Taking Control Of Your Diabetes: An Innovative Approach to Improving Diabetes Care Through Educating, Motivating, and Making the Connection Between Patients and Health Care Providers.

Abstract

The gold-standard goal of diabetes management has been to achieve meaningful and sustained glycemic control to reduce the risk of long-term complications. Unfortunately, results from the National Health and Nutrition Examination Survey indicate that only ∼50% of adults with diabetes in the United States, mostly with type 2 diabetes, are achieving an A1C <7.0%, and this percentage has not changed over the past decade (1). In addition, the proportion of patients meeting individualized targets has declined according to the American Diabetes Association and American Association of Clinical Endocrinologists, and the overall proportion of patients in very poor control, defined as an A1C >9%, has actually increased (2,3). The Healthcare Effectiveness Data and Information Set results, with data from >1,000 health plans covering >171 million lives, are even more striking, demonstrating that, in 2014, ∼40% of commercially insured health maintenance organization patients and 30% of government insured patients achieved an A1C <7.0, again reflecting no change in the past 10 years (4). All of this has occurred despite the introduction of >40 new treatment options for people with type 2 diabetes. This fact is quite shocking and difficult to understand, especially given that our armamentarium of effective and safe type 2 medications has expanded over the same time period to include dipeptidyl peptidase 4 (DPP-4) inhibitors, sodium glucose cotransporter 2 inhibitors, designer insulins, inhaled insulin, and glucagon-like peptide 1 (GLP-1) receptor agonists. Although there may be many reasons why these new treatment options haven’t made a dent in the glycemic control of our patients with type 2 diabetes during these past 10 years, I feel strongly that the basic and primary issue is a lack of patient education, motivation, and activation. Type 2 diabetes is a silent condition with few or no symptoms caused by poor …