Upcoming team meetings

MHA Team Clinicians - September notes

Focus - Standard of Care Guidelines

Chair - Adele Hite (See a list of Metabolic Health Alliance volunteers and their biographies. Corrections & additions welcome!)

Type 1 Diabetes - 

Directed at clinicians who are already in the metabolic health / low carb space. 

• Adele Hite would appreciate reviews of the following drafts: 
  • Clinical implementation
  • Scientific rationale
• Inward facing and safety focused
• Looking for pharmacist input
• Initial research showing reversal of early Type 1 diabetes? A healthy normal phenotype before beta cells begin to degrade?

Type 2 Diabetes 

Initial protocol outward facing, for clinicians who are less familiar with metabolic interventions.

Chair - Juan Carlos Torres-Urrutia. Team David Crutchfield, Donal Collins, Adele Hite

• Based on “general guidelines” housed at LowCarb USA
• More work done on this at Diet Doctor, IPTN & by Murdoch et al. 
• Add: more specific information for T2DM; behavioral nutrition support; etc.

Standard of Care general points

• Extend existing guidelines to treat specific metabolic conditions.  Help clinicians who need the evidence basis for this intervention.  
• Protocols - include what diagnostic tests to run when. For example, including cut off points for normal range for fasting insulin assays

Registered Dietitian sub-team

Tailoring protocols to the needs of dietitians and Certified Diabetes Educators (CDE), especially regarding T2D. Once protocols are agreed upon would address education.

Alyssa Gallagher, Emily Norbryhn, Adele Hite. 

Building my metabolic health practices.

• Google my business / Knowledge panel.  Register with directories using this spreadsheet checklist.
• Future
  • Behavior modification - Speakers
  • Sharing lessons learned - What has worked for IPTN
  • Building referrals and your regional network

Members - Cecile Seth. Vyvyane Loh, David Crutchfield, Philip Ovadia

Future Wish list

• Education module for Employers on the cost savings of T2D
• Research on behavioral approaches to lifestyle modification to achieve metabolic health. My greatest challenge is modifying behavior in patients. We know what to recommend, but how do we get patients to comply? (Team approach).
• Undergraduate course online.  (Starting with an inventory of existing modules and gaps)

Useful ideas

• Target clinicians with information to help them educate their patients.
• Target patients with information they can bring to their clinicians. 
• Diabetes is an insulin resistance problem not just a disease of high blood sugar. 
• Continuous Glucose Monitor (CGM) documentation of a hypoglycemic episode that has occurred may induce insurance coverage 
• Patients need to be informed and then be able to choose their particular treatment that fits their foals and life view. Document in patient records.
• Consistency of terms and content across platforms facilitates understanding and clarity
• Establish baseline measures - Critically important to document the current state of metabolic health care to have a point against which to measure progress. E.g., nutrition and metabolic education in medical school. Sophisticated funders will want to measure the metabolic health movement’s effectiveness against a baseline to demonstrate cost savings, health improvements, etc 

Insightful Nuggets 

• “Unique, unprecedented involvement by clinicians”
• “Food first, medication reducing approach”
• De-prescribing links (Add)
• “Because of our experiences, we feel obliged to teach / help other people.”
• “Metabolic health approach is a bridge builder. (many ways to get there.)  A diplomatic effort.  A multi-disciplinary approach.”
• “Pay us if we add value.” Reduction in medication costs pays for the metabolic intervention