Point of view:
Managing diabetes now and in the future
1. What are you most proud of regarding your position at Joslin?
Im proud of being able to work with a team of very dedicated professional, administrative and support staff. It is a privilege to be able to serve as the Chief Medical Officer for a world-renowned diabetes center. Joslin is the biggest diabetes research center and provider of diabetes care and education in the world and prides itself on providing the best diabetes care to the people it serves.
2. What are some of the biggest challenges that face people with diabetes? Why?
Elliott Joslin [the founder of the Joslin Diabetes Center] said the biggest challenge for people with type 1 diabetes was learning to think like a pancreas. People living with type 1 must figure out the connection between their insulin, food, and exercise, and need to check their blood sugar every day. There have been huge medical advances made but this balancing act is still an enormous challenge for people and one they can’t stop facing daily.
For people living with type 2 diabetes, the biggest challenge is modifying their lifestyle. So many people could be better controlled if they made some lifestyle changes. There are medical treatment guidelines, but the physician’s challenge is to get to understand the individual patients which includes their behavior, what motivates them, their goals, what they are able to achieve, and when they are ready to make behavioral changes. The physician must also use medications wisely, not only to improve glucose control, but to reduce all cardiovascular risk factors. The physician must understand each patient as a unique individual. At Joslin, we practice a team approach to care because no single provider can have all the skills necessary to help people in so many ways. Our teams include physicians, nurses, nurse educators, dietitians, and exercise physiologists–all CDE’s. We also provide programs designed for specific needs such as an intense education tune-up, weight management, mental health issues, or early signs of medical complications. We also have programs for children, the elderly, women planning pregnancies, and multicultural groups whose needs differ. We embrace the entire spectrum of diabetes and its related complications.
3. What do you think will change in the future regarding caring for the diabetes patient?
I think the delivery of care will change. Elliott Joslin created the team approach to diabetes care and trained the first diabetes educators. They would go into people’s homes to teach them to care for themselves. Then it became more cost effective for patients to come to the physician’s office for treatment. Now we can actually go back into the patient’s home by leveraging technology. This is what I believe is needed for the delivery of care for people living with chronic medical conditions. Being able to virtually treat patients at home through smart phones or through web-based programs will make a huge difference. Patients can download information, send their data and questions to their health care providers, and we can make recommendations right away. In the past, patients might have about four encounters, or about two hours, a year with their diabetes care providers. But people live with diabetes 24 hours a day, 365 days a year. With technology we can engage with the patient as often as needed, make interventions in treatment sooner, and help people feel they are not alone when it comes to managing their chronic conditions.
Virtual care would enable people who don’t have access to medical care to be receive care anywhere in the world. People everywhere should have access to good information about diabetes care, nutrition and exercise and this would assist doctors in areas with limited resources.
Virtual care should of course always be complemented with face-to-face contact with providers, but fewer visits to the doctor’s office would reduce the wait time for many other patients to be seen.
4. What are your ideas and thoughts about keeping people on track with their medication regimens?
We have tools that potentially can help us be on top of things more effectively. Medication adherence is a huge challenge for people. More frequent contact with a health care provider, either in person or virtually, would hopefully increase adherence.
There are many new medications coming on the market and safety is always paramount. With continuing advances in medications, the question is how to pay for new medications. We can justify their use if we know they are effective. We can deliver diabetes care less expensively and more effectively with new technology. To reach more people living with diabetes, we need to help physicians identify the most difficult to manage patients and provide resources virtually.
5. What else would you like to share with the diabetes community?
We have a huge opportunity to make a difference in the lives of people living with diabetes. Health care providers sometimes feel they are on a continuous treadmill when patients continue to struggle, but we need to remember that every time we see a patient we are making a difference in someone’s life.