DiabetesSource

By David L. Joffe, BSPharm, CDE, FACA

Diabetes is the fastest-growing disease in the United States and the rest of the world. It was estimated that one of every three children born in 2000 would have diabetes in his or her lifetime. Now epidemiologists suggest that by the year 2015, one in every two children born will have diabetes. Think of it: In 15 short years the chances of acquiring diabetes will have increased by 50%.

The challenge of diabetes care and management also continues to grow. For every five minutes we can spend with a patient talking about food choices and activity, there are hundreds of hours of TV commercials and thousands of advertisements undermining the message we deliver.

When I first got interested in diabetes care, it was pretty simple. Diet and exercise for the first six months, then oral medicine for a couple of years, and then insulin, and we hoped we got it right. We were not very good at keeping those diabetes patients alive, and so often they died before all the complications set in.

Years later, things have really changed. We know so much more about the disease and have much better diagnostic tools, not only for the disease but for the complications as well. We have new classes of oral medications and insulins, and we even have medications made from lizard saliva, but still the epidemic grows.

The devices we have to measure glucose levels have rapidly evolved; we can measure glucose accurately and simply any time we want. We can get a two-week average, or a three-month average, in a matter of minutes from a simple finger stick, and we can even slip a small wire under the skin and get a digital reading every five minutes. And yet with all this technology, the number of diabetes patients continues to grow.

We have medications to prevent complications. We have procedures to reverse retinopathy, prevent amputations and save kidneys. And still diabetes patients get complications in increasing numbers.

We have tons of food information, nutritional products, natural products, vitamins, minerals, ayurvedic compounds and homeopathic mixtures. And still the disease grows.

Why are we losing the battle?

• Diabetes is 95% the responsibility of the patient. In fact, diabetes requires more patient involvement than any other disease. We are a “we want a pill to fix it” society, and unlike most other diseases, diabetes cannot be fixed by pills alone.
• Patients encounter mixed messages: low carb or high carb; low fat or high fat; more fiber or less fiber; high glycemic or low glycemic. Which messages are correct?
• There is not enough time to work with the patient. Spending 15 minutes with a diabetes patient is just not enough. Especially if he or she is a new patient.
• Diabetes education is not accessible enough. Every day, programs are closing and insurance companies are refusing to pay, so fewer than 25% of diabetes patients ever get referred, and fewer than 11% ever attend classes. And the experts in diabetes care, Certified Diabetes Educators, cannot even get paid directly to see patients.

Where does that leave us? I am not naive enough to think that these things will change overnight, and my guess is that things will get worse before they get better. In addition, since diabetes experts can’t seem to agree on the way to help patients with diabetes, it makes everything more complicated.