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Article Critique - Diabetes
Article Critique - Diabetes
from insulin resistance or deficiency. While it can be managed with exercise and dietary
Americans have diabetes, or 8% of the population, and of these, 90% have type 2, or ‘acquired’
diabetes (Danaei et al., 2011). Because the Centers for Disease Control (CDC, 2015) has
classified diabetes as an epidemic – now prevalent not just in adult, but in children as well – it is
critical for both medical caregivers and laypersons to understand implications, symptoms, and
treatment vectors. The following work will explore a range of scholarly sources which examine a
range of factors pertinent to both diabetes researchers and clinicians, as well as those which are
intended for ‘broader’ consumption, as by the layperson or lay diabetic. Through use of the
National Library of Medicine tutorial on critiquing internet health information, this work will
show that lay sites often provide strong information, but their motives are suspect.
Scholarly Sources
diabetes, and cause resistance to insulin, depriving cells of necessary nourishment, and causing
physiological damage through excess serum glucose levels. Information provided by the Centers
for Disease Control, for instance (2015) present such damage as causing pathological change to
the endothelial lining of blood vessels, and evidence to show that if diabetes is left untreated with
insulin, it may predispose the diabetic to an increased risk of cardiovascular disease, premature
disability or death (CDC, 2015). Though such information may well be of use to the lay patient,
they go into considerable detail with respect to the pathology of this condition, including factors
like increased liver production of glucose, impaired pancreatic function, cancer irradiation, and
autoimmune disease (CDC, 2015). Talukdar and Reddy (2017) focus upon “pancreatic exocrine
insufficiency” as it relates to Types 1 and 2 diabetes, and though their research has clinical
implications, including that “pancreatin supplementation could also have a positive effect on the
glycemic status of…diabetic patients,” it is a work of pure research with little relevance to the
lay patient (Talukdar & Reddy, 2017, p. 61, 69). Other scholarly studies explore the role which
Metformin (Fortamet) plays in the reduction of damaging glucose formation in Type 2 diabetics,
including Hundal et al. (2000), which found that this drug played a key role in a “a reduction in
the bloodstream (Hundal et al., 2000, p. 2068). Though Metformin has seen increased popularity
in recent years, these works’ stark scholarly tone would seem to exclude most lay patients.
Other scholarly sources which examine diabetes did so from a clinical perspective,
through analysis of patient compliance with insulin administration and other care regimes. For
instance, Currie et al. (2012) explain that many diabetes diagnoses are delayed for years due to
lack of demonstrable symptoms, and even once care is initiated, as many as 50% of diabetics fail
to fully comply with some or all aspects of their ordered care (Currie et al, 2012). From this
point, other studies explored causal vectors for such patient noncompliance, as linked to social
and behavioral issues, including patients’ feelings, thoughts, interpersonal relationships, and
culture or social class (Currie et al., 2012). Further barriers shown in scholarly studies include a
lack of education as to knowledge and skills required for treatment, improper health beliefs and
poor attitudes regarding the necessity of treatment, and the presence of environmental barriers to
adversely affect the ability of patients to perform self-care (Currie et al., 2012). Finally, social
isolation from or conflicts with family may also serve as barriers to diabetes management, as
well as psychological or psychiatric disorders including depression, anxiety, and eating disorders
(Salam & Siddiqui, 2014). Associated studies have highlighted the clinician-patient relationship
as one of the most important factors to bolster, if care compliance is to be improved (Sawyer &
Deines, 2013), especially as linked to the quality of this relationship, with superior outcomes
shown in patients who trust their physicians (and their advice) implicitly (Lowry et al., 2014).
Layperson Sources
Mitigating the effects of Type-2 diabetes, a disabling and life-shortening illness, are only
possible through deliberate care coordination by the patient and the clinician. Though patients
may take physicians’ advice on ‘face value,’ many often seek out their own information, and as
such, may turn to internet patient resources for guidance. Two sources informed this analysis of
‘lay’ diabetes informational resources: The first ‘lay’ source is WebMD, and while researchers
Semigran et al. (2015) showed that the popular ‘symptom checkers’ provided by this site – and
many others – had major “deficits in both triage and diagnosis,” and tended to provide advice
which was “generally risk averse,” and served to encourage “users to seek care for conditions
where self-care is reasonable,” this is not necessarily a negative with respect to WebMD’s
diabetes care advice (Semigran et al., 2015, p. 4). The WebMD site chosen, “Understanding
Diabetes -- Diagnosis and Treatment” (2018), is written in a format and in language which is
easily-understood, and defines both Type 1 and Type 2 diabetes, before outlining the various
tests that prospective diabetics may expect (including a fasting glucose test, oral glucose
tolerance testing, and A1c testing), and treatment methodologies. Critically, though WebMD
may encourage passive self-treatment for other conditions, this popular lay medical advice portal
is explicit in its treatment recommendations: “Diabetes is a serious disease,” it argues, “that you
cannot treat on your own,” and it recommends seeking physician advice (WebMD, 2018, p. 1).
The second ‘lay’ website, Dr. Axe: Food is Medicine, was chosen for its high search
placement on Google under the terms ‘natural diabetes cure‘. The ‘Dr. Axe’ site contains a host
of information about Types 1 and 2 diabetes, including the same CDC warning about diabetes
reaching ‘epidemic’ status in the U.S., before presenting a range of foods which prediabetics and
diabetics may incorporate or remove from their diets in order to slow their diabetic progression,
or to halt it altogether (Dr. Axe, 2018, p. 1). Dr. Axe recommends that prediabetics follow a
specific diet plan – one high in fiber, chromium, magnesium, and ‘clean’ protein – as well as
reduce their intake of refined sugar, grains, cow’s milk, and alcohol (Dr. Axe, p. 1). Though each
recommendation is supported by links to studies corroborating these claims, its prescribed meal
plan’s promise of reversing diabetes “naturally, in 30 days or less”, is suspect (p. 1).
Using the template for lay criticism provided by the National Institutes of Health (2018),
both WebMD and ‘Dr. Axe’ can be considered reasonably reputable sources. Of these, WebMD
is the stronger of the two as a patient information resource. It maintains four core staff doctors,
and a team of 100 ancillary physicians upon whom they rely to ensure that their content is “up to
date, accurate, and helps you live a healthier life” (WebMD, 2018a, p. 1). Information provided
on this site is judged on the basis of its “relevance…clinical significance,” and “emerging health
trends,” and aside from advertising sales, does not appear to have any ulterior motives (WebMD,
2018b, p. 1). That said, its presentation and major promotion of a ‘symptom checker,’ a tool
which has been shown to reduce patient reliance upon expert care (and has been linked to the
greater promotion of potentially deleterious self-care) is questionable. Though this major health
information ‘portal’ – which is the 157th most-visited website in the U.S., and averages 148.6
million monthly unique visitors – is backed with links to peer-reviewed studies and other strong
information, its reliance upon advertising dollars means that it must attract visitors in order to be
profitable (Similar Web, 2018). To this end, while its diabetes information is sound, the site’s
overall impact upon lay information (as reflected in the Semigran et al. [2015] study) has been to
Dr. Axe, by contrast, offers a strong resource for diabetes information, albeit one which is
reduced by motives which seem linked to the titular physician’s line of health products. Though
Dr. Josh Axe is a “certified doctor of natural medicine, doctor of chiropractic and clinical
nutritionist,” and founder of a Nashville-based “functional medicine center,” hailed as one of the
world’s “most renowned” clinics, the site’s advice with respect to diabetes care appears to reflect
a ‘quick cure’ mentality (Dr. Axe, 2018a, p. 1). While this may be promising, such promises are
rarely useful for the diabetic patient. To the site’s credit, it includes a range of links to strong
clinical and scholarly works to support its claims. That said, its promotion of branded health
supplements for diabetes care, including chromium picolinate, cinnamon, and bitter melon
extract, are backed by studies which consider the impact of such supplements among patients
who already have strong glycemic control, meaning that their efficacy as a diabetes ‘cure’ is low.
Finally, the site promises that following the dietary plan it lays out – to the apparent exclusion of
physician recommendations – will lead to the reversal of diabetes symptoms, and the need for
insulin, within thirty days. Especially as backed by prompts to purchase branded supplements
from the Dr. Axe online store, this promise is self-interested, disingenuous, and dangerous.
Scholarly sources tend to be focused upon clinicians or researchers, so their technical
findings are often of little use to the lay diabetic. The online sources considered, by contrast, tend
to provide some useful information, but such information is offered in an environment whose net
effect is one of either promoting ‘self’-reliance upon potential diabetics (though WebMD is
explicit in arguing for the importance of physician advice), or appears to be designed to push
customers toward purchasing branded supplements and other products. In any case, the best
option for diabetics is to seek out their physician’s advice, and then follow it to the letter.
Works Cited
Centers for Disease Control and Prevention (2015). Diabetes. Retrieved February 3, 2018 from
from http://www.cdc.gov/diabetes/home/
Currie, C.J., Peyrot, M., Morgan, C.L., Poole, C.D., Jenkins-Jones, S., Rubin, R.R., & Evans, M.
Danaei, G., Finucane, M.M., Lu, Y., Singh, G. M., Cowan, M.J., Paciorek, C.J., & Rao, M.
(2011). National, regional, and global trends in fasting plasma glucose and diabetes
Dr. Axe: Food is Medicine (2018). How to Reverse Diabetes Naturally. Retrieved February 3,
(2018a). About Dr. Josh Axe. Retrieved February 3, 2018 from https://draxe.com/about-
dr-josh-axe/
Hundal, R.S., Krssak, M., Dufour, S., Laurent, D., Lebon, V., Chandramouli, V., & Shulman,
Lowry, P.B., Zhang, D., and Wu, D. (2014). Understanding Patients’ Compliance
Behavior in a Mobile Healthcare System: The Role of Trust and Planned Behavior.
http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2529599
National Institutes of Health (NIH, 2018). Evaluating Internet Health Information. Retrieved
Salaam, M.A., and Siddiqui, A.F. (2014). Role of health education and barriers to compliance
among diabetic patients. Rawal Medical Journal 39(2): 212-215.
Semigran, H. L., Linder, J. A., Gidengil, C., & Mehrotra, A. (2015). Evaluation of symptom
checkers for self diagnosis and triage: audit study. British Medical Journal 351.
Similar Web (2018). WebMD.com: December 2017 Overview. Retrieved February 3, 2018 from
https://www.similarweb.com/website/webmd.com
Talukdar, R., & Reddy, D. N. (2017). Pancreatic Exocrine Insufficiency in Type 1 and 2
64-71.
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