“It appears that advances in diabetes care over the past decade have not translated into meaningful improvement in population-level treatment outcomes.” These are not our words although we have said something very similar, no these words come from a study published in JAMA Internal Medicine Evaluation of the Cascade of Diabetes Care in the United States, 2005-2016 by Pooyan Kazemian, PhD; Fatma M. Shebl, MD, PhD; Nicole McCann, BA; et al.
The authors conclude:
“It appears that the diabetes care cascade in the United States has not significantly improved between 2005 and 2016. This study’s findings suggest that gaps in diabetes care that were present in 2005, particularly among younger adults (18-44 years), women, and nonwhite individuals, persist.”
Now think for just a moment all the major advancements we have seen since 2005- insulin analogues, GLP-1, SGLT2’s, DPP4’s, CGM, “Smart” Insulin pumps, Connected Insulin Pens, Apps, Blogs and Website – yet with all the toys in the toy chest all the drugs in the medicine cabinet and the way cool whiz bang from 2005 through 2016 NO SIGNIFICANT IMPROVEMENT.
Therefore it makes perfect sense that we do the exact same things, which is exactly is happening. Try as they might to be way cool whiz bang and way innovative Livongo is just an old idea in a shiny new box, the idea didn’t work when they called it disease management and used telephone calls to interact with the patient and it won’t work now just because they use text messages when they interact with a patient.
OneDrop, Onduo and the rest of Livongo competitors won’t get it right either no matter how many Facebook posts they have or how much money is invested in them.
Ironically life should get much better for insulin using patients now that Tyler is coming. The question given the conclusions drawn by this study is will Tyler have the impact he’s capable of having. Is the problem with patient access to all this way cool whiz bang or does the study reflect what we have always suspected that without real skin in the game the patient does not want to do all the heavy lifting required to manage their diabetes properly?
Perhaps this study will begin a new debate and take attention from those very vocal Type 1’s who make up a minority of the patient population yet have an undeserved amount of influence. A group that shuns patients with Type 2 diabetes believing they are far superior to these plebs and that everyone should manage their diabetes as they do. A group of people who are completely clueless as to how the business aspects of diabetes impact the management of diabetes. Yes West Coast Mafia we are talking about you.
We hope every executive in the diabetes industry reads this study and begins to understand something we wrote about a while back IT’S TIME TO TAKE DIABETES MANAGEMENT OUT OF THE CLINIC AND START TREATING PATIENTS AS CONSUMERS. Perhaps they will finally understand that diabetes is chronic disease that the majority of patients don’t understand, didn’t want in the first place and requires lots of work to manage properly. Think of that the next time you receive yet another bonus for making your number.
Frankly the hypocrisy in the diabetes industry is beyond disgusting and this includes the West Coast Mafia. What everyone has forgotten is patients with diabetes aren’t robots they are human beings who have lives to live. That these people want to LIVE THEIR LIVES WITH DIABETES AND NOT FOR THEIR DIABETES. They crave simple solutions to what is a complex problem. They are tired of being treated like children being told what to do when to do it and then given guilt when they don’t do it.
Unfortunately as true as this study is, we doubt much will change. The fascination with the toys in the toy chest will continue. Everyone will continue to be impressed by way cool and whiz bang. Patients who do not use insulin to treat their diabetes will continue to be treated as inferior patients not worthy of respect. The focus will not be on what we can do to change, what can be done so ten years from today we don’t have another study that reaches the same conclusions.
No instead of reflection and a call to action for real substantive change there will be pontificating and lots of hot air. This study and its conclusions reminds of us of the many mass shootings we’ve seen. Unfortunately these mass shootings have become part of our daily lives so much so that there is a pattern of behavior after each incidence. Outrage, candlelight vigils, lots of pontificating, calls for new gun laws and then the furor dies down until this process is repeated after the next mass shooting.
As outraged as we were when we read the study we weren’t at all surprised by its conclusions. This is something we have known and written about regularly. The facts yes, those pesky facts tell us that nothing much will change that billions will go on being wasted on stupid studies, worthless companies and ideas that are way cool whiz bang ideas that unfortunately bring nothing new to table.
We know change is hard and we aren’t naïve either as there is no simple solution. However we also know NOTHING will change or even have a chance at changing IF WE KEEP DOING THE SAME THING OVER AND OVER AGAIN. As Albert Einstein said that is the definition of insanity performing the same behavior over and over again and expecting a different result. Momma Kliff put it best when she said “Change is the hardest part of life, no one likes change but there are times when change is not just necessary but imperative. The real issue isn’t whether change as hard as it may be is possible, no the real issue is do people have the WILL to change.”