TCOYD Newsletter, Vol. 33, 2010

I have never met a person with diabetes who does not want to live a long and healthy life. However, people with diabetes who do not have perfect glucose control are often labeled as “non-compliant.” I see this all too often in the hospital among the medical students, residents, endocrine fellows, dietitians, CDEs and other faculty and staff.

Once a person with diabetes is labeled as non-compliant in their medical record, healthcare professionals who read the record in preparation for a visit have already developed a preconceived notion that this person does not follow the rules. It is a common situation that is pervasive among healthcare professionals and has been proven difficult to change.

So why is it that many people with diabetes have high A1c values? The reasons are diverse, ranging from emotional and physical barriers to uninformed caregivers. Frequently, there is limited access to the best therapies currently available. Of the many variables that influence glucose control and the eventual development of diabetes complications, the “activation” of the person living with diabetes to take a more dedicated role in his or her care is the most critical. Activation basically means that the PWD has been educated, motivated and empowered to take control of their diabetes with a positive attitude.

As we spoke about in our previous newsletter, Extreme Diabetes Makeover (XDM) will soon be available to millions of people around the globe to view online. TCOYD’s XDM program successfully addresses how to help people with out of control diabetes to become active in their own healthcare. Trust me, it’s not rocket science.

For our first XDM program we accepted seven individuals living with diabetes who have extremely poor control of their condition (A1c values mostly between 9% and 11%, indicating an average blood glucose value of more than 250mg/dl) Over a 5-month period, they greatly improved their control and completely changed their attitudes about living a normal and proactive life with diabetes. TCOYD helped provide them with a dream team of diabetes specialists including myself; Dietitian Janice Baker, RD, CDE; Nurse educator Angela Norton, RN, CDE; Exercise physiologist, Larry Verity, PhD, FACSM; and Clinical psychologist Bill Polonsky, PhD, CDE. We gave them the attention they needed, gained their trust and addressed their emotional and physical barriers. This occurred only after we were able to truly connect with the group and develop a meaningful understanding of the issues that were preventing them from living successfully with their diabetes.

There is no question that we helped to activate these individuals who were generally disheartened with the day-to-day frustrations of this chronic condition and all of the demands put forth by our professional community. I have always wondered how well physicians would do when asked to prick their fingers and test their glucose three to four times per day, follow a consistent and rigid diet, exercise each day with consistent duration and intensity, take medications regularly including insulin injections and deal with the requirements to see multiple care professionals throughout the year as part of their diabetes treatment.

What does it take to activate someone living with diabetes? It takes understanding, sincerity, knowledge and the ability to empathize with individuals in regard to what it is like to live with diabetes on a day-to-day basis. It also takes a conscious shift in attitude from categorizing someone living with diabetes who has poor control as non-compliant, to regarding them as not being active in their own condition.

The answer to improving care in this country is, in part, developing new drugs and devices, but also changing the attitudes of caregivers toward their patients with diabetes by encouraging them to become activated in their own self-management, while addressing their individual physical and emotional fears, needs and concerns. This takes time and is a multidisciplinary approach. We must allow for these vital requirements within our new healthcare policies to take action. As patients and healthcare providers, let’s work together to improve lives and ultimately change the face of diabetes in this country.

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