I few days ago I touched on the subject of NY-area drug store chain, Duane Reade. The company established a free diabetes program a while back, offering advice, education and support groups. Duane Reade says it's expanding the program because of customer demand.

Is this part of a larger trend? Looks like it. According to yesterday's New York Times, more and more people are turning to drug stores for medical services. We're talking non-urgent things like sprains and minor infections...and diabetes care. Some are frustrated by lack of access to their regular physician. Others are having budget issues going the traditional route. It's super-convenient because you can be seen without an appointment, then get your prescription filled right there.

Drug store chains - Duane Reade, Wal-Mart, CVS and Walgreens included - are stepping up to the plate to fill the void. "Urgent Care Lite," is the tag it's been given. According to the Times, the number of these clinics has exploded in the past two years. And many feel that's a big problem because these clinics are not tightly regulated.

Diabetes rates skyrocketing! is a unified message plastered across the daily news. I've often wondered how improved diagnosis and awareness of diabetes has impacted this incessant news alarm.

Federals scientists analyzed a data set from the National Health and Nutrition Examination Survey to find the total proportion of the population with diagnosed and undiagnosed diabetes. Statisticians found the overall age-adjusted proportion of the population with diabetes has not really changed much from 1988 to 2002, the most recent year of available federal data. Katherine M. Flegal, an epidemiologist at the National Center for Health Statistics, published the results in Diabetes Care last year.

Two subgroups (men and non-Hispanic blacks) did have a small, yet statistically significant increase in the diabetes rate. Dr. James Smith, a senior economist at the Rand Corporation, took an independent look at the male data from the national survey to find out why. He stated the data were distorted by inconsistent surveying of gestational diabetes in women. After removing it from the data, similar rises were seen across both genders.

Dr. Smith does not want to minimize the serious problem of diabetes in this country. But he believes the perception that diabetes is rapidly rising is exaggerated due to confusion over diagnoses versus the actual number of people with the disease. We may need to turn off that rising diabetes news alarm. Read the full story and view a helpful graph on diabetes rates in the NY Times.

The current system, rests on a precarious and complex (or should I say, chaotic?) relationship between public and private healthcare providers and the insurance industry. Sadly, reform may not be possible until Americans get much, much angrier about how badly they are being let down by the system that's supposed to serve them. A great place to start your reading is the editorial in today's New York Times. Titled "World's Best Medical Care?," it neatly summarizes not just how the US needs to do better, but also describes how badly the US is doing in relation to the rest of the developed world. The key issues: forty-five million uninsured, many more underinsured, and quality of care that varies wildly depending on the size of the patient's wallet.

What about diabetes? Surprise! The news is not good. According to the Times editorial, the US came in last in an eight-country comparison of lives lost to a number of major diseases, one of which being diabetes.

Dr. Faustman's lab is currently collecting blood samples from individuals with established Type 1 diabetes. These samples are being used to quantify the number of autoreactive T-cells and develop the adequate dosage for Phase 1 of human trials to cure Type 1 diabetes.

The research has been presented and the NIH confirmed it. By reeducating the confused T-cells and instructing them not to attack healthy islets, an apparent cure of established type 1 diabetes in non-obese diabetic mice is possible. Now, Dr. Faustman is collecting human samples to bestow the same cure for diabetes in humans.

If you wish to be a part of this revolutionary event for curing Type 1 diabetes, please contact the Clinical Coordinator or call Dr. Faustman's lab at (617) 726-4084. Each participant is asked to bring a control person along with them - an unrelated person without Type 1 diabetes or another autoimmune disease. Diabetic or not - you can be a part of history in curing Type 1 diabetes!

Among the best restaurants in Tallahassee, Florida, is Kool Beanz Cafe, where both the eats and the atmosphere are colorful, inventive and fun. That Kool Beanz inventiveness now extends to pastry chef Kim Bertron (pictured), whose design for a syringe won her first prize in the History Channel's "Invent Now Challenge" in March. Today's Tallahassee Democrat profiles Bertron and talks to her about her winning entry, the SimpleShot syringe.

The SimpleShot can be preloaded with both a drug, in powdered form, and a diluting solution. The two substances are stored in separate compartments of the syringe until a dose is required. Then the user needs only to press the plunger, piercing the membrane separating drug from solution and - presto! - it's ready to go. The device brilliantly eliminates the need to measure and load before a shot is given.

The idea came to Bertron after a horrific scare involving her young daughter, who has Type 1 diabetes. When her little one suffered a hypoglycemic episode, Bertron rushed to administer a glucagon injection but her trembling hands fumbled and the needle broke. Bertron ran to her car for her backup kit and her daughter was okay, but mom was severely shaken by the experience.

The invention was actually a team effort involving Bertron as well as two of her friends: mechanical engineer Brian Boothe and patent attorney Wiley Horton. However, it was Bertron who came up with the initial concept, understanding the need for a foolproof syringe; one that could administer drugs fast and with a low risk of dosage errors. Although designed for diabetics, the device could be used by the millions of people taking other reconstituted drugs - injectable powders that must be mixed with a diluting solution immediately before use.

Judges of the Invent Now Challenge included such figures as Apple co-founder Steve Wozniak, Time Magazine editor Jeremy Caplan, and New York Times technology editor David Pogue. Click here to read Pogue's blog, in which he praises the SimpleShot.

I am often guilty of diabetes isolationism. I tend to think about diabetes within a United States vacuum. But diabetes is a worldwide disease. The World Health Organization website identified the worldwide prevalence of diabetes at 171 million in 2000, and projects this number will rise to 366 million in 2030. Unfortunately, diabetes treatment and education is severely lacking in developing countries.

Mexico is one developing country where the public health system is failing the disease. Diabetes is the leading cause of death in Mexico, with 138 deaths per 100,000 adults aged 20 to 84 in 2000. That compares to 82 deaths in 100,000 here in the United States. Mexico also has one of the world's highest prevalence rates -- 10.7 percent of adults 20 to 69 have diabetes.

Half the population in Mexico is medically uninsured. That statistic blew me away. Many Mexican families are unable to afford the most basic tools to manage the disease such as blood glucose meters, lancets, blood test strips, syringes and cotton swabs. Chronic hyperglycemia results in extensive complications such as nerve damage or vision loss. Families become more impoverished as their loved one with diabetes cannot work.

Congressional investigators have been looking into very serious claims that Avandia's maker silenced medical professionals who attempted to speak out about the potential for cardiovascular problems by using the drug.

Dr. Buse, who is about to become the president of the American Diabetes Association, was an early and frequent critic of Avandia after it reached the market in 1999. In a March 2000 letter to the F.D.A., he said Avandia might raise patients' risk of heart attacks, and he criticized the company's marketing, saying it employed "blatant selective manipulation of data" to overstate the drug's benefits and understate its risks.

More recent questions about Avandia's potential risks, as outlined in a New England Journal of Medicine article last week, have prompted the Congressional hearing. The author of that article, Dr. Steven E. Nissen, a heart specialist at the Cleveland Clinic, has also been called to testify. See the full story on the upcoming congressional hearing.

Remember learning about "checks and balances" in U.S. History class? When state leaders gathered in 1787 to draft the Constitution, they established three branches of government (legislative/executive/judicial) to protect individual freedom and prevent government from abusing its own power. Now, Congress is questioning the balance of powers over at the Food and Drug Administration (FDA).

Republicans and Democrats in the House and Senate have called for an investigation into the FDA in the wake of the New England Journal of Medicine study which suggests the popular diabetes medication, Avandia, significantly increases the risk of heart attacks. A House hearing is set for June 6.

Original trials by the drug's maker, GlaxoSmithKline, revealed twice the rate of ischemic heart disease for patients taking Avandia versus recipients of placebos. The medical reviewer for the FDA initially expressed concern, but determined the risk was more benign following further analysis.

"A few times I've been around that track so it's not just gonna happen like that because I ain't no hollaback girl", like Gwen Stefani says in her motivational chant - I want answers.

This is not an attack in any way. This is an attempt to get answers as to why human synthetic insulin was manufactured without C-peptide. Yesterday Eli Lilly called me back. Admittedly, J Scott Macgregor told me he doesn't receive many questions about human synthetic insulin development. He asked me to email. No problem. My email said:

Why did Eli Lilly manufacture human synthetic insulin without c-peptide?

As Scott Strumello points out in his blog, I've tried to contact Eli Lilly before about this issue. And I guess it look a little while for the resonating curiosity of the blogosphere to provoke a response. Again - no problem. The content of my email is an open opportunity for every diabetic injecting insulin to ask away. I think we've got Eli Lilly's attention and we're on the right path to getting answers. Now where's that turn for C-peptide?

In 2005, insulin cost state Medicaid programs $500 million. The diabetes epidemic is causing the government to question one of the big-ticket items on the shopping list - insulin. Insulin was developed over 20 years ago and many of these original forms are now off patent. This is a screaming opportunity for generic drug makers to prosper and government programs to save.

Two of the largest insulin makers, Novo Nordisk and Eli Lily, say they are opposed to any F.D.A. action that would approve generic insulin without clinical studies. Why the concern? The combined sales in the United States for Humulin and Novolin is about $1 billion. No wonder.

A drug maker needs to prove the generic version contains the same active ingredients, purity and quality, and provides equivalent delivery over time as the brand-name version. However the makers of generic drugs agree that the approval process for generic biologics, like insulin, would be more complex than the current shortened process for other generic drugs. Anybody have a guess as to what the hold up is for this much needed and overdue generic insulin explosion?

A wiki about a controversial prescription drug has been ordered by a US court to remove a link to documents which originated with Eli Lilly, the drug's manufacturer. Eli Lilly has paid nearly $1.7 billions to settle cases over its alleged side effects from its drug Zyprexa, including diabetes.

The wiki about Zyprexa published a link to internal Eli Lilly documents which the New York Times said showed that the company deliberately downplayed the side effects of the drug, which are alleged to include weight gain, high blood sugar levels and diabetes.

The judge in one of the product liability cases ordered the site and a number of named individuals to refrain from distributing the documents. A digital rights group defended the free speech rights of one anonymous poster but the judge would not budge. The electronic gag order will remain in effect until the case is resolved, sometime after January 16th.

James Hirsch, a type 1 diabetic, agonized when his three-year-old son started showing the symptoms of diabetes. His agony took the form of remarkable brilliance in his book, Cheating Destiny: Living With Diabetes, America's Biggest Epidemic. The book portrays diabetes from the perspective of someone living with the disease. He explains how diabetes is treated in this country, the shortfalls in the governance, both economically and physiologically.

Hirsch, a former reporter for the New York Times and the Wall Street Journal asks the editor of a hugely popular web site about the quality of care for diabetes in this country. The response he received: "It stinks." Hirsch details the physical complications that arise from diabetes and health insurance companies' reluctance to fully reimburse relatively low-cost education programs. These programs are designed to prevent the high-cost diagnostic testing and hospital care resulting from diabetes complications. Makes you wonder if it's unintuitive bureaucracy or intuitive capitalistic malfeasance. Don't be silly -- it's nothing personal, it's just business.

Being a person with diabetes is never simple. Hirsch explains, "insulin and food, food and insulin. I imagine them like armies in the night, battling inside a diabetic's body,"..."the battles never produce a winner. The armies simply live to fight another day." Fight the good fight, James. Thank you for sharing your perspective with remarkable brilliance and enlightening reality.

The American Diabetes Association has gotten a lot of flak the past few years for the choices they've made in corporate sponsorships. When it comes to raising funds, the ADA is not the type of organization to slip under anybody's radar.

The mission of the ADA is growing as urgently as the number of diagnosis each year. The need for funding, and the sources from where this funding derives, is becoming equivocally difficult. The food and drug industry is adequately equipped to fund the needs of the ADA, but many shake their finger at the ADA for choosing to take money from companies like Burger King and Cadbury-Schweppes.

The question we should be asking is not where the money derives, but what the money is doing. The American Diabetes Association is the proverbial Sisyphus of medical nonprofit organizations, condemned to the eternal hard labor of pushing the big rock of diabetes. They continue to be the nation's leading nonprofit health organization by providing diabetes research, information and advocacy. I don't care if the money for this heroic cause comes from Ronald McDonald or Donald Duck. What matters is the fact the research continues, the campaigns are effective, and the advocates are influential. It's not fair to bite the hand that feeds the operation. Let us not judge from where the money comes, let us focus on where it takes us.

The New York Times has done so much in the past year or so to educate about diabetes. Going beyond the "latest research" headlines seen in most news sources, NY Times journalists periodically produce lengthy, excellent-quality articles on aspects of diabetes and its impact on America.

Now the latest: a report on diabetes and the mentally ill. Apparently, Type 2 diabetes occurs with "alarming frequency" amongst people with mental illness. So much so that one psychiatrist interviewed for this article says that he screens new patients for Type 2 before he even begins therapy sessions. It is estimated that one in five of the mentally ill have diabetes, which is around twice the rate found in the general population. The article raises the unpleasant notion that certain anti-psychotic drugs are aggravating and perhaps even causing diabetes, hence the disturbing statistics above.

And here's a great quote: "Uncontrolled diabetes can ruin a person's life as much as uncontrolled schizophrenia." That from the same psychiatrist, Dr. John Newcomer of Washington University School of Medicine in St. Louis. This is the message that we need to get across: that diabetes is a serious and life threatening disease.

Australians -- or should I say the Australian media -- have been in a tizzy this week over new statistics that reflect just how bad the diabetes problem is becoming in that country. The big stat that's upsetting everyone came from the International Diabetes Institute, claiming that 275 Australians a day were developing diabetes.

In response, there has been a flurry of articles, editorials and letters to the editor in Australian news sites. This article, in the Sydney Morning Herald, is just one example. In it, Australia's Health Minister, Tony Abbott, is quoted urging Australians to rethink their lifestyle habits and undergo a culture shift to limit the spread of diabetes.

Hmm. Personal responsibility, huh? It's interesting. I could be wrong, but it seems to me that calls for lifestyle change to counter the spread of diabetes are more common coming from the governments of countries other than the US. I get the feeling that politicians here are afraid to tackle the issue because they won't risk driving away voters who may take offense at helpful lifestyle tips from their elected representatives. Maybe people here are more afraid to confront the stigma associated with Type 2 diabetes, which I mentioned in my previous blog with relation to the latest New York Times article on the subject.