Ok Now What?
Late last week a study published in the The Lancet concluded;
“We stratified patients into five subgroups with differing disease progression and risk of diabetic complications. This new substratification might eventually help to tailor and target early treatment to patients who would benefit most, thereby representing a first step towards precision medicine in diabetes.”
Per an article posted on the FirstWord Pharma web site;
“Scientist Leif Groop remarked “this is extremely important, we’re taking a real step towards precision medicine,” adding “in the ideal scenario, this is applied at diagnosis and we target treatment better.”
No disrespect to Leif but we’re not exactly sure these findings are that important when looked at from a real-world perspective. For in the real world the problem has never been how diabetes is defined. The problem has been and continues to be getting patients with diabetes engaged with their diabetes management.
Perhaps in the ivory tower world of academia this is big news but out in the real world not so much. Perhaps in that ivory tower these researchers can dream of a world when diabetes management is specifically tailored to the individual patient. Given all the attention being paid to Artificial Intelligence these days we suppose it is possible using these new definitions combined with AI it’s possible to provide a patient with a diabetes management plan tailored to their unique needs.
The problem is getting the patient to follow that plan. This is what researchers and so many seem to miss. That all the information in the world, even if it’s tailored for the individual is meaningless if the patient doesn’t follow the plan. Again, this is a case of giving the patient the how to but doing nothing to help with the want to.
In a somewhat ironic twist patients who are insulin dependent and using an insulin pump may have an easier time managing their diabetes than a non-insulin using patient. As we witnessed at ATTD serious progress is being made in the quest for a true closed loop insulin delivery system. A system which collects data analyzes it and then using insulin dosing algorithms helps the patient make better decisions. In it’s purest form all of this will be done automatically. The patient will still have to interact with the system but the day to day interaction will be much less than it is today. Simply put for these patient’s diabetes management just became a lot easier.
The same is not true for non-insulin using patients or insulin plus oral patients. Now once these patients are hooked up to a CGM this might change but as it stands today these less intensively managed patients are not yet embracing this technology. As we keep stating if there is no data to analyze the whole system falls apart. Interconnected diabetes management (IDM) is not that different than a true closed loop insulin delivery system in that both are merely a series of interconnected devices combined with AI. The difference obviously being a real closed loop insulin system does all the work for the patient while with less intensively managed patients they must do what they are being told to do.
Even if these patients do hook themselves up to a CGM and have all their data analyzed and recommendations are made as to how they can better manage their diabetes THEY MUST STILL EXECUTE. These recommendations are meaningless if they are not acted upon. To put this in terms everyone can understand think about someone who wants to lose weight. They buy themselves a way cool whiz bang Apple Watch to track their activity. They search the internet and find a diet that fits. Some will take the even bigger step, join a health club and find themselves a trainer who develops a workout plan. Then after all this effort they continue to eat what they have been eating and fail to workout.
We see this every year at our health club when all the newbies show up in January after making a New Year’s resolution to lose weight. Yes, the treadmills are filed with these people for about three maybe four weeks and then they start to disappear. Come Valentines Day in February most have gone back to the lives they had before, by NCAA tournament time it’s the same core group of workout junkies. These newbies who were so motivated back in January lose interest instead of weight. They realize that it takes WORK lots of WORK. That results come after TIME and even when they reach their goal it takes an equal amount of time to stay at their new weight.
Diabetes management is very similar. We see it all the time with newly diagnosed patients. Yep in the beginning its all about doing it by the book. While some stick with it most don’t for the simple reason diabetes management is a job and there are no days off.
The reality is and always has been coming up with a plan to treat diabetes isn’t that difficult. Giving the patient the how to manage their diabetes is the easy part. However, as we keep seeing no one has yet to figure out how to give these patients the desire so they want to manage their diabetes. Listen we could care less if there 5 subgroups or 10, that isn’t and never has been the problem.