November is National Diabetes Awareness Month, and few are as close to the front lines of diabetes awareness as the American Diabetes Association (ADA). We were pleased, therefore, to get a chance to talk to Dr. Richard M. Bergenstal, the President of Medicine and Science of the ADA, about what awareness means, and what the ADA is doing about it.
Dr. Bergenstal started as the President of Medicine and Science at the beginning of this year, but has been involved with the ADA– volunteering and working on a number of different committees– for much longer. Dr. Bergenstal now helps guide the ADA on issues of medicine, science, and endocrinology, working to define nationwide standards of patient care.
Despite the large responsibilities inherent in his role, Dr. Bergenstal, like many involved with the ADA, is a volunteer; he gives his time after and above being a leading endocrinologist and Executive Director of the International Diabetes Center in Minneapolis, Minnesota. Dr. Bergenstal has been a practicing endocrinologist for over thirty years, having been drawn to the opportunity endocrinology provides to develop an ongoing relationship with patients, working together to manage diabetes. “Endocrinologists like to solve puzzles,” he explains, and diabetes requires a complex puzzle-solving plan, unique for each patient.
After thirty years in the field, Dr. Bergenstal has a very clear view of the problem that much of America is just beginning to see: diabetes is an emerging epidemic, and we need all the help we can get to combat its spread. In his role as the President of Medicine and Science at the ADA, Dr. Bergenstal hopes to contribute as much as he is able to solving the problem of diabetes. There are, of course, many diabetes-focused organizations, each with its particular constituency, but Dr. Bergenstal volunteers with the ADA because he feels it acts as the overarching organization of diabetes, addressing the whole spectrum of the disease from research to patient to doctor to Capitol Hill.
This broad, umbrella-like role puts the ADA in a unique position to set the standards of care and to advocate for both patients and doctors, and Dr. Bergenstal aims to help them do just that. At the ADA, Dr. Bergenstal has been emphasizing the importance of the “patient-centered care team,” a unified group of doctors, educators, and friends that help each patient achieve physical and emotional health. The ADA aims to keep the team patient-focused, ensuring that each person with diabetes is educated and able to actually participate in his care. With that in mind, Dr. Bergenstal and the ADA fund research at the patient level, develop programs to get patients and providers on the same page, and create educational materials that put the diabetic audience front and center.
One problem with patient-focused care, though, is that the patient is not always ready or willing to participate. The ADA here shies away from the label “noncompliant,” and encourages diabetes care teams to do the same. The problem isn’t noncompliance, Dr. Bergenstal explains; the problem is life. Take, for example, the classic “noncompliant” act of eating at McDonald’s. “Is it good for you?” Dr. Bergenstal asks. “No– but it’s fast, it’s convenient, and it’s cheap.” The solution is not to label patients noncompliant and penalize them, but rather to develop alternatives and encourage good lifestyle choices where possible. The ADA thus has a number of programs that help to make fresh fruits and vegetables more affordable and attainable, and to educate patients as to the benefits of a well-balanced diet. The goal is not 100% adherence, but movement towards healthier living on the whole.
This focus on patient education is particularly important in light of the recent reports from the Center for Disease Control (CDC) which estimated that 1 in 3 American adults would be diabetic by 2050. According to Dr. Bergenstal, given those numbers, in the coming years treatment will remain important, but prevention will be key. To this end, the ADA is focusing on educating everyone– both patients and professionals– about the warning signs and dangers of diabetes, so that at-risk patients can be screened. If high-risk and pre-diabetic patients can be identified early, they can be helped early with lifestyle changes and cost-effective prevention programs.
The CDC report, though, hit the national press; CNN, the New York Times, everyone was abuzz about the coming diabetes epidemic. So, this Diabetes Awareness Month, one must ask– is awareness or lack of education really the problem? All the focus on patient education and early screening– who hasn’t heard yet about the threat of diabetes?
The push for awareness, Dr. Bergenstal explains, is as important as ever. Even though many people know that diabetes exists, and can even name a family member or friend with diabetes, few people understand fully the seriousness of diabetes. The new ADA campaign, Stop Diabetes, is designed to combat exactly this gap– too many people know about diabetes without knowing the devastation that will come if we don’t work to stop its advance. The goal of the ADA, then, this November and going forward, is to raise awareness of the seriousness of diabetes, and also of the hope of effective treatment if we act now and act fast.
I sincerely hope the ADA will consider changing some aspects of their strategy regarding recommendations for Diabetes care. The cost is simply too high for society to have people think that because “life gets in the way” it’s ok to damage oneself by eating inappropriately or by not managing a chronic illness. I’m not in favor of a ‘scare campaign’ but ‘reality campaigns’ seem to be fairly effective for many societies to stop negative health behaviors.