The Wrong Debate
It seems the diabetes world is up in arms once again. This time the debate centers around a statement from the American College of Physicians which concluded that most Type 2 diabetic patients’ A1C levels should be 7% to 8%. The group, which based its recommendation on a review of existing guidelines and clinical trials, published its guidance statement in the Annals of Internal Medicine. This statement is in sharp contrast to the widely held belief that patients should achieve an HbA1c of 7 or below.
The statement also comes at a time when many believe that HbA1c while an important measure for control by itself does not provide a complete picture of control. Thanks to CGM technology many now believe time in range should be considered when defining whether a patient is or is not in control.
While we applaud these efforts to come up with a more complete definition of control this debate while important for academics misses the point. By our way of thinking there is nothing wrong with different measures of control for different patient groups. As we have noted diabetes is not a one size fits all disease. However, the problem isn’t how control is defined, the problem is getting patients to care.
Yes, there is a subset of patients who care but most patients don’t. We hate to keep repeating ourselves but most patients with diabetes have a chronic disease which they do not understand and requires work to manage properly no matter how good control is defined. To these patients it does not matter if the target is 7 or 8. What matters is making their diabetes management as simple as possible.
Think of it this way as Body Mass Index (BMI) has supplanted weight as a measure whether a patient is considered obese. BMI considers the patients height and weight. Yet the fact remains even when these additional metrics are factored in millions of patients remain obese. Losing weight and then keeping it off is not that much different than diabetes management, in that it takes hard work. And in the real world not the academic world most patients would rather eat a deep-dish pizza than a garden salad.
Well the same goes for diabetes sure in the ivory tower world one would think that a patient would do all the heavy lifting. That they would not wish to experience the many complications that come with poorly controlled diabetes. They would think this but the facts, yes, those pesky facts clearly state otherwise. In the real world most patients understand that managing their diabetes is important they just don’t want to do all the heavy lifting.
Now we all know where this is going as these patients have no INCENTIVE to do all the heavy lifting. Listen it does not take a clinical study to know what everyone knows in that INCENTIVES work whether it’s losing weight or managing diabetes. There is thankfully data to back this up yet even with this data no one seems to be listening. As Momma Kliff used to say; “Just because something is true does not mean for a moment that people will act upon it.”
See this is what’s so damn frustrating about this debate as it fails to include the person who matters most, the patient. It does nothing to solve the biggest issue of all, getting a patient engaged with their diabetes management. No matter what the definition is or becomes it doesn’t mean a damn thing if the patient does not do their part.
But alias here we are on the 21st Anniversary of Diabetic Investor and the same problem that faced diabetes back then is the same problem we have today. With the advancements we’ve seen the fact remains most patients are not achieving good control, and this has nothing to do with how control is defined and everything to do with the heavy burden the 24X7X365 job of managing diabetes. And yes, it is that simple.