The American Association of Diabetes Educators has spent big bucks this year ensuring its point of view gets across to our representatives in the federal government. The AADE spent $375,000 on lobbying in just the first half of 2007, according to a Senate disclosure form that has been picked up by the media. The law requires that such disclosures be made public. Members of the organization include big Pharma names like Eli Lilly, Novartis and Merck.

The AADE is, obviously, a member organization for diabetes educators, with advocacy in Washington - for professionals and patients - coming as an additional service. The government-run site Healthfinder lists more about the AADE if you're interested. Given the amount of money involved, I'm surprised how little attention this has attracted on the Web. Many news services have featured the disclosure, but only in brief. What I'd like to know is: what issues were the AADE lobbying for and against?

Details are emerging from today's advisory committee meeting on Glaxo's Avandia. First up was a presentation by Dr. Robert Ratner of Washington's MedStar Research Institute outlining the unprecedented spread of type 2 diabetes. Ratner emphasized the inadequacy of current drug therapies for diabetes and the strain on the health system caused by the disease. The possible implication: Avandia does more good than harm right now, so let's keep it as an option.

Next, in written preview comments, an official from the US Food and Drug Administration stated his belief that the diabetes drug should be taken off the market. The official, Dr. David Graham, says the heart risks posed by Avandia mean it's just not worth the risk to patients. Especially, he said, not when there are safer alternatives like Actos (by Takeda), which also stabilizes blood sugar levels.

It's a significant step that someone from the FDA publicly made this statement. But will anything come of it? Maybe not. The decision about whether or not Avandia stays on the market is not up to Dr. Graham, who The New York Times reports has a history of coming down harder on drug risks than many colleagues. (Give the guy a medal!) Thing is: there appear to be plenty of other officials within the FDA who don't agree with Graham's interpretation.

An issue in dire need of attention - climbing rates of Type 2 diabetes amongst Native Americans - has made it to Washington. Experts on diabetes and its impact on Native Americans went to Washington Thursday to basically beg for money to continue with the treatment and prevention programs currently in place.

Charles Grim, head of the Indian Health Service, testified yesterday to the Senate Indian Affairs Committee (SIAC) about the disastrous impact diabetes is having in Native American (aka American Indian) and Alaska Native communities. "In some communities, the prevalence rate is as high as 60 percent among adults," said Grim. But the scariest thing is how fast diabetes is spreading amongst younger people. According to the Indian Health Service, diabetes grew by 128 percent amongst teenagers between 1990 and 2004. It also affected many more younger children, but not as badly: the rate of increase for the same period was 77 percent for kids younger than fifteen.

In addition to the testimony of Grim, two North Dakota physicians also spoke at the hearing, urging the SIAC to renew funding for prevention and treatment programs that are currently due to expire next year. Said one of the docs, "We don't want history to repeat itself." The other, Dr. Biron Baker of Bismark, ND, was openly critical of ongoing efforts to stem the spread of diabetes, saying "Administrative ineptitude within the Indian Health Service is a glaring problem."

I guess the answer to the question "Is Congress listening?" is yes. Problem is, those in government who want to help have to come up with money for these programs. Then there are those who take a more cautious approach before they'll approve treatment and prevention programs. People like Wyoming Republican Craig Thomas, who was quoted as saying he wants to see evidence that current programs are effective before throwing his weight behind proposals to improve services. Funny how the money is always available for other pet projects and disastrous wars, but not for stuff like public health programs...

There's an interesting new article in the Philadelphia Inquirer about diabetes, specifically the recent expansion in treatment options available to diabetics. The opening paragraph illustrates the intense level of interest in these new drugs by describing how crowds of people were turned away from the recent American Diabetes Association convention in Washington. All of them were hoping to learn more about Byetta, the drug that controls blood sugar and also (as a side-effect) causes weight loss.

Anyway, the article describes how much the situation has changed from previous decades, when insulin was the absolute foundation of diabetes treatments. Now you have a slew of new drugs as well as a bunch of new delivery and monitoring devices. Obviously, the surge in treatment options has grown in response to simple consumer demand, as diabetes rates soar.

The catch, of course, is that many of these treatments are financially beyond the means of many people. The question is how many diabetics are going to continue to miss out on optimal medical care due to being uninsured or underinsured? Also, medical professionals don't want people to get the impression that the solution to their diabetes problem lies entirely in some magical combination of the new drugs. Says Kenneth J. Snow, of Boston's Joslin Diabetes Center, "Ideally, weight control and exercise is by far the best way to treat [Type 2] diabetes."