What’s missing in diabetes innovation: a new provider-patient relationship

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The above picture was taken when I spoke at the International Diabetes Federation side panel at the World Health Assembly this past May in Geneva. The quote is my perspective as it related to the session:

Access to diabetes medicines and care in underserved populations: patient, health worker, government and multilateral perspectives on policy

Access to care is a major problem around the world. Yet while we may one day solve access to meds and affordability, there’s another type of access almost none of us have. Access to providers who work with us in a way that supports and encourages sustainable self-management. Why is there no innovation on this front?

Today companies are mushrooming everywhere with new multi-purpose drugs, devices, apps and services for diabetes management. Big companies are buying little start-ups, like Roche buying the popular app MySugar last week, to have more data, data, data. Yet, no one is thinking among all this external “hardware,” where is the “heartware” people need – the connection with their provider, the confidence building – to manage their condition?

In other words: Is the quality of interaction between health care providers and people with diabetes manifesting patients who are confident, enthused, skilled and committed to their daily self-care? Mostly, no. Why?

There is no major training for providers in chronic illness. So instead providers are applying what they’ve learned, acute care and attempt to fix our numbers, they are trying to repair what they see as broken in us. While Americans over the age of sixty increasingly live with one or more chronic illnesses, we should be training health professionals a different way of working with this enormous population. And, that treating someone with a chronic illness, requires something else entirely than a condition that will heal.

We know intuitively, and there is scientific evidence, that confirms people act when they feel safe, when they feel trusting. This is actually part of our neurobiology. People take new actions when they feel there’s a chance they’ll be successful, and that’s in part because someone makes them feel that they have their back.

We can throw as many new meds, meters, and apps at people living with diabetes as R&D budgets allow. That’s the easy thing to do. But studies show it doesn’t make all that much difference helping people be more successful managing their diabetes.

However, innovating the patient-provider interaction, that’s what we should be doing to help the millions of people with diabetes who still struggle with their care. That’s what we should be doing to help those doing well, continue to do so. That’s what I’m doing.  When the doctor paid a house call fifty years ago that’s what he was doing.

The single best advice for managing blood sugar

I say this all the time – eating less carbs will make your blood sugar more stable, more in range, and make it far easier to avoid highs and lows. Many, many people with diabetes know and follow this wisdom.

Today I read it again as espoused by Adam Brown, Senior Editor with diaTribe, which happens to be a fantastic, free online newsletter covering diabetes – new meds, devices, start ups, and like Adam’s Corner, experiential wisdom. I lifted this from Adam’s post:

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For Adam’s full post click here.

How to wear a Dexcom CGM on your arm

My last post featured my recent article for the HuffPost that we have much to learn from people with illness who do well.  A few days ago, when I went to put on my Dexcom CGM, on my upper arm where I wear it, I realized that I learned how to do this from a fellow PWD, Diabetic Danica. She created just the video to guide you through the process. Here below:

I found Danica’s video when I was in Japan two years ago and thought, hmmm…I’ve seen a lot of PWDs wearing their Dexcom on their arm. How do you do that? And there she was, joyfully guiding me through the process.

Because I use my CGM intermittently, I find myself always going back to Danica’s video for instruction.

Dexcom only advises wearers to place the sensor on your abdomen because that’s the only spot they have FDA approval for. But we who wear it have discovered there are many places on the body you can wear it. The upper arm is a favorite for many – it’s unobtrusive and I find I get more days with it, more like 14 instead of 10, and it becomes accurate faster.

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Thank you Danica. I don’t know if I could have done it without you, but I’m glad I didn’t have to find out. Another round of applause for people doing well with illness.