January 13, 2015

A Lovely Rant by Ira Hirsh

I started using the acronym YDMV years ago on web boards as a way of responding to individuals who aggressively pushed a single 'RIGHT WAY' of managing diabetes. Some time its was the right pump or meter. Occasionally it was shots vs pumps vs pens. Sometimes it was even this is THE I:C ratio you should use because it work for us perfectly.

I would typically agree making a general point about our family's approach to attention to care without mentioning "RIGHT WAY" and add Your Diabetes May Vary. That way when they disagreed with my way it was covered by the YDMV statement and gave others the same out if they didn't agree with the "Right Way."

I also thought it would be fun if it became a commonly used term on the boards. It did.

Part of the new care shake up in the US is grading doctors based on metrics. (For the record I HATE the word metrics. It is a buzz word typically used by people who substitute a number for thoughtful consideration.) Measures would be great if the metrics aligned with the current ADA treatment recommendation about individualization of targets based on the patient's specific situation. (1) It would be fantastic if there was a measure that identified that caregivers spend the time necessary to find the individual targets and customize goals for each patient.

That ain't how it works. (see I feelings for the word metrics above.)

The new system holds Docs to static levels of HbA1c, LDL-cholesterol, and blood pressure. So if you are the doc and you have a patient who is way out of range and you help decrease variability, lower A1C make progress on LDL and blood pressure it doesn't count. Progress is not the end static measure are. In this model success is a number not behaviors.

Hey Who ever makes this stuff up. YDMV.

All diabetes is a progressive. Succes is adapting and changing to make living with diabetes about life not about numbers.


Dr Ira Hirsch as a lovely rant about this. Have a read.

(1) American Diabetes Association: Glycemic targets. Diabetes Care 2015;38(Suppl 1):S33–S40.