Daniel Lorber, MD, FACP, CDE
POINT OF VIEW:
Increased education and resources, first and foremost
Dr. Lorber, Medical Director of the Diabetes Care and Information Center of New York, Flushing and board member of Diabetes Care, talked with us about his experience with patients over the years, which has driven his desire to stress the need for education to government agencies and health care providers, and basically everyone involved in the diabetes community at large.
Since you have worked with and sat on the board of Diabetes Self-Management, what changes or trends have you noticed in diabetes patient education?
You can’t separate education from everything else in this area. The tremendous increase in obesity, the changes in insurance costs and plans and the need to take care of health issues sooner make the whole issue of patient health maintenance complex. We are dealing with many more people who have diabetes, a small number of specialists, a slightly larger number of educators but not enough and a system that does not yet entirely respect the need for education.
What do you see as a possible solution to this problem?
It’s about decreasing this epidemic by starting at the beginning. Teaching kids how to exercise, parents how to feed their kids properly, teaching school boards that cutting recess and after school activities is entirely the wrong direction. The diabetes epidemic is a public health issue rather than a medical issue. At a time when we’re seeing more people with diabetes, we simply don’t have enough resources. Fewer patients have been coming to the doctor because of the costs, but a lot of people are trying to do what they can to create a healthy life for themselves. Certain groups are working toward alleviating this problem. Sanofi, for example, just sent me a great list with very little branding on it, which I thought was extremely admirable. But we need to do more starting with taking health education seriously.
What approach do you think is best to take right now in order to improve the issue of patient adherence?
The most important issue is people need to understand that diabetes does not fit the typical American paradigm. I don’t treat diabetes at all, I teach patients how to treat their own. The solution is to get the word out in a positive way that your health is in your hands. The problem is that by the time we get a diagnosis, patients are already firmly wedged in the American theory that a pill can fix it. But the reality is that people need to take responsibility for their own health and this is an indication of how off-track we are with that.
What do you think is the best time for an adherence program to be administered to most effectively keep patients adhering to their necessary protocol?
Over and over and over again. I can’t stress that enough. Certainly for newly diagnosed patients, but from there, over and over. This is a marathon disease, not a sprint. Educating and problem solving teaching people to problem solve along the way is essential.
What do you think about the concept of the Fit4D Pathways as a tool to help create better patient adherence?
Particularly with the advantage in technology, we can provide a number of opportunities and ways to reach people, which I think is great. But I think that the new methods need to be tested and we can’t be so afraid to try them out in order to get a good measurement on their outcome. People have to decide what kinds of outcomes they can measure and why. We spend a lot of money on health care and it needs to be spent efficiently. Anything we want to try needs to have built-in outcome measurement to see if it works.
What news do you want to share right now with the diabetes patient community?
Don’t expect medication to be the answer. Each patient needs to understand how to use their medication but also understand that it really is up to them to take care of their own diabetes. The most important point is that this is your diabetes and you can do something about it.
Dr. Lorber received the Outstanding Physician Clinician in Diabetes award from the American Diabetes Association in June 2009. This award is presented to an individual who has made outstanding efforts in diabetes care and is recognized as a highly regarded clinician and educator with more than 10 years of distinguished service. He speaks frequently at different hospitals on the topic of diabetes care.
Interviewed by Alexis Fedor, Fit4D Online Marketing Manager