This is part two of my conversation with Dr. Ann Albright, director of the Division of Diabetes Translation at the Centers for Disease Control and Prevention (CDC).
In part one Albright talks about meeting the challenges and opportunities to improve diabetes care through public health programs.
Q: What stands in most people’s way regarding preventing and managing diabetes?
Ann Albright: I can best answer that question with a model many of us in the public health sector use. Imagine concentric rings, and in the middle ring is the individual.
For those of us who have diabetes or are at risk, there are things we personally need to do: pay attention to the foods we eat, get physical activity, look at how we manage stress.
All the things we do have some impact and influence on us, but we’re not an island. We all live influenced by the things around us. So the next ring in this model is your family and those in your close network. They also impact how an individual lives with this disease.
The next ring out is your life systems, where you work, go to school, your place of worship, where people spend a lot of time interacting with others. Those entities also have a big impact on us.
For instance, what are the policies in your workplace? What support do you get for health care coverage from your job? What types of health care are available to you? All these things have an impact.
The final ring in the model is policy and the bigger community. These are things where you might change people’s access to things. For instance, are there food deserts in the community? How far do people have to travel to get fresh fruits and vegetables? Can they afford them? All these things affect our ability to make healthy choices.
So while we have to think about what the individual does and individual responsibility, the individual does not live in isolation. We all are influenced, and supported or undermined, by those other circles. You have to intervene in those areas so that as we say in public health, “The healthy choice is the easy choice.”
Q: Are there other obstacles for people in managing their diabetes?
Ann Albright: I think three intersecting areas affect people’s ability to take care of themselves. That’s medical management, self-management and ongoing support.
In medical management, while a person has to take their medication as prescribed, the health system they go to also has to have health care professionals who really know how to manage diabetes. People who understand what it’s like to live with a chronic disease. You know like I know that it’s 24/7. You don’t get any breaks.
In self-management the individual has to know how to live with their disease and take responsibility for their daily choices. For instance, they need to understand what their numbers mean and what to do about them. Too many people never get this information.
Regarding support, we know when you live 24/7 with something people get burned out. They get tired and frustrated. Ongoing support is critical, whether it’s from close people in our lives or having a supportive environment.
When you look at the whole picture it’s these kinds of things that broaden your view as to why people wrestle with managing their diabetes.
I’m about to hit 44 years with Type 1 diabetes so I’ve had it way longer than I haven’t. But that doesn’t mean you don’t have days when you’re thinking, oh, my god! Particularly when you’ve done everything you’re supposed to be doing and it’s not behaving or cooperating the way it’s supposed to. Those are the very frustrating days.
Q: Is there more that stands in people’s way of good self-management?
Ann Albright: I think it’s similar to prevention. In part, people don’t feel any different when they get diabetes. They don’t feel symptoms if their blood pressure or cholesterol isn’t where it should be so they don’t do much.
Diabetes complications may not happen for quite some time, so you’re asking people to act now to prevent something from happening in the future. For many people that’s a difficult thing to do. Also, some people have issues around consistently taking their medication, or they may not be able to afford their medication.
We also do a poor job putting managing diabetes into context for the patient. By that I mean talking about it in terms of what matters to him or her. When I was seeing patients I had a gentleman who was just not interested in checking his blood sugar. He said, “I just don’t know what this is all about. I’m busy traveling and there are lots of things I want to do, not spend my time doing this.”
I wasn’t a magical educator, but I listened to him and discovered he wasn’t afraid of poking himself, he wanted time to do what he liked doing. So I asked about his hobbies and I tied testing his blood sugar to giving him more freedom to do those things he liked to do. That way it became real for him and there was a reason to do it.
Q: What do you do to keep yourself healthy and your diabetes managed?
Ann Albright: I check my blood sugar six to eight times a day. I work to make sure my food choices are healthy. I enjoy yummy things like the next guy but I am particular about how much of those foods I’ll eat. I keep physically active by riding my recumbent bike and dancing.
I also volunteer for groups that support diabetes. It helps you to cope and adjust when you give to others. And I think you have to develop a philosophy about living with a chronic disease. A positive, constructive philosophy. You have to think how can I live successfully with this?
Of course I would say I didn’t want diabetes and I wouldn’t wish it on anyone, but if it comes to you take it by the horns and make the best of it and use it in a way that can help you be healthy and productive.
I’m incredibly blessed and fortunate to have the opportunity to do something that helps others, to have an impact on improving the public’s health. For me it doesn’t get much better than that.
Personally, I will not forget the openness, energy and passion Albright radiated when I met her. It’s comforting to know she’s advocating for all of us at the CDC.
