You Diabetes May Vary So Access Matters (Wherein I borrow from Manny & Scott)

Diabetes is complex.

It is highly dependent on patient self-care actions that include daily self-monitoring of blood glucose, medication and dosing adjustments, diet measurement, carb management, physical activity, and logistic management of all the stuff needed to do all of the above. Diabetes has a well-documented comorbidity of clinical depression and a subclinical level emotional exhaustion from the burden of management. Diabetes is complex.

Whoever manages it, needs tools they can work with.

My dear friend Manny Hernandez has a spectacular visual representation of the time patients self-manage. A chart that shows the percentage of time people with diabetes self-manage vs the time we spend with our physicians, diabetes educators, and care teams. It is below.

See that little white line? That is time with the care team. BUT to make the little white sliver visible, Manny had to exaggerate its proportion of the graph. This is not to minimize the role of our professional care teams but to make it visible. Manny is not alone in making the point of the importance of patient self-care. Here is Manny’s chart, presented by renown endocrinologist Dr. David Marrero at the ADA Scientific Session in 2015. In the image, we see one diabetes doctor talking with a huge room full of other diabetes doctors making the point that respecting the role of patients is critical to success.

Image source Diabetes Mine - Twitter

Let just pause and think about what this image represents: a doctors and a patient collaborating to advance the art and science of diabetes care at the ADA Scientific Sessions.

I think that patients and doctors collaborating is a brilliant model. 

All the diabetes complexity outlined in the opening paragraph, along with all the associated variability is self-managed the vast majority of the time by patients guided with a small but critical sliver appointments with their health professionals. Somehow in that little white space, doctors and patients figure out jointly how to make the time represented by the blue space successful.

All this is a very long way of starting to making a case for asking, "Who knows best what will drive success in the all the blue time on Manny’s chart?"

To put it briefly, again, I turn to a friend:

"My initial reaction is that healthcare decisions, such as which insulin pump to use, should not be made outside of the doctor/patient relationship," - Scott Johnson

We have seen that disruption to access to testing supplies in an attempt to reduce supply costs, resulted in increased hospitalization, costs, and mortality.

Diabetes is complex. It is highly dependent on patient self-care.

There are 30 million or so people with diabetes in the US. It is a safe bet we have different approaches to succeeding in the blue space on Manny’s chart. Long-term diabetes costs are contained by what happens in that blue space. 

The best practice is individualized diabetes care programs. The appropriate device may vary.

You Diabetes May Vary - So Will Your Care Program and Your Diabetes Stuff. 

Access matters for long-term success. 

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Related (and ancient) YDMV  Content:

The Best Pump

Why Buy into Pumping

Access is the point of Advocacy

The prompt for today:

Let’s kick off Diabetes Blog Week by talking about the diabetes causes and issues that really get us fired up. Are you passionate about 504 plans and school safety? Do diabetes misconceptions irk you? Do you fight for CGM coverage for Medicare patients, SDP funding, or test strip accuracy? Do you work hard at creating diabetes connections and bringing support? Whether or not you “formally” advocate for any cause, share the issues that are important to you.

Yes.
All of the above,
and then some.

Diabetes is Big. Policy is Big.

They touch at a lot of different points. Because both are big, often one touch point doesn't know what the other is trying to do.

It would be glorious, for example, if efforts at prevention were connected to the key idea of access via insurance reimbursement for quality education on how to successfully prevent or at least postpone type 2. Great if third party payers looked at education as the investment in saving lives and expenses down the road that it is, sadly it is not always seen that way.

The list of issues in the prompt seem quite different;

• 504 and schools
• Misconceptions
• CGM and CMS
• Special Diabetes Program
• Test Strips
• Connections with peers

I don't see it that way. To me they are all access to issues:

• Access to safe school environments.
• Access to accurate public messages about diabetes.
• Access to treatment and technology to continue to successfully manage diabetes.
• Access to research to better treat diabetes. 
• Access to reliable devices.
• Access to people who can help individuals stay positive and engaged. 

Advocacy is acting to ensure access. What people need access to may, like diabetes, vary. The need to act with and for each other doesn't vary. If we don't act for better diabetes access, who will?