Diabetes Day

Now that the midterm elections are over, well almost over and not to digress but it seems to us that if we can have a hybrid closed loop insulin delivery system shouldn’t the state of Florida be able to count votes, just saying. Anyway no matter which way a person leans politically it’s obvious that healthcare was a big issue when people hit the voting booth. An issues which will not go away and an issue which divides this country as to how best to fix it.

A common chorus is Medicare for all or some sort of single payor system. Others want to role back ObamaCare blaming it for less competition, higher premiums and higher deductibles. Still others are calling for some sort of middle ground perhaps open access to Medicare with ObamaCare fixed instead of shredded. The fact is there are no easy answers here and when it comes to diabetes the issues are very complex.

One of the more recent issues shows how complex as many still are screaming about the “high” out of pocket cost patients pay for insulin. They want insulin to be more “affordable” or the extremist want it given away for free. As we have noted many times even if given away for free there is no hard evidence that this would produce better patient outcomes. But let’s look at a different issue, “affordability”. A term thrown around so often it should be defined right?

Not a chance as what’s affordable for one person is out of reach for another. Think of it this way if you’re an executive at big Pharma making six or seven figures affordability is one thing. One the other hand if your the administrative assistant for this executive making less than six figures affordability is another thing. Think if this admin is a single mom supporting a kid or two. A single mom with Type 1 diabetes in a high deductible plan.

Much has been made about the coming transformation to outcomes based reimbursement. Many including us see this as more positive then negative but its not easy either. For just as affordability is hard to define so too are outcomes. For years the gold standard has been HbA1c a reading of 7 or below is good, higher than 7 not so good. But with the advent of CGM what about time in range which is proving to be an equally important metric when measuring control.

Yet studies have shown that for some patients striving for an HbA1c of 7 or below does more harm than good, that for these patients maybe an HbA1C of over 7 is ok. And what about patients who cannot afford CGM, if time in range becomes a metric where will the data come from. The same goes for drugs if the patient does not have access to them either because they are not covered by their healthcare plan provider or not affordable does it matter how good they are?

For years now we have been watching one of the greatest transformations in diabetes as finally all this whiz bang way cool technology is beginning to bear fruit. We have better toys to play with and better drugs in the medicine cabinet. Patients have a plethora of options when it comes to assistance managing their diabetes. We have seen an explosion in apps, websites and blogs many of which offer excellent advice. And the future looks even brighter and not just for insulin using patients but all patients no matter how they manage their diabetes.

Still with all these advancements and those to come the question is will anything change in terms of outcomes. Using history as a guide sadly the answer would be no. And it’s not just getting all this great stuff into the hands of patients it’s also about getting the patient to use all the damn toys and take their damn meds.

No matter what is done in terms of healthcare reform no one can legislate adherence or compliance or whatever the current politically correct term we’re using today. It’s not popular to acknowledge it but the patient with diabetes does bear some responsibility too. Patients with diabetes are NOT victims they are not disabled they have a chronic disease which can be managed.

Frankly its pathetic and insulting the way some characterize patients with diabetes. Treating these people as if they were children who don’t know better, rather than having an adult straight forward conversation. We have long maintained that all this coddling has done more harm than good. It’s about time patients were treated with some damn respect. If the patient then choses not to engage quite frankly they deserve what they get. We know this view is not popular it just happens to be accurate.

The “high” cost of insulin is a perfect example as what do we hear all the time, the programs offered by the insulin companies are too complex or benefits don’t come fast enough, there are forms to fill out and questions that must answered. Listen it would irresponsible if these companies didn’t have some sort of vetting process but the way so many see it these companies should just give insulin away for free to anyone who claims they cannot afford it. Sorry folks we too would like to believe that no one would attempt to get something for nothing, that everyone who seeks assistance actually needs it. We’d like to believe it but unfortunately it just isn’t true.

As Momma Kliff used to say there’s a lot of sadness in the world but there are also lots of dishonest people too.

Diabetes for the first time in years perhaps decades is on the cusp of major advancements. Yet we cannot help but temper the enthusiasm we have by the fact that this time around may be no different than the last time. That outcomes won’t improve nor will patients lives be made any easier. As we advance through Diabetes Awareness Month perhaps some thought should be given to leaving the past behind. Perhaps its time to take a holistic view of the situation.

It’s easy to blame big bad pharma – payors – ObamaCare – the boogie man whatever – placing blame is the easy part. It’s easy to paint the patient as a helpless victim battling evil forces when instead the patient bears an equal amount of responsibility. Would it not be better to stop the blame game, stop the stupid and inaccurate characterizations and actually work towards solutions. We aren’t sure when compromise became a dirty word but that’s what needed here.

Patient advocates must stop blaming everything on big pharma and big pharma or device has a responsibility to put the patient first. These groups should and can coexist IF they are willing to compromise. Unfortunately from what we have seem everyone wants to take the easy way out and nothing gets done. Sad but true.