Every November is Diabetes Awareness Month – a time to reflect on the progress we have made in treating the nearly 26 million Americans with the chronic disease. We take stock of new treatments, awareness, better adherence to diabetes medications and ask ourselves, “what more can we do?” to better treat this serious public health concern.
Already, America’s biopharmaceutical companies are in the process of developing 180 medicines to treat diabetes and there are 200 active diabetes clinical trials in the United States. The promise of these potential treatments and trials offer tremendous hope to those impacted by the disease.
However, the question of what more can be done to make a difference for the millions affected remains, so we asked Dr. Fran Cogen, Director of the Childhood and Adolescent Diabetes Program at Children’s National Health System the following question:
How can we best promote healthy lifestyles and adherence to needed medicines to tackle diabetes?
The care of a chronic disease such as diabetes requires a supportive team. Therefore, a multidisciplinary program that encompasses indispensable medical, psychosocial and family support should be the recommended approach for diabetes management. Adherence to treatment including oral medication or insulin administration via injection or insulin pump therapy, as well as self-blood glucose monitoring is a major task. In addition, we ask our families to promote healthy eating in terms of carb counting or other dietary recommendations and exercise 30 minutes 5 times/week. This can be an enormous burden to the person with diabetes and their caregivers.
It is my belief that promoting healthy lifestyles and adherence requires the participation of the entire family of the person with diabetes and the health care team. There needs to be a reason for the individual with diabetes to work diligently in performing self-care skills. Based on the results of the seminal The Diabetes Care and Complication Trial, along with other studies, it is clear that there is a positive direct correlation with hb A1c and the development of microvascular and macrovascular complications: the lower the hb A1c, the lower the risk, and the longer the person with diabetes lives a healthier life.
It is up to the team to help support and motivate our people with diabetes to reach these goals by applying new technology and hopefully an eventual cure resulting from evidence based research. By assigning “coaching” roles to individual members of the healthcare and family team, and depending on the particular needs of the person with diabetes, at a particular difficult time, we pinpoint the appropriate assistance.
To continue with the team approach, I often assign roles to my health care providers and family members. I appoint myself as the “head coach/manager” providing the appropriate playbook (treatment plan) and -depending on the season- appoint offensive/defensive coordinators or pitching/hitting coaches. The person with diabetes is the “captain” of the team. If he/she does not play well, the team loses.
In summary, adherence to treatment in chronic illness requires the setting of a few behavioral goals at each visit. It is important to keep in mind that the more complex the steps/goals required; the least chance there is of success. As the “captain” meets with his/her coaches, our approach should be as supportive and positive as possible in order to enhance adherence to both medication and required lifestyle changes.
This is a game we cannot afford to lose.
Conversations and healthy debate about issues facing our industry and the health care system are critical to addressing some of today’s challenges and opportunities. The Catalyst welcomes guest contributors including patients, stakeholders, innovators and others to share their perspectives and point of view. Like in our Conversations series, views represented here may not be those of PhRMA, though they are no less key to a healthy dialogue on issues in health care today.