or I'll leave the stack of printouts with Post-It notes with her nurse, to pass on to her. By remaining informed and keeping my doctor informed, I have the best chances of getting appropriate care, and of my doctor being able to provide the best care possible to all of her patients.