HIPAA doesn’t apply to businesses

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. I always thought HIPAA 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 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 HIPAAcovered 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?

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 — 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.

As soon as you stop the behaviors, 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.