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Today we honor Dr. Martin Luther King who on August 28, 1963 delivered his famous I Have A Dream speech. Dr. King spoke eloquently of his dream for racial equality stating;
“I say to you today, my friends, so even though we face the difficulties of today and tomorrow, I still have a dream. … I have a dream that one day this nation will rise up and live out the true meaning of its creed: “We hold these truths to be self-evident; that all men are created equal.”
Today I also have a dream it may not be as noble or as eloquent as what Dr. King dreamed of but to me anyway and to millions of patients with diabetes it’s just as important. Unfortunately like Dr. King’s dream of racial equality it’s also a dream that in spite of all the progress we have made over the years, all the research done, all the money spent remains elusive.
See my dream is that one day the majority of patients with diabetes will be under good control. That no longer will we see that embarrassing slide in every presentation that states even with all the toys in the toy chest, all the drugs in the medicine cabinet, all the way cool whiz bang apps that still almost two thirds of all patients are not achieving good control. That instead of talking about more way cool whiz bang that we talk about REAL improvements in outcomes for ALL patients regardless of how they manage their diabetes.
Reflecting on the two shows we just attended CES and JPM it occurred to us, or actually reinforced something for us, of the major disconnect between the industry of diabetes and the people who actually have diabetes. While so many in the industry think they understand what the patient wants they really don’t. Yes toys are fun to play with and the apps are way cool but what these patients want more than anything is NOT TO HAVE DIABETES.
Far too many in the business of diabetes believe they are making lives easier for patients when in fact they are doing the exact opposite. A perfect example of this is the idiotic belief that patients will whip out their smartphone at every meal they eat and take pictures of what they are eating. Sure sounds like fun doesn’t it? Or what about this belief that patients want a completely automated insulin delivery system, a system that makes ALL the decisions for the patient. Yep we sure want the toys we play with, toys which happen to deliver a necessary yet lethal drug to deliver this drug unchecked by a human.
Next to not having diabetes at all what patients want more than anything is for their diabetes management to be 100% STUPID. They don’t want to think about it. They don’t want diabetes to run their already complex busy lives. They are sick and tired of being told what to do and when to do it. Is it any wonder so many patients tune out instead of tuning in? These people aren’t stupid they know they have a serious chronic disease which needs to be managed. But they sure as hell are sick of being treated as if they are stupid.
Wouldn’t it be refreshing if patients had a real interest in their diabetes management? That instead of an app telling them what to eat or to take their meds. That they actually got something real, something tangible, something they could see feel or touch for doing all the heavy lifting required to manage their diabetes properly. We will go to our grave, and we likely will, believing that until patients are incentivized in some way, we will NEVER see a major improvement in patient outcomes.
Diabetes is NOT a math problem; technology alone will NOT solve the problem. Diabetes is a chronic condition which is manageable IF the patient chooses to do so. And it should be the patient’s choice how they manage it, they should NOT be chastised or ostracized by the choices they make. There are far too many in the diabetes blogger community who are as bad the physicians when it comes to laying on the guilt when the patient doesn’t do things as they want them too.
It sickens me when a person with Type 1 diabetes feels superior to a patient with Type 2 diabetes. That somehow the burden of Type 1 diabetes is more difficult than the cakewalk Type 2 patients have. This is complete and utter crap, but this attitude unfortunately exists. Diabetes is diabetes no matter how it’s treated, the complications associated with poorly controlled diabetes do not ask whether a patient uses insulin or not.
My dream extends to patients as well we do not absolve them from the responsibility they have. However where we differ from most is that we understand that how they manage their diabetes IS THEIR CHOICE. That how they manage their diabetes should not be FORCED upon them. What patients want most, next to not having diabetes or diabetes management being 100% stupid, is the facts. Facts they can us to decide how THEY will manage their diabetes.
Yes, we are all for improved access to the drugs in the medicine cabinet and the toys chest. And we will say it again NO PATIENT SHOULD EVER HAVE TO CHOOSE BETWEEN PAYING THEIR RENT OR GETTING THE DRUG THAT KEEPS THEM ALIVE. There is no question we can always use better drugs and devices. However there is nothing wrong with the drugs or devices we have today should a patient CHOOSE to use them as designed.
One day I hope my dream becomes a reality. That one-day patients will be treated with respect. That one-day patients will CHOOSE to take an active role in their diabetes. That these patients who CHOOSE to take an active role get something other a better A1C for doing all the heavy lifting. Most of all our dream is that slide we see in almost every presentation disappears, that the money being spent, the research being done produces real improvements in outcomes for ALL patients regardless of how they CHOOSE to treat their diabetes.
This will be a welcome relief from the nightmare we continue to live with and worse seem to accept. Dr. King dared to dream why shouldn’t we?