DEAR DR. ROACH: I am confused about how HIPAA applies to my medical information. Some people are saying they don't have to tell people if they have been vaccinated or not or respond to an employer that is requiring the vaccine to go back to work or to businesses that may require vaccination for entry. I always thought HIPAA applied to doctors and insurance companies and was about providing my health information to third parties without my authorization, not about me providing that information directly. Can you please explain who's correct? — D.L.G.
ANSWER: The Health Insurance Portability and Accountability Act was passed by Congress in 1996 and signed into law by President Bill Clinton. It was designed to protect health coverage for people who change jobs, required medical providers to give patients access to their personal health information, and required medical providers to protect the privacy of health information. HIPAA applies to health plans, clearinghouses and providers. In my role as a physician, I must comply with HIPAA. However, most employers and businesses, such as cruise lines, are not HIPAA-covered entities, so HIPAA does not apply. A business is free to require vaccination, and you are free to refuse and take your business elsewhere, if you so choose.
DEAR DR. ROACH: You recently told a reader who was a newly diagnosed diabetic that Type 2 diabetes is a "stable" diagnosis: Once the diagnosis is made, you always have diabetes, even if your blood sugars become perfectly normal and you are off medicine.
Is prediabetes similarly a stable diagnosis? If someone has never been diagnosed with Type 2 diabetes, but likely would have been but for closely watching diet, exercise and weight, is it important for them to be diagnosed as having diabetes? If so, what tests are appropriate to diagnose this? — A.A.
ANSWER: Prediabetes and Type 2 diabetes are on the same spectrum: It's a matter of severity. The same underlying problem — insulin resistance, also called impaired glucose tolerance — is responsible for both prediabetes and Type 2 diabetes.
Most people with prediabetes can get their blood sugars into the normal range by careful control of the three factors you identified: a diet low in simple sugars and starches, regular moderate exercise and weight control. Unfortunately, these behaviors do need to be lifelong. You don't "cure" yourself of diabetes by getting to your target weight and having good diet and exercise. That is, if weight loss is appropriate. Some people with Type 2 diabetes are normal weight or underweight.
As soon as you stop the behaviors, or if the weight gets back to the area where you had prediabetes, you are likely to have prediabetes again. In fact, insulin resistance tends to worsen as people get older, so the degree of control of weight along with healthy lifestyle needs to be better over time to keep diabetes away forever. Even people with prediabetes are at higher risk for heart disease compared with a person with no prediabetes. But the risk in general is not as high as someone diagnosed with diabetes.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.