Now that there is a plethora of connected devices, many believe that one day outcomes will be customized for each individual, that I would have a different set of goals than say my podcast co-host Amber Clour. Personally, I believe far too many People With Diabetes (PWD) are overly concerned with outcomes, and that they are allowing diabetes to rule their life instead of living life and then managing diabetes.
How Diabetes Is Measured
The gold standard for measuring diabetes management has always been HbA1c, which is basically an average over three months. The HbA1c test requires a blood draw, and easy to interpret, “general rule of thumb” has always been that a measurement of “7” or below is “good” control and a measurement of over 7 is not as good. However, now that we have Continuous Glucose Monitors or “CGM”, a new school of thought is emerging that Time In Range (TIR) is as important as HbA1c. Thanks to the great work of Dr. Irl Hirsch, it was brought to attention that even though two PWD may have the exact same HbA1c, they may have vastly different TIR or time spent neither “high” or “low”.
Diabetes Data Overload
To a person who doesn’t have diabetes, all these data talking points may create confusion. Heck, all this data can create a headache for PWD. This is why I believe that each PWD should set their own personal outcome goals regardless of what the numbers say. Again, I personally believe this over fascination with data does more harm than good. Given the numerous variables that a PWD CANNOT control, trying to hit a certain number consistently can be frustrating.
Agree To Disagree
There are plenty of PWD that disagree with me. And while I do believe that PWD should do everything they can to manage their diabetes in order to achieve “good” control, hitting certain targets can lead to frustration. The problem (well actually I have several problems with universal targets) is that not all PWD want to put in the time, they want to have a life beyond managing their diabetes. I am fully aware of what COULD happen to me if I don’t manage my diabetes. I definitely do not ignore my diabetes, but I take a proactive and rational approach to management.
I'll Drink To That
I live my life, I eat what I want, I drink what I enjoy and I LIVE my life. Thankfully I am educated about diabetes and I understand that many of the “bad” things that COULD happen to me will not happen overnight. Since I also pay attention to what I am doing, I will also see bad trends developing and can take steps to correct them. While many healthcare professionals try to make PWD think that one or two bad days will lead to a diabetes hell, there is NO data to support this. As I like to say, a person does not develop lung cancer from smoking one or two cigarettes – they develop lung cancer by smoking several cigarettes over several years.
You Do You
The reality is there will always be PWD who micromanage their lives, prioritizing their diabetes management over living their lives to the fullest extent possible. They will worry about everything they eat or drink and I’m ok with that, it’s just not what I want. I think there is far too much focus on data and not enough focus on managing diabetes while having a full and productive life. I believe that this focus on data creates more opportunities for guilt and drama. The data shouldn’t be ignored by any means, it just shouldn’t be the end all be all.