How Racial Bias Impacts Health Outcomes

COVID-19 is killing black Americans at three times the rate of white Americans. But it is not just COVID-19. Four hundred years of systematic discrimination has created systems that leave black people with dramatically worse health outcomes than others. Many living with diabetes have faced discrimination in their lifetime. Diabetes still poses barriers to getting fair treatment in our society, whether in school or work, exclusion from sports teams, or mismanagement in the hospital setting. All too often, living with diabetes as a person of color will compound these barriers.

Studies have shown that there are systemic, negative biases against people of color embedded in our healthcare system. This is layered on top of inequitable social determinants of health that people of color face, leading to poorer health outcomes, additional complications, and earlier deaths.

Black People Have a Higher Rate of Diabetes

Black people are more likely to have diabetes. There are 4.9 million non-Hispanic African Americans aged 20 years or older who have diabetes in the United States, according to the CDC. They are 77% more likely to have diabetes than non-Hispanic Caucasians. Part of this trend may be genetic, but one’s environment and socioeconomic status play a significant role in the development of type 2 diabetes, especially in a society without a robust social safety net.  Among racial and ethnic groups, African Americans have the highest poverty rate at 27.4% (compared to Hispanics at 26.6% and whites at 9.9%). Additionally, 45.8% of young black children under the age of 6 live in poverty, compared to 14.5% of white children.

There are many factors that contribute to this, but a history of institutionalized racism (the legacy of slavery, redlining and Jim Crow laws) have largely prevented African Americans from cultivating intergenerational wealth (which for most Americans comes from buying and selling real estate), and breaking the cycle of poverty proves to be nearly impossible in most circumstances.

Poorer, segregated (de facto segregation) black neighborhoods are more likely to face food deserts (areas where there are few or no grocery stores), lack access to healthy foods (including fresh fruits and vegetables), families may lack access to reliable meals (especially in the summer, when schools are no longer serving children breakfast and lunch), and unsafe streets and a lack of green space (few or no public parks). Neighborhoods of lower socioeconomic status are all risk factors for obesity and the eventual development of type 2 diabetes. 

Black People Have Higher Rates of Complications and Death

Black children and families are more likely to develop diabetes, and when they do, they face graver health outcomes. One recent study found that black youth have an average HbA1c of 10.6% compared to 8.3% for their white peers, and black children are twice as likely as white children to die from diabetes. Blacks are also more likely to experience greater disability from diabetes complications such as amputations, blindness, kidney failure, and increased risk of heart disease and stroke. Diabetic retinopathy is 46% more prevalent in African Americans than non-Hispanic whites, and African Americans are at least 2.6 times more likely to have end-stage renal disease due to diabetes than Caucasians. Most telling: the premature death rates for blacks with diabetes are 27% higher than for whites with diabetes.

racism and diabetes

Photo credit: iStock

Racism Is Built into Our Healthcare System

Implicit bias plays a large role in the unfair treatment of black people in the health care setting. In 2005, the National Academy of Medicine released a study that found that “racial and ethnic minorities receive lower-quality health care than white people, even when insurance status, income, age, and severity of conditions are comparable.” This suggests that poverty and lower socioeconomic status does not account for the whole picture of poorer health outcomes in black people with diabetes.

The report continued, “…minority persons are less likely than white persons to be given appropriate cardiac care, to receive kidney dialysis or transplants, and to receive the best treatments for stroke, cancer, or AIDS. It concluded, “some people in the United States were more likely to die from cancer, heart disease, and diabetes simply because of their race or ethnicity, not just because they lack access to health care.” Simply put: people are dying at higher rates just because the color of their skin is darker.

One study of 400 hospitals in the United States showed that black patients with heart disease received older, cheaper, and more conservative treatments than white patients presenting with the same disease and symptoms. Black patients with diabetes have higher rates of amputations than white patients, even when less invasive interventions are available. Additionally, another study showed that physicians were more likely to prescribe pain medications to white patients, mistakenly believing that black people “feel less pain”.

COVID-19 is killing black Americans at three times the rate of white Americans.

Where Do We Go from Here?

Social determinants of health, physician and healthcare workers’ implicit bias and systemic racism in our healthcare system all contribute to higher rates of disease, complications, and death. Neighborhoods and schools remain dramatically segregated and unequally funded.

The United States has a two-tiered health care system that provides fantastic care to those who can afford private health insurance, and little to none to those who cannot (aside from Emergency Department visits). We, as a society, do not value or fund preventive health care as much as we should. We don’t prioritize feeding our babies healthy food, or making sure they have space and safety to exercise regularly. We step in with too little too late for those who need help the most. We are biased in our healthcare decisions and have not fought against institutionalized racism early or long or loud enough. Now is not the time to “not be racist”, but to actively dismantle institutionalized racism from the inside out.

We need more black physicians, and nurses, and emergency medical technicians. We need to put our dollars into segregated neighborhoods and schools and prevent diabetes before it devastates underserved communities even more. We need to listen to black patients in hospitals. We need to trust black people when they voice their health concerns. We need more black voices in the diabetes online community. We need to lift up the voices of black people.

We need to do more for those that we have failed for far too long. We have already lost so much, and we need to act before it is too late.

Source: diabetesdaily.com

The Benefits of Working from Home with Diabetes

COVID-19 has officially changed the way the world runs. More than ever, people are staying home (whether by choice or mandate), spending more time with their families, avoiding public events, and yes, working from home. Essential employees, such as frontline healthcare workers, grocery store clerks, sanitation crews and workers rendering city services, are still having to report in person, but COVID-19 has made a third of Americans (over 100 million people) switch to home work.

This can be extremely beneficial if you live with a disability or chronic disease, and can be helpful if you live with diabetes. And while Americans still work more than anyone else in the industrialized world, working from home can help balance the stress of diabetes management. Here are some of the benefits of working from home if you live with diabetes.

No Commute

Let’s face it, commuting is not fun. The average American working full-time (8 hours a day, 5 days a week) commutes an average of 4.35 hours a week and over 200 hours (nearly nine days) per year. That is a lot of wasted time. With rising costs of living and stagnant wages, more people live farther and farther from their jobs, and have longer commutes than ever, which can cut into both one’s sleep and time for exercise. “Commuting” from your bedroom to your home-office leaves more time for quality sleep, morning exercise, and a healthy breakfast, which can set your blood sugars up for an excellent day, which can increase work productivity as well.

Not commuting will also save lots of money that would normally be spent on parking, car maintenance, tolls, and gasoline. Even if you normally take public transit to work, metro and bus tickets add up quickly! Working from home is also much better for the environment; transportation accounts for one-third of all greenhouse gases produced in the United States. Staying at home for cleaner air is an easy and simple way to help the planet.

Healthier Meals

Takeaway Chinese food or pizza at lunchtime can be a blood sugar nightmare. Working from home affords people the ability to cook easy, healthy meals in their kitchens, which is not only a healthier option, but saves money, too. It’s easy to cook lentils or beans in a slow cooker, or wash and chop up fruits and veggies for a quick grab and go snack if you get the afternoon munchies. Additionally, check out these easy, low-carb recipes that you can quickly make from the comfort of your own home!

Fewer Sick Days

People who work from home both take fewer sick days and get sick less often (no sharing germs in a communal setting or on the train en route to work!). Also, going into an office with a mild cold or flu can be miserable, but doing some work from home is almost always accessible. Plus, diabetes can mean dawn phenomenon, a kinked pump site midday, or a bad low that would previously require coming in late or leaving early- none of which would be necessary with a work from home schedule. It’s healthier for everyone!

No Judgement

Ever take a correction dose during a meeting, and get the side-eye from a nosey coworker? Ever have someone compare your diabetes to their distant relative who died of horrible complications from diabetes (when you never asked for the story?). Are people always questioning what you’re eating (or not eating), or how much you exercise (or how much you don’t)? Working from home prevents judgement and prodding questions, and you can go about your day and take the best care of yourself without intervention from others.

A Flexible Schedule

This can depend on your organization or company, but many offering work from home will grant their employees some flexibility in their schedules. If you have an endocrinologist appointment in the morning, shifting your work schedule back an hour or two can prevent the need to take personal leave for the entire day. Likewise, a flexible schedule can allow for a lunchtime run, which can counteract high blood sugars in the afternoon. Need to change your pump site or CGM midday? Working from home can let you do all that while still getting you work done. Flexibility is key to excellent diabetes management, and working from home makes it much easier.

Have you been working from home since the COVID-19 pandemic hit? How has it benefited you and your diabetes management? Is there anything that you particularly like or dislike about working from home? Share your story in the comments below; we love hearing from our readers!

Source: diabetesdaily.com

Improving the Transition from Pediatric to Adult Care for Patients with Diabetes (ADA 2020)

At the American Diabetes Association (ADA) 80th scientific sessions, Dr. Robert Zimmerman MD, Vice-Chairman of Endocrinology and Director of Diabetes Center Cleveland Clinic, and his team discussed the importance of creating a smooth and seamless transition from pediatric to adult care.

This time of transition is considered a high-risk time for patients living with diabetes. Diabetes aside, these patients are dealing with other life stressors that often emerge at this point in their life. Coming off their parent’s health insurance, going off to college or out in the workforce, and having to pay their own bills can create a lot of stress. Because of this, patients often neglect their diabetes care. Having a transition plan in place from pediatric to adult care can help these patients feel empowered and equipped to handle their own diabetes care as they become young adults.

Key Takeaways

  • Each year, thousands of adolescents with both type 1 and type 2 transition to young adults and also from pediatric to adult care.
  • The developmental stage between ages 18-30 is defined as the period of emerging adulthood.
  • Due to life stressors, this is a period where many are distracted from their diabetes care.
  • During the first phase of transition, around age 18-24, many patients feel overwhelmed and have a tendency to reject parental control.
  • During the second phase of transition, at about age 25-30, the young adult tends to take on more responsibilities in life and usually starts to place more importance on diabetes management.
  • The period of emerging young adulthood is considered a high-risk time for patients with type 1 or type 2 diabetes.

Differences Between Pediatric and Adult Care

  • Pediatric Approach
    • Family-oriented
    • Holistic
    • Visits are with both child and parents
  • Adult Approach
    • The patient is autonomous in their care
    • Individualized counseling
    • The patient makes their own decisions regarding care

Major Risks During Transition

  • Suboptimal Glycemic Control
    • Only 32% of patients between 13-18 years old met ADA goals
    • 18% of children under 18 achieved the ADA recommendation for A1c
    • 56% of adults achieve an A1c of 7%
  • Neglect of Diabetes Care
    • Older teens and young adults tend to disengage from health care
    • Both short-term and long-term complications can occur as a result of neglecting care

Factors That Increase the Risk of Hypoglycemia and DKA

  • The loss of parental guidance
  • Less frequent doctor visits
  • Work/school stressors that take precedence over diabetes care
  • Consumption of alcohol
  • Change in physical activity
  • Different dietary patterns than once had under parental care
  • Lack of motivation to stay on top of health

Patients Face Many New Challenges During This Period

  • Psychosocial challenges include worrying about the future, lack of a plan or goal in place for managing their diabetes, feeling anxiety, or being overwhelmed with care, handling uncomfortable social situations regarding diabetes.
  • Psychological issues are prevalent during this time, although these can occur at any time while managing a chronic condition. Feelings of depression, anxiety, eating disorders and suicide are all concerns that need to be addressed during this time.
  • Pregnancy is another issue that arises during this period of emerging adulthood.
    • Contraception use is lower for adults with diabetes from the age of 20-44
    • 39% of adults with diabetes do not use contraception compared to 27% of adults who don’t have diabetes
    • An increasing number of women with pre-existing diabetes are becoming pregnant and having children
    • Only 1 in 4 women with diabetes age 16-20 were aware of the risks involved with getting pregnant with diabetes and the importance of optimizing glycemic control before and during pregnancy in order to maximize the odds of conceiving and delivering a healthy baby.
  • Other health risks that can happen at any age for people with diabetes seem to be most prevalent during these years: alcohol use, illegal drugs, smoking, driving and hypoglycemia.

Current ADA Recommendations for the Transition

  • Pediatric health care provider works with the patient and parent planning for transitioning starting up to 1 year prior
  • Preparation focusing on self-management for emerging teen
  • Preparation should include the differences between pediatric and adult care and should help guide the patient on major decisions such as health insurance, etc.
  • The provider should prepare and provide a list for the patient and new adult doctor summarizing the patient’s medications, assessment of skills, history, etc.
  • Healthcare providers need to recognize all the changes during this period can lead patients to neglect care.
  • The transferring provider should provide patients with specific referrals to adult physicians that would best fit the patient’s needs.
  • The transferring physician should empower patients and provide them with any educational materials and resources that can help them to stay on top of their diabetes care.
  • Care must be specific to the patient and strive to avoid both short term and long term complications.
  • The provider must evaluate and treat emerging teens with any disordered eating behaviors or affected disorders.
  • On-going appointments should take place every 3 months for patients on insulin and every 3-6 months for patients with type 2 who are not taking insulin.
  • Screening guidelines should be followed for both microvascular and macrovascular issues as well as the management of lipids and hypertension.
  • Birth control, drug use, driving, STDs, etc. should all be discussed with the teen and their parents by both the transitioning and adult physician.
  • Both providers should make sure the patient is getting primary and preventative health care and feels comfortable with the care and support they are receiving.

Transition Options Available at The Cleveland Clinic Foundation

  • Transition clinic: here, adolescents are taught how to manage their diabetes on their own. They are then introduced to the adult care endocrinologist who oversees the patient’s care after this first visit. The follow-up with the adult endocrinologist can happen on the transition floor or at Adult Endocrinology at the diabetes center.
  • Transition shared medical visit: In this instance, a shared medical appointment takes place instead of their traditional appointment and the goal is to make the transition as smooth as possible for the patient.
  • Adult endocrinology office visit: patient goes directly to the referred adult endocrinologist.

Cleveland came up with an Autonomy Checklist which helps patients to learn necessary information that they should have while transitioning to more autonomous care.

Group Visits

Cleveland Clinic put into place group visits that take place approximately every 3 months where they have an educational speaker, review A1cs, glucose readings and insulin adjustments to engage the adolescents as well as give individual exams.

Cleveland Clinic’s Transition Recommendations Moving Forward

  • Creating flexible appointments: nights, weekends and special availability while young adults are home from college are important. Virtual appointments and classes will likely be the main way of interacting for this group. Dr. Zimmerman stated that their office went from “1% virtual visits to 75% in approximately one week’s time”.
  • Building relationships: community support groups led by a provider, monthly events and taking advantage of organizations and apps like College Diabetes Network (CDN), where they can connect with others living with diabetes is useful.
  • Transition simulation nights where young adults going off to college can go through possible scenarios and problem-solve together as a group. Questions like “my insulin fell and cracked open, where can I get insulin in the middle of the night?” or “My blood sugar suddenly is dropping, but I am in the middle of taking an exam, what should I do?” would be addressed.

Conclusion

Young adults transitioning from pediatric to adult care are a high-risk group that needs a supportive and comprehensive system in place, where caretakers understand the unique complexities of this life stage. Creating a seamless and specific transition plan will help guide these patients to achieve optimal health during these years.

Source: diabetesdaily.com

Diabetes Deadliest Mistakes

Whether you are living with type 1 or type 2 diabetes, you likely take medication that helps keep you alive and functioning properly. We continually measure, count and remind ourselves to take our medication and/or insulin very meticulously to ensure we are taking the proper medication and correct doses.

But we are human, and mistakes do occur. Sometimes these mistakes can be deadly.

Recently, while mid-conversation, I managed to take 18 units of Fiasp instead of my long-lasting insulin, Tresiba. This has happened to me one time before when I was first diagnosed when I took 16 units of Humalog instead of Lantus. My endocrinologist sent me right to the hospital because at the time I was new, nervous and unable to handle it on my own. This time, the moment I released the needle from my skin my stomach dropped to my feet.

Fiasp is even faster-acting than Humalog and I knew I had minutes to ingest a whole lot of carbs to counteract the large amount of insulin I had just taken.

I managed to inhale over 200 g of carbs in 20 minutes in the midst of a mild panic attack. I was nauseous, jittery and scared for what lay ahead. The day wound up being a series of lows but I was lucky I came out of it unscathed. Had I not realized I took the wrong insulin I could have easily passed out, had a seizure or died. My original plan for the day was to kick it off with a walk to a nearby shopping center so had I not realized, my blood sugars could have plummeted and I could have been left for dead on the side of the road.

I got lucky. We all have gotten lucky. Some have not. Many of us, unfortunately, know people who have lost their lives due to a diabetes mistake; and yes, sometimes their own.

I asked our friends in the diabetes online community what their biggest and deadliest diabetes mistakes were and this is what they had to say.

“I forgot a snack after breastfeeding and had my first hypoglycemic seizure. The first reading they could get was 27.”

“I am a type 2 diabetic and sometimes get shaky and I know I need a snack. I grabbed a brownie as I left my house but I wasn’t feeling any better. I realized that I grabbed a low-carb brownie so it wasn’t going to help raise my blood sugar! I wound up having to stop for a soda.”

“I’ve mixed up my insulin before. 27 units of Humalog is much different than 27 units of Levemir!”

“In my last year before I quit drinking, there were 2 distinct times I can remember where I was so low and so drunk I couldn’t figure out how to get food to save my life. One time I had my friend help me. The other time I went back to sleep and miraculously woke up the next morning.”

“I took some expired test strips from someone in the diabetes online community. For days I kept reading really high and couldn’t understand why. Finally, I rage bolused and took a hefty correction dose. I started seeing spots and beads of sweat formulated all over my entire body. My reading was 28. Turns out those test strips were bad and I could have killed myself trying to save a couple of bucks.”

“I forgot to check my blood before I had breakfast and had a banana and shot up to 500!”

“I recently bolused for a snack twice. I was low in the middle of the night but the snack was larger than needed to fix so I did took a partial bolus and went back to sleep. I woke up and didn’t remember taking any insulin so I did it again. Rollecoasting ensued. I’ll mess up worse, I’ve only been at this for 2.5 years.”

“Bolused for 80 carbs instead of 8 before a workout without realizing it. Dexcom alerted and I quickly realized how much IOB I had. Apple juice and gels to the rescue.”

“I’m on Zyloprim for my gout and I fill my pill case once a week. I accidentally put Zolpidem in and was wondering why I kept waking up so damn tired!”

It is safe to say that managing our condition can be risky at times. We are administering medication and insulin, which can be extremely dangerous if the wrong dose is given. We must remain diligent at all times to avoid errors, all the while realizing that we are human and we do make mistakes. Have grace with yourself.

Have you ever made a dangerous mistake? Comment and share below, hopefully, we can help each other to avoid similar occurrences.

Source: diabetesdaily.com

Debate: Can Technology Eliminate Hypoglycemia? (ADA 2020)

Advances in diabetes technology have brought forth a lot of new and valuable tools to people living with diabetes. From continuous glucose monitors (CGMs), to insulin pumps, to integrated systems that can automatically adjust insulin delivery based on CGM reading to safeguard against hypoglycemia, diabetes tech is rapidly evolving. For all insulin users, low blood glucose is of particular concern; too much insulin on board can quickly result in an emergency situation, if not promptly addressed.

At the American Diabetes Association (ADA) 80th Scientific Sessions, experts debated the following important question:

Can technology alone solve the problem of hypoglycemia in diabetes?

Dr. Richard M Bergenstal, MD from the International Diabetes Center at Park Nicollet argued “for”, while Dr. Emma G. Wilmot, MD from the University Hospitals of Derby and Burton present her case “against” this notion. Here is the synopsis from this exciting debate. Notably, both presenters disclosed numerous relationships with technology companies and pharmaceutical companies.

Yes, Technology Alone Can Solve the Issue of Hypoglycemia

Dr. Bergenstal began by defining four specific “problems” of hypoglycemia:

  1. “Dangerous levels and ripple effects of hypoglycemia”—low blood glucose levels can cause mental turmoil and may prevent patients from striving for optimal glycemia
  2. Defining hypoglycemia
  3. Detecting hypoglycemia
  4. Preventing hypoglycemia

We have been pretty unsuccessful at preventing hypoglycemia; that is, until technology was introduced,” he stated.

Strikingly, the presenter mentioned that after over 20 years of improvements to the average a1C levels, they are now increasing across the board. Dr. Bergenstal attributed this largely to people’s fear of hypoglycemia. He also mentioned a recent paper that indicates that, sadly, we are also experiencing a “resurgence in diabetes-related complications.”

Next, the presenter addressed the importance of consistently defining hypoglycemia. He explained that the official definitions of hypoglycemia (as defined for clinical trials reporting) have been evolving in recent years, now often defined by levels.

Then, the speaker moved forward to discuss that CGM technology was critical to the most thorough detection of hypoglycemia, noting that self-monitoring of blood glucose (SMBG, or finger-sticks) did not present the whole picture of blood glucose trends, making it more likely that low blood glucose could go unnoticed. Moreover, he argued that the accuracy of today’s CGM devices are on par with many blood glucose meters.

As far as the capability of technology in preventing hypoglycemia, Dr. Bergestal presented data from a very large international study showing that CGM use resulted in a tremendous decrease in both hyperglycemia and hypoglycemia, across a large patient population, across the board. He also presented data from several other studies that demonstrated the benefits of CGM technology as related to the incidence of hypoglycemia.

Next, he also addressed the role of “smart insulin pumps” that communicate with CGMs in helping to further reduce hypoglycemia. Strikingly, the results from one study using an “automated basal/hybrid closed loop system (closed loop at all times with meal-time manual assist bolusing)” resulted in a 100% reduction in hypoglycemia. The presenter also showed some case reports that suggested more technology (CGM + Pump vs. CGM + MDI) may yield better glycemic management. Furthermore, he touched upon several other advancements, ranging from faster-acting insulin formulations on the market and in development to smart insulin pens, and their relevance in improving outcomes (see below).

Dr. Bergenstal had this to say in conclusion:

“Technology can address [all four problems of hypoglycemia]… We’re going now from just good clinical care, to really ethics and just morality, I think. This journal of HealthCare Ethics Committee Forum, they looked at and postulated that continuous glucose monitoring is really a matter of justice. I know that sounds a little extreme, but if it can do what I’m showing you it can do, and people are struggling every day, maybe they really do have a right to use this technology… I think we better rely on technology to prevent the highs and the lows of diabetes.”  

No, Technology Alone Cannot Solve the Issue of Hypoglycemia

Dr. Emma Wilmot began by sharing that she loves diabetes technology, and that it plays an important role in reducing hypoglycemia. “However, technology ALONE can solve the problem of hypoglycemia? If only it were that simple,” she stated.

The speaker went on to present data showing that despite CGM use, as many as 25% of users are still experiencing severe hypoglycemia. She argued that “structured education” in diabetes management plays a more central role in reducing hypoglycemia, pointing to numerous research studies showing significantly improved outcomes following a formal diabetes education program.

Moreover, Dr. Wilmot commented on the role of hypoglycemia unawareness, and how reducing the incidence of low blood glucose levels via educational programs, also helped to mitigate hypoglycemia unawareness, in turn likely reducing severe hypoglycemia even more.   In contrast, she stated that there is no research to show that technology use can help to mitigate hypoglycemia unawareness. Furthermore, the presenter discussed several studies that showed “no additional benefit” of technology use (CGM and/or insulin pumps).

Technology is not for all,” Dr. Wilmot noted, citing issues like various technical problems, alarm fatigue, and site skin reactions. Strikingly, according to data from T1 Exchange, “41% had stopped using CGM in the past year.” Similarly, she noted, “30% of youth discontinued the hybrid closed-loop system”. Access and affordability is another paramount issue, she noted.

Rebuttals

While Dr. Bergenstal remarked that he understood and appreciated the role of patient education programs, he noted in his rebuttal, that the glycemic outcomes are not optimal in these patient populations, stating he believes technology can give us better control, reducing both hypo- and hyperglycemia.

Dr. Wilmot concurred that the levels of glycemia currently being achieve are “nowhere near good enough” and also agreed that several established educational programs are now incorporating technology education as well. However, she maintained that technology alone was not the sole solution.

Dr. Bergestal concurred with this, but also stated that technology is “outpacing everything else we’ve thrown at hypoglycemia so far.”

Conclusions

While most will agree that technology use can help to reduce hypoglycemia, whether it can be altogether (or even mostly) overcome with technology use alone remains a point of debate. Undoubtedly, the role of education in diabetes management plays a pivotal role. There is no “set-it-and-forget-it” in diabetes management today, not quite yet, anyway, and certainly not across the board for patients. Perhaps, as smart technology evolves further and becomes more mainstream, it may eventually overtake patient education in importance when it comes to preventing adverse events.

What are your thoughts on this subject?

Source: diabetesdaily.com

A Letter to My 12 Year Old Self: Diabetes, 20 Years On

Dear Chrissy,

It’s June 20th, 2000, and right now you’re in the emergency department of the King’s Daughters Children’s Hospital in Norfolk, Virginia. You were supposed to be on a weeklong vacation with your siblings and parents, frolicking in the salty seawater and eating cotton candy on the boardwalk of Virginia Beach, but instead, on day three of the trip, you’ve been rushed via ambulance to the ER, feeling weak, nauseous, and on the brink of unconsciousness. You’re small. An active cheerleader in your middle school, you’ve lost over 30 lbs in a little under a month, which is striking on your lithe frame. Every nurse notices how underweight you are.

The glucometer at the Urgent Care your parents took you to this morning simply read, “HIGH”. When the nurse looks at your parents and says the words, “your daughter has diabetes”, it’s the first time you’ve ever seen dad cry. You’re completely terrified that the word “diabetes” has “die” as the first syllable. Are you going to die? Thankfully, no. Not today, and not within the next 20 years, either.

The next few years will be hard, actually, they all are. Sadly, even though diabetes is technically “manageable”, it never really gets any easier, but you’ll become tougher. You will try out four different insulin pumps before you find one, at the ripe old age of 30 (and spoiler alert, it’s tubeless). You’ll prick your tiny, fragile fingers literally thousands of times, but in 15 years (the time will fly by, I promise), you’ll use a seemingly magical machine that checks your blood sugar 288 times per day for you, without you having to do A THING, and it’ll transmit the numbers to your telephone (those things are cordless in the future, too). Eventually, but I’m getting ahead of myself now, those numbers will talk to your insulin pump for you, and make dosing decisions while you drive, or work, or makeout, or go running, or read a novel. Science is pretty neat.

Once you start the 7th grade, you won’t tell anyone about your new mystery disease. Honestly? You’re embarrassed. The only other people you’ve ever met with diabetes were your elderly next-door neighbor’s sister and Wilford Brimley, from TV. You make your mom pinky swear that she won’t tell your friends’ moms, and you promise yourself that you just won’t attend sleepovers until you go away for college. Please don’t do this to yourself. Spare yourself the heartache. Diabetes will give you physical battle scars and mental wounds, but it will also develop some of the most beautiful attributes people will love about you: your compassion for others, your enthusiasm to live in the moment, your fearlessness in the face of adversity, your humility, your grace.

You’ll be the only 13-year-old girl drinking Tab at your bestie’s summer birthday party. Don’t be embarrassed. Exotically-flavored seltzer waters will be all the rage in 20 years. You’re just ahead of your time.

You’ll grow up quickly. You were always conscientious, polite, and studious, but having diabetes will make you disciplined, strong-willed, and courageous–you won’t really have a choice in the matter. Diabetes will toughen you where you’re soft; diabetes will break you open.

You’ll become obsessed with counting carbs (trust me, this is good), and dosing correctly (also good), but will become preternaturally focused on food and nutrition. You will deny and deny and deny. You’ll eat an apple when everyone is enjoying an ice cream; you’ll swear that string cheese is more fun than cookies. This can sometimes be good in the name of a better hba1c, but please, let yourself be a child for a little while longer. You’ll cry, because having a chronic disease can be very lonely and sad sometimes, and it’s okay to be sad sometimes, too. Go to therapy. It’ll be worth it.

Your mom will make you go to diabetes camp. You will resist going at every turn. You will cry and scream, and when she drops you off at the loading dock of Camp Setebaid, you swear you’ll never talk to her again. But by night three, you will have forgotten all about the hardships of living amongst “nons”. You’ll meet some of your closest friends at diabetes camp, and they’ll last a lifetime. You’ll have camp crushes, and camp kisses, and still remember campfire songs until your mid-30s. You’ll go waltzing with bears, and do the polar bear swim, and learn how to build a campfire, and get lost in the woods under a velvety night sky, and will learn how to use a cleavus, and will eat two dozen chocolate chip cookies one night when you accidentally replace your dose of Lantus with Humalog (oops). You’ll pee your pants laughing, and cry every summer when camp ends. You’ll make many friends along the way–friends who get it, who get you, for the first time ever. You’ll lose some of them over the years, to diabetes, or depression, or both, and will weep at their funerals. Your best camp friend will be in your wedding party in 17 years.

You’ll become tough. You never asked for this life, but you sure have made a point of living it to the fullest. There will be many doctors who will try and tell you things you can’t or shouldn’t do: join the swim team, play competitive sports, travel abroad, go to college out of state, have children–and you’ll prove most of them wrong. You will learn to not take no for an answer. You’ll develop an iron will. You’ll become gritty as hell.

Diabetes will encourage your interests in health and well-being, and out of college you’ll be a social worker, eventually getting your master of public health (I don’t think this degree exists in 2000, but it’s coming down the pike). You’ll be a vegetarian. You’ll run marathons. You’ll climb something that’s called a 14er (I know you live in Pennsylvania, but someday, when you live in Colorado, this will be a very big deal). You’ll find your dream job of working in diabetes advocacy, that will take your passion and use it to help thousands of other people who struggle with the same issues you do. You’ll change lives for the better.

One day, you’ll meet a man at work, who’s sweet and kind and compassionate. One evening, still in the early days of dating, you’ll notice he bought three containers of glucose tabs and stored them in his pantry without telling you. “Just so you feel safe here,” he says. Three years later, you’ll marry him.

In 20 years, you won’t have everything all figured out, but you’ll know more about who you are, and who you want to be. And diabetes, in large part, has helped to craft that. I know you’re seeing dad cry right now, so why don’t you go give him a hug and let him know everything will be okay. Because, really, in time, it will be.

Love,

Christine

Source: diabetesdaily.com

Study Shows the Need for Intensive Telehealth Intervention in Rural Areas (ADA 2020)

Access to specialty care and intensive self-management programs can be beneficial to patients living with diabetes and can help them improve their overall diabetes management. Unfortunately, these programs are lacking in rural areas and can lead to poor diabetes outcomes for those patients. With telehealth emerging as our new normal, this gives rural areas the opportunity to have better-specialized diabetes care.

This week at the American Diabetes Association 80th Scientific Sessions, the results of a study that examined the implementation of an intensive telehealth intervention in a rural area were presented. The researchers used the infrastructure of already existing Veterans Health Administration (VHA) and Home Telehealth (HT). This study took into account that the services provided would be in addition to already receiving in-person care.

Study Methods

Elizabeth A. Kobe led the 6-month telehealth intervention for patients with “poor glycemic control” (typically an A1c>8.5%), which was earlier found to be effective in a randomized trial.

The Advanced Comprehensive Diabetes Care (ACDC) combined telemonitoring, self-support management and medication management guided by a clinician. From 2017-2019,  the ACDC was implemented in five rural VHA sites with guidance from the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework.

Key Findings

  • A1c improved from an average of 9.25% at baseline to 7.89% at six months
  • Implementation at each site was well-received with an average of 8-10 of 12 scheduled ACDC calls complete
  • ACDC improved patient engagement and awareness of their diabetes management

Conclusions

There is no question that intensive telehealth interventions, when properly designed using already existing infrastructure, is a much-needed addition to standard care for many and can lead to improved and sustainable glycemic control improvements, especially for people living with diabetes in rural areas, who may have less access to traditional care and diabetes education approaches.

Source: diabetesdaily.com

David’s Journey to Becoming a Certified Diabetes Educator

We spoke to someone with type 1 diabetes who is working on earning their Certified Diabetes Care and Education Specialist (CDCES) credential, formerly known as Certified Diabetes Educator (CDE). David shares some of his journey and explains more about this educational process. 

Hi David, thank you so much for taking the time to speak with me. So many people living with diabetes are passionate about our cause and choose a profession related to our condition. I am always seeing questions within the community about how to become a Certified Diabetes Care and Education Specialist (CDCES) and I thought it would be helpful for our readers to have someone walk us through their journey on becoming a CDCES.

When were you diagnosed with type 1?

I was diagnosed with type 1 diabetes on October 13, 2008 when I was 11 years old.

How did you handle it growing up?

I didn’t know how to handle it as a kid, honestly. I hadn’t fully accepted my disease until I turned about 14 years old when I began to take this disease into my own hands in a more responsible fashion. Once I fully accepted this disease, I handled it very well, in a positive light!

Have you always wanted to become a CDE or did you start down a different path?

No! I actually didn’t want to be a certified diabetes educator until my junior year of college. I was choosing to go on several different routes. I started out majoring in biomedical sciences/pre-med to become an endocrinologist, then changed to pre-dentistry, and then I lastly switched to graphic design. I was convinced I wanted to be a graphic designer, up until I was in my third year of college, I realized my calling to become a diabetes educator, as I realized my passion for educating others on diabetes and tackling some of the common misconceptions behind it.

I then dedicated all my design work to becoming centered around diabetes education and stereotypes and then graduated with my BFA in graphic design, emphasis in photography and digital illustrations, creating a final Senior Gallery Exhibition where I was able to hold a display in a gallery of design work 100% related to type 1 diabetes. Now, a year later, I am getting my master’s in public health, majoring in health education and wellness coaching to eventually become a Certified Diabetes Educator, all with a designer’s twist to it!

Did you have any mentors (like a diabetes educator) who helped you with diabetes management? 

I would say first and foremost, my very first (pediatric) endocrinologist who diagnosed me as a type 1 diabetic and was very encouraging to me that I could lead a normal life with type 1 diabetes. I also have been inspired by several active members and leaders in the diabetes community who have truly shaped my passion and experience in this diabetes space.

Photo credit: David Mina

Did you have any positive or negative experiences with educators that shaped your perspective of how to best approach helping others with the condition?  

Yes! Absolutely. When I was about 13 years old and began caring for my diabetes on my own terms, I wasn’t caring for my diabetes in a responsible way, which led my hemoglobin A1c to skyrocket and be at the highest it had ever been. Once I went in for my 3-month check-up with my endocrinologist and diabetes educator, my diabetes educator sat me down and gave me a very mean and stern lecture as to how I was not caring for my diabetes and if I kept that up, I would be facing some very serious consequences, such as amputations, heart problems, and vision loss.

After that appointment, as scared and depressed as I was, I took that anger and frustration and proved not only my diabetes educator wrong, but I also proved to myself that I could reach a certain level of peace and stability over my own diabetes management. Though my diabetes educator hurt me with the words she used and her strict demeanor, I thank her for instilling that drive in me to fight against my diabetes and create a world where diabetes does not have to be the “worst case” for anyone! That is when I chose to start up my social media brand, @type1livabetic, where I try to encourage others to view their diabetes with positivity, rather than negativity!

What was the first step you took in order to get closer to your goal of becoming a CDE?

The very first step I took in order to get closer to my goal of becoming a CDE was to finish my undergraduate degree in graphic design, create a full body of work related to type 1 diabetes, then apply into a masters program that would grant me a Masters in Public Health (MPH). Once I finish my master’s program in December of 2020, I will be one step closer to earning my title as a Certified Diabetes Educator (CDE).

I understand you are more than halfway through the Health Education & Wellness Coaching Program through the School of Public Health. Congratulations! How has that been? I know you mentioned you liked to incorporate type 1 into class discussions and assignments, can you give us an example of something you did?

So far, my program has been pretty enjoyable for the most part. My biggest challenge thus far has been transitioning from design school and being a graphic design major, where I was so used to projects, rather than studying for tests and doing assignments. So now, being in a more health-related field, I am having to adjust my whole mentality in terms of how to go about studying and applying real-life health situations into my program.

When I get the chance, I always make sure to incorporate type 1 diabetes into any class discussion and/or assignment. At certain points in my program, we would have an assignment for class discussion and the topic would be diabetes that week. I chose to share my experiences with diabetes and try to educate my classmates at the same time, as I am aware that many still have some ideas about diabetes that may not be true, so I find as we all make it our mission to become health care professionals, I am able to help them gain a better understanding on what diabetes actually is, both type 1 and type 2, through simple lectures, class discussions, and assignments.

Photo credit: David Mina

What type of schooling do you need to have before you can go on to become a CDE? And are there different options?

The traditional route, from what I have heard, is that most CDEs have a background in nursing, nutrition, and/or dietetics, however, the type of schooling I need, based on the unique path I am going towards, is that I will need to gain my MPH degree, then obtain a certain amount of internship hours in the field of diabetes afterwards. After that, I will take the CDE exam and hope to become an official CDE finally!

Have you found other people living with diabetes going through your program?

I honestly have not, as my path is very unique, however, in sharing my own journey and experiences with this program, I have found a handful of my type 1 friends and followers showing interest in going through my program, which is amazing!

What have you found to be, or think will be, the most challenging part of becoming a CDE?

I believe that given I am a type 1 diabetic myself, I will be able to have a stronger impact on my patients as a CDE, making it easier for myself and for others, however, I believe the hardest or most challenging part will be having to learn how to work with others from a variety of different backgrounds and be able to still help them and connect with them on a very personal level.

I understand you need a certain amount of hours interning, how many exactly and where do you hope you can spend that time learning? In a hospital setting? Private office on-line coaching, etc?

Yes, I am not entirely sure of the exact amount of intern hours needed, however, I do know it is somewhere between 1,000-1,600. I feel as though it can vary depending on which program I go towards. I plan to somehow connect with a diabetes-based company or organization, whether a medical device company or a certain organization, and help in interning as a designer, educator, or any outreach/marketing professional in their space, as a way to practice my educating degree, as well as my degree and strong passion of design.

Now, more than ever, providers are making use of telemedicine as much as possible? How do you feel this affects patient care? Are there pros and cons to an online educational setting? 

I personally have had a few medical (diabetes-related) appointments through a telehealth system and have found them to actually be very nice and convenient, from a variety of different perspectives. For the most part, it is nice to be able to see a doctor from the comfort of my own home and still be provided with the exact same patient care I know I need. I believe that this can affect some patients in a way that some may feel they receive better care in person with a doctor and are able to gain more from that face-to-face interaction. In this case, I would say that the pros and cons to an online educational setting truly depend on the patient as everyone is different and may require or desire a different degree of medical attention.

How has this education impacted you financially? Is it manageable, do they have any special programs or resources you can recommend to anyone who is interested but may not feel like they can afford it?

This form of health education has not impacted me financially, only in the sense that my insurance at the moment has been great and has helped me in receiving the care I desire. However, many organizations or medical offices have been great, especially these days, in providing a discounted program for patients who need to see their doctors regularly, but cannot afford it these days, given the current state we are all living in. I think it is always worth it to ask a doctor for any recommendations they may have for patients who may not be able to afford certain online care, such as a savings card, insurance coverage, or any local telehealth programs that allow a patient to receive the same type of care they normally would have, only online now.

What advice would you give someone just starting on their road to becoming a CDE?

Stick with it. I know it may seem a bit discouraging now, but think of the big picture. You are needed in this field to change the way we discuss and manage diabetes as a society. Think of yourself when you were newly-diagnosed with type 1 diabetes (if you have diabetes), and how you could have benefitted from having a certified diabetes educator, just like you! Do it for yourself and do it for others as well!

Source: diabetesdaily.com

A Diabetes Educator Walks Us Through a TeleHealth Endo Appointment

With our country slowly heading back to our “new normal,” we will likely have to go back to our regularly scheduled lives, which includes being diligent about keeping up with all our routine doctor visits. It is even more important when living with diabetes to have annual eye appointments, physicals, dental appointments, and of course, our endo and diabetes educator appointments.

Since many are apprehensive about this new set up and wondering how exactly it will work, I thought it would be great to talk to Dawn, a nurse practitioner and certified diabetes educator who works in an endocrinologist office and have her walk us through the process and what we can expect.

Thank you, Dawn, for taking the time to talk to me today! How long have you been living with type 1 diabetes? 

24 years at the end of this month. 

Did living with diabetes play into your decision to become a CDE?

I had a great CDE in 1995 in a rural town which was unheard of. Then in college, I had a great nurse practitioner (NP) that I still look up to as a mentor for my practice. She talked to me like a person. She talked to me without pressure, shame, guilt, accusations and disappointment. She helped me come to terms with my diabetes and I will forever be in debt to her. I want to pass on that experience to other people living with diabetes.

How has your endocrinologist office responded to COVID-19? Have you closed down? How did you prepare for seeing your patients virtually?

We stopped seeing patients in the office at the end of March. We do still need labs so our lab is open but that significantly reduces foot traffic. We are only ordering labs that are necessary and will dictate current decisions. If they are not needed right now, then they can wait. We have two practice locations and staff are staying at one location. This way, if one office is quarantined we still have the other office to ensure patients have medical support.

We transitioned to virtual visits using the telehealth visit option within our EMR (electronic medical record) and we are using doxy.me as well. We are calling patients ahead of time to let them know about the change in the appointment and encouraging them to try to log in and make sure it works prior to their appointment. This would give you the chance to troubleshoot technical issues prior to your appointment.  We have had a few patients who still needed to be seen in person but almost all of our visits can be completed via telehealth.

I know many patients are curious about how an appointment like this will work. Is there anything the patient needs to do prior to the appointment? I know my son has an upcoming telehealth appointment and we had to download a certain app.

I would recommend as listed above making sure your means of communication works. Do a trial run at the location you plan to be at. If you will be at work during the call, make sure it works at work. If you are at home, then make sure it works at home. Will you use a computer or a smartphone? Do you know how to troubleshoot the speakers, video and microphone? Do you have a pump, continuous glucose monitor, or meter to download ahead of time? If you do, then get these downloaded at home prior to your appointment. Do a practice run a week ahead of time so if you need to call for help you have time to do so.

Having blood sugar readings and pump downloads ahead of time has streamlined my practice. I can view them prior to the appointment and focus on key items to make the appointment more productive. We are encouraging all patients to download at home, but we have made the exception for a few (elderly) to come and download at the office.

Can you walk us through what to expect during the appointment?

My wonderful medical assistants (Ariel, Tonya, and Whitney) have been calling patients to go over medications, any new changes to medical history just before the appointment and checking to make sure the telehealth app or doxy.me is working. Hopefully, I have already reviewed blood glucose logs and pump downloads ahead of time. If not, I will encourage the patient to get that for me.

What are some of the drawbacks of a telehealth appointment? I know my endocrinologist usually examines my thyroid, heart, etc. How will the doctor be able to check vitals as well as other routine measures? 

Yes, not being able to physically assess a patient sometimes is tough. However, if I am concerned enough that we need an in-person assessment ASAP, then they likely should have an urgent appointment with their primary care provider. If someone is complaining of an enlarged thyroid, with a keen eye, we can visualize that in most people via video. However, nothing replaces a hands-on assessment. We will see a patient in the office urgently if needed.

Do you find that overall providers have more or less time to spend with their patients this way?

When we have data (CGM/BG/Pump/labs) there is more time for providers to spend having meaningful conversations with patients. This streamlines appointments.

As a medical professional, how are you finding the telehealth appointments? What do you find most challenging?

  • When I have the data prior to an appointment, I love telehealth. I also love that I can go over reports with the patient and educate them on what I am seeing.
  • The most challenging part is obtaining data prior to the appointment. My medical assistant makes 2-3 calls prior to an appointment trying to prepare each patient. If I don’t have data, then essentially we are making an educated guess about what medications need to change.
  • For example, a patient can complain of afternoon hypoglycemia. However, it could be a reduction in basal insulin needs, overcorrection of pre-lunch blood glucose, or a too aggressive carb ratio. If we do not have data (CGM/BG/Pump) information, there is no way to tell for sure. So we ask questions around and around to try to figure out the most likely scenario but if we are wrong, you may have less hypoglycemia but BG will run higher. I know I do not want my provider to essentially guess at what needs to change.
  • Another example is a high A1c and the provider increasing the long-lasting insulin (basal) or basal rates unnecessarily causing low blood sugar in the middle of the night. I see this often when providers are grasping at straws trying to improve blood sugar control. When the real reason may be significant after-meal blood sugar spikes.

For someone who is unfamiliar with Zoom and other related apps, it may present a novel challenge. Have you found patients are having trouble with the new set up? Do you provide explicit directions on how to get set up for the appointment?

Most patients who have reliable internet access and have a smartphone or computer with a camera the platforms we use work beautifully. Doxy.me just requires the patient to click on the link we provide in an email. Click and then wait for me to start the appointment.

What do you think the patients will find the most pleasant about the virtual appointment? And what about the worst aspect?

The best part is that you can sign on from anywhere with cellular service or Wi-Fi. So your time away from work or other commitments is minimal. The worst part is that you are still at work or home and there are often other distractions. For example, if children or a dog are disrupting the appointment, this can be distracting and cause the appointment to take longer. It is also not a good idea to have an appointment while driving.

What can you tell us about privacy compliance? How can patients be sure their information is safe?

When using the Healow app or Doxy.me, the voice and video access is encrypted, keeping the visit private. The actual video does not access the patient chart in any way.

Looking forward, what do you think our medical system will look like after COVID-19? What about in 10 years?

I have no idea. I have learned to never assume anything in medicine because just when we think something will happen, the opposite occurs. I am hoping this opens doors allowing more rural telemedicine. This will provide medical care, especially those with chronic diseases, living in rural areas that travel 1, 2, or sometimes 3 hours for appointments. Historically, telehealth is not covered by insurance and the cost falls onto the patient. This hopefully will allow for proper insurance billing of these appointments to be more cost-effective and convenient.

Thank you so much, Dawn, for taking the time to walk us through what a telehealth appointment will look like. I have had two so far and they both went successfully! Best of luck and thank you for what you do!

Source: diabetesdaily.com

$35 Insulin on Medicare Pilot: Is This the Beginning of Affordable Insulin for All?

On Tuesday, President Trump held a press conference announcing a new pilot program for seniors on Medicare that would cap the monthly co-payments of insulin to $35. The announcement was attended by senior executives of two main insulin manufacturers, Eli Lilly and Novo Nordisk, and staff from the American Diabetes Association, as well as the Surgeon General, Jerome Adams.

In typical Trump style, midway through his announcement, he proclaimed, “I don’t use insulin. Should I be? Huh? I never thought about it, but I know a lot of people are very badly affected.” While this comment has created a wave of groans and eye-rolls throughout the diabetes online community, the core of his message is more important: seniors in America will now be more able to comfortably afford their insulin.

For everyone on earth, insulin is a necessary hormone to live. People without diabetes produce insulin endogenously, whereas people with diabetes must take insulin exogenously. Without adequate access to affordable insulin, people with diabetes face serious complications, such as kidney failure, blindness, amputations, and premature death. Unfortunately, the rising costs of insulin over the past few decades have become a major barrier to appropriate management of diabetes. American seniors are some of the hardest hit by the rising costs, who are partially-retired or out of the workforce completely, often trying to survive on smaller, fixed-incomes.

Trump remarked, “Today I’m proud to announce that we have reached a breakthrough agreement to dramatically slash the out-of-pocket cost of insulin. You know what’s happened to insulin over the years, right? Through the roof.”

The pilot program will take effect starting in 2021, and would be part of the enhanced Medicare Part D Senior Savings Model, to which over 1,750 standalone Medicare Part D and Medicare Advantage plans have applied to participate in, according to the Centers for Medicare and Medicaid Services (CMS).

s$35 Insulin on Medicare Pilot

Photo credit: Adobe Stock

This is a welcome respite from the high cost of insulin for American seniors on Medicare, who, despite being covered by health insurance, sometimes have to pay hundreds if not thousands of dollars for their monthly insulin prescriptions.

Despite the multitude of executive orders and policy decisions the Administration has made to chip away the Affordable Care Act, this enhancement of American’s largest healthcare social safety net was met with applause from seniors all across America, many of whom have cooled their support of the President since the beginning of the COVID-19 pandemic and our nation’s response to it. This is an excellent first step to ensuring that our aging Americans can afford the insulin they need to take care of themselves.

It is estimated that Medicare beneficiaries (generally Americans over the age of 65) who use insulin and join a plan participating in this pilot could see average savings of $446, or 66% for their insulin every year. The pilot is funded in part by insulin manufacturers who will pay $250 million in discounts over the five years of the pilot. There has been a positive response from Medicare Part D plans nationwide, and CMS predicts coverage in the pilot will be available in all 50 states, D.C., and Puerto Rico. Medicare beneficiaries will be able to enroll in a pilot-participating plan during traditional Medicare open enrollment, which is October 15th-December 7th, 2020, for Part D coverage that begins on January 1, 2021.

1 in 3 Medicare beneficiaries has diabetes, and over 3.3 million Medicare beneficiaries use one or more types of insulin, so this change isn’t insignificant. Out-of-pocket spending on insulin by seniors in Medicare Part D quadrupled between 2007 and 2016, from $236 million to $968 million, putting a harsh burden on millions.

Seema Verma, administrator of the Centers for Medicare and Medicaid Services said, “We think that this creates a foundation and a platform to fix some of the problems that we have in the Part D plan (of Medicare). It’s time for that program to be updated.”

While this is a great first step, the pilot is only slated to last for five years, and it will only apply to the Medicare population- generally, people living with diabetes who are 65 and older. This begs the bigger question: how do we afford our insulin before we are eligible for Medicare? How can we ever hope to make it to that point, if insulin is unaffordable every step of the way? Men with type 1 diabetes have an average life expectancy of 66 years, compared with 77 years among men without it. Women with type 1 diabetes have an average life expectancy of 68 years, compared with 81 years for those without diabetes. Realistically, this may not even help people who have diabetes for very long.

We can only hope that this initiative creates enough momentum for the federal government to start capping the actual price of insulin, for the other 7 million Americans who rely on it every day to survive.

Source: diabetesdaily.com

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