The main goal of diabetes management has been achieving meaningful and sustained glycemic control in order to reduce the risk of long-term complications. Unfortunately, results from The National Health and Nutrition Examination Survey (NHANES) indicate that only about 50% of adults with diabetes in the United States, mostly type 2, are achieving a hemoglobin A1c (A1C) of less than 7.0%.1 This percentage has not changed over the past decade despite the fact that our armamentarium of effective and safe type 2 medications, such as DPP-4 inhibitors, SGLT2 inhibitors, designer insulins, inhaled insulin and GLP-1 RAs, has increased.
While there may be many reasons why new treatment options haven’t made a dent in glycemic control of our patients with type 2 diabetes during the past 10 years, we feel strongly that the primary issue is a lack of patient education, motivation and self-advocacy. Type 2 diabetes is a silent condition with few or no symptoms arising from poor blood glucose, blood pressure and lipid control.2 Therefore, what is lacking is a sense of urgency. People with type 2 diabetes are asked to take a handful of pills, give themselves injections and “prick” their fingers several times a day when they do not feel any different if they follow (or don’t follow) the orders we, as their health care providers (HCPs), give them.
For those living with type 1 diabetes, there is a real sense of urgency, but it is so difficult to achieve and maintain adequate glycemic control. The most recent data show that less than 30% of people with type 1 diabetes achieve an A1C less than 7%, with little change over the past decade.3 The unmet needs include excessive and unpredictable glycemic variability, fear of hypoglycemia, weight gain and risk for cardiovascular disease, sharing some of the concerns in people with type 2 diabetes. The emotional and psychological burden is also present in all people with any type of diabetes as well as their loved ones.
Diabetes control in this country and around the world is inadequate for the majority of people living with this chronic condition. However, there have been numerous advances in the field of diabetes that can potentially wipe out or greatly reduce the amount of human suffering and cost associated with diabetes. Why is it that advances in the diabetes medical field have far outpaced care at the community level? We believe one of the most important missing links is that patient education and motivation have been seriously lacking or even nonexistent. The people living with this condition need to be the most knowledgeable members of their health care teams and take the main responsibility for their own health.4 People with diabetes (PWD) need to be their own best advocates and work in collaboration with their HCPs to get the best care possible. They must learn what needs to be done in order to live a long, healthy and productive life with diabetes.4 Being smart and persistent is one of the central themes of Taking Control Of Your Diabetes (TCOYD), a 501(c)(3) not-for-profit charitable educational organization founded in 1995 (tcoyd.org).
Guided by the belief that every individual with diabetes has the right to live a healthy, happy and productive life, TCOYD educates and motivates people with diabetes to take a more active role in their condition and provides innovative and integrative continuing diabetes education to medical professionals caring for people with diabetes.
TCOYD engages and educates PWD in a variety of ways: through our flagship national series of conferences and health fairs (over 200 as of this writing); our award-winning YouTube video series, The Edelman Report; our monthly digital newsletter; the fifth edition of the TCOYD book; our content-rich, mobile-optimized website; our social media platforms; and our Spotlight series of evening seminars in San Diego, all intended to keep PWD engaged and proactive in caring for their own health.
Our full-day conferences consist of specialized type 1 and type 2 tracks covering topics that are important for each of these quite different forms of diabetes. Participants are also given the opportunity to meet one-on-one with a variety of medical specialists, including physicians, dietitians, pharmacists, nurses, certified diabetes educators, etc., and to participate in small group physical activities. An extensive interactive health fair, healthy banquet lunch and closing session with an inspirational speaker round out the day. Participants leave feeling knowledgeable, hopeful and motivated to more effectively manage their diabetes.
Over the years, we have learned that the keys to successfully educate and motivate large numbers of people include utilizing a faculty of diabetes experts who can effectively speak to a lay audience, have upbeat attitudes and infuse humor into their topics. We’re firm believers that the use of humor leads to information retention, and the thousands of comments we’ve received from participants confirm they agree. Information is presented in a positive and understandable manner in order to inspire and activate people to put diabetes higher on their priority list. We also focus on educating family members and loved ones who are actually caregivers and associates in the care and feeding of the person with diabetes. Family members and loved ones are an unrecognized but extremely important piece of the diabetes care puzzle.
For the past 14 years, we have also offered the very unique Making the Connection continuing medical education (CME) series of programs for the HCPs. This series offers cutting-edge information on the advances in diabetes care as well as a greatly improved understanding of what it’s like to live with diabetes on a day-to-day basis.
TCOYD has taken on this challenge that, to our knowledge, has not been successfully completed anywhere else in the world. Educating physicians about the most up-to-date treatment strategies in diabetes management is a difficult and sometimes slow process, but one of the biggest challenges is improving the attitudes of health care providers toward their patients who are struggling with diabetes and to establish an empathetic, trusting atmosphere with more open, two-way communication.
We feel strongly that if the health care providers in this country really knew what it is like to have diabetes, both emotionally and physically, their level of empathy and genuine
understanding would greatly improve. Patients often experience guilt and embarrassment surrounding their difficulties with treatment adherence and may not be able to admit these shortcomings to HCPs unless their relationship is strong. We have also discovered that people with diabetes need to understand the day-to-day administrative difficulties HCPs face, including the strict time constraints imposed upon them. This Making the Connection series is specifically designed to bring together the educational needs of both clinicians and PWD in order to break down barriers by improving communication and understanding between providers and patients, ultimately improving long-term patient outcomes.
The vision of TCOYD is for all people with diabetes and their loved ones to have full access to proper education and therapy in order to allow for the prevention, early detection and aggressive management of diabetes and its complications.
Our vision statement is also our future challenge. TCOYD conferences touch the lives of the many people who attend in a profound way. However, the total number of participants nationwide is only a fraction of the people in this country who are living with diabetes and need help. Even though our reach is expanding with an enlarged digital footprint, face-to-face diabetes education and motivation must be seriously recognized by our health care industry as an essential part of the treatment strategy. Effective diabetes education programs must be carefully developed and offered to all people with diabetes and their loved ones.
Educational protocols don’t need to be multiple meetings held over a prescribed period of time, such as three months. One single day of education can be highly effective, but the education must be informative, practical, adaptable and compatible with the wide range of ethnic groups and unique individuals who make up our country. Most importantly, it must be presented in an upbeat fashion with a humorous undertone, and it must focus on enabling people to become engaged and activated in their own health. Becoming activated in one’s own health is the ultimate key to successful blood glucose control over time. In addition, there are no short cuts. Very few individuals will turn their diabetes control around from poor to good with a phone app. Once a person has been activated in their own health, online programs may be good extenders helping to maintain motivation over the long term.
We have never met a PWD who did not want to live a long and healthy life, and the vast majority of HCPs went into the field of medicine to help people live long and healthy lives. The trust and two-way communication between patient and provider are the most powerful factors in improving diabetes care in this country.
Access additional resources and practical information to enhance the care and treatment of your diabetes patients.
About our experts:
Steven Edelman, MD
Endocrinologist, Founder & Director, TCOYD
Clinical Professor of Medicine, UCSD School of Medicine
Director, Diabetes Care Clinic, VA Medical Center
San Diego, CA