There are several disturbing facts about COVID and patients with diabetes being at increased risk for developing the virus. One very disturbing fact is the virus impact on the African American population a population which is already disproportionately impacted by diabetes.
According to the journal Clinical Diabetes;
“4.9 million African-American adults, or 18.7% of all African Americans ≥ 20 years of age, have diagnosed or undiagnosed diabetes, compared to 7.1% of non-Hispanic white Americans. The risk of diabetes is 77% higher among African Americans than among non-Hispanic white Americans.”
In our never-ending quest to look for good from bad perhaps this crisis will become a call to action. Perhaps at long last helping patients with diabetes will get more than lip-service from our elected officials. Perhaps we can move on from worrying about the high out of pocket cost of insulin and begin helping patients use insulin more effectively.
COVID may be a pandemic but diabetes has been a global epidemic for years and shows no signs of abating. Year after year this epidemic continues to ravage the global population. Billions have been spent on developing new therapy options and new devices. Patient access to high quality information has never been easier. Yet one indisputable fact remains – PATIENT OUTCOMES ARE NOT IMPROVING.
We hate to jump on our soap box but it’s time to make outcomes matter and matter to the patient. Somehow someway outcomes must matter to the patient and not just because they will avoid the many serious complications that come from poorly controlled diabetes. The biggest problem facing the diabetes industry is their continued fasciation on the wrong problem. The problem is not the drugs in the medicine cabinet or toys in the toy chest. The problem is and continues to be outcomes do not matter to the patient.
Think about everything a patient with diabetes is told to do. Monitor their glucose levels, exercise, eat properly and take their meds as prescribed. They are asked to do all this every day with no days off. Yet what do they get? Do they pay lower health insurance premiums for better control? NO. Do they pay less out of pocket for their meds or testing supplies? NO. Do they get anything that matters NOW and not years from now? NO.
Everyone is telling these people what to do, how to do it but no one gives the patient any skin in the game. They assume, incorrectly, that patients WANT to do all this work because they will ‘feel” better. They assume, incorrectly, that patients understand what the heck good control is. They assume, incorrectly, that patients respond to constant mothering.
Yes there is a minority that gets it and will do all the work. However THIS IS A MINORITY OF THE PATIENT POPULATION. The MAJORITY of patients have a chronic disease which requires lots of work to manage properly. A disease they don’t really understand and NEVER WANTED IN THE FIRST PLACE. What the industry fails to acknowledge is that what these people want most is NOT TO HAVE DIABETES IN THE FIRST PLACE.
Just by way of example let’s look at what our friends at Livongo are doing. According to Livongo patients who join their platform will achieve better outcomes and the employers who sign on with Livongo will save money. Are these employers sharing these savings with their employees or are they just fattening their bottom lines? Listen we have problem with employers lowering their healthcare costs. However what’s in it for their employees with diabetes? What are they getting?
The same can said for physician groups, hospitals, etc. who are incentivized for meeting certain standards of care. This is great but again what does the patient get? How is the patient who is doing all this hard work incentivized?
We say it all the time because it’s true this is all about money – who makes it, who saves it and who spends it. Right now the diabetes industry is making it, employers are saving it and patients are spending it. And just what are patients getting for all this money they are spending? What is their return on investment?
Would it not make sense if we changed this paradigm so that the patient spends less and saves more when they achieve better outcomes? Would not everyone benefit from this new paradigm? Wouldn’t drug companies sell more drugs, device companies more devices and coaching platforms have more patients if everyone shared in the diabetes money pot? Is there not something wrong when the people doing all the hard work do not share in the fruits of their labor?
There was a time long ago when the world worked with this way. Where the people who did all the work didn’t benefit from their labor. In ancient Egypt it was the Pharaoh and the Egyptian people who benefited from the work done by their Jewish salves. Here in America it was the southern plantation owners who benefited from the work by done by their negro salves.
Silly us we thought slavery ended when Moses freed the Jewish salves and President Lincoln ended slavery in America. The fact is patients with diabetes are being held in slavery failing to benefit from their hard work. This isn’t just repugnant but morally wrong. It’s time to FREE the people with diabetes allowing them to share in the diabetes money pot. After all they are doing all the work and taking the greatest risk.