Diabetes Technology is Better, So Why are Outcomes Worse?

This is a well written piece by Ross Wollen over at ASweetLife blog.

He notes the surprising trend in diabetes management metrics going the wrong way with large increases in tech touted to improve management and lifestyle as well.

Wollen makes the observation that the portion of people doing better often eat similar meals at the same time every day and pay attention to consistently pre-bolusing.

This is a good read.


Yes, pretty good read!

I see he noted the wrong way trend, “particularly among adolescents.” Most of the people I see in clinic are T2D, but once I saw a young person, in the 9th grade who came in with his mother. I tried very hard to convince them to do CGM, with no success. His parents were divorced and he was constantly shuttling back and forth between them, with terrible consequences for his eating. Throw in being poor and surrounded by kids who ate terribly, I just despaired so much. All we could do was continue to soldier on. Really, the key for kids with T1D is for his/her parents to act like and accept, really accept, that they have T1D. For me, it’s so obvious that that level of rigor and discipline is the only way.

Excessive weight gain - double diabetes! OMG, I have never heard of this! Do the nightmares never end???

I don’t like that term for clarity reasons but I can attest to becoming insulin resistant and over weight as a T1D. That is one nasty combination. Low carb eating finally derailed for good that metabolic devil train.

Outcomes are worse because our whole way of eating in the US is screwed up. In the past decade there was the fat free craze and everybody was buying and eating excessive amounts of low fat processed foods. As the fats were lowered by the food industry, they were replaced with carbohydrates. I could eat low carb yogurt for many years, but when yogurt went low fat instead, I had to stop as there were too many carbs.

The US diabetic public is also, in general, not well educated in food nutrition as it relates to diabetes and as a result is making poor food choices out of ignorance. The better educated patients that care about their diabetic health come to boards such as this one to learn and implement a food and medicine strategy that will keep them healthy for years to come.

Every endo and GP should encourage their patients to learn about their disease. In my 30+ years as a diabetic, not once has any doctor or endo even suggested going beyond their recommendations to learn about food and medicine options.


I’ve been lucky the past 30 years to have three great endocrinologists and one CDE. They all came out of the same practice. They share and suggest ideas and Important resources to me, and I share my “in the trenches” knowledge and experience with them. I am very truly blessed in this regard. It’s made a real impact on my management of this disease and my life.

I think outcomes are worse even with improved tech because it takes so much more than tech to do well with diabetes. For starters, people who do best managing diabetes are people who take ownership of it. It’s not just some metabolic inconvenience to deal with so that they can move on to living their real life. Diabetes is their real life. Not their entire life, but just as much a part of them as a hand or a foot.

They’re curious and dig into how their diabetes works while they read all they can about managing diabetes and learning from their peers who are doing it well.

Successful diabetes managers don’t often enjoy medical professional inspiration and often have a hard time getting collaborative and collegial support from their doctors. I realize there are exceptions to this perspective but I don’t think my experience of 36 years going to quarterly doctor appointment without establishing a truly satisfying doctor/patient relationship is all that atypical.

But you know what? It’s not absolutely necessary. Knowledge, peer support, curiosity, and persistence combined are much more important than kindred-spirit doctor support. In fact given enough time and experience, one often realizes that the every minute experience of living diabetes adds up to any incredible knowledge bank as the years go by.

Diabetes can teach us a lot if we’re willing to watch, listen, experiment and do the work. Technology cannot yet replace those fundamental human traits. I think that day will come, sooner than we expect.

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I’m a perfect example of the weight issue.

Restricted diet all through my childhood, adolescence, and part of young adulthood. No major weight issues. Then in my mid-20s suddenly told I can eat anything I want now as long as I bolus the right amount of insulin for it.

I tried that for five years. I was in my 20s and my doctors had given me permission. I gained 100 pounds before I realized that eating whatever I wanted wasn’t working. Switched back to a more restricted diet (avoiding high-GI food, most of the time).

Ten years later, I’m still trying to lose the weight.

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Y’know, a lot of what Ross Wollen writes is not too different than the epilogue to Bliss’ 1982 book The Discovery Of Insulin. At the end of that book, Bliss worries that diabetics with ready access to insulin will just eat and get fat rather than diet and be healthy.

I think there are different measures than just A1C as to level of control and quality of life. In my first 30 years with diabetes I had several emergency room trips for severe hypos. I know for sure with Tresiba (a recent insulin that works super well for me as a basal) and now a CGM I have far lower risk of a severe hypo sending me to the ER, than ever before. Yet preventing severe hypos doesn’t have a super direct connection to lowering A1C (in fact if I prevent regular hypos maybe my A1C ticks up just a little bit).


I thought this was an excellent article. It was shocking, but at the same time not surprising. I became a diabetic decades before the new technology. At home glucose monitors weren’t available until I was 30 and I became a diabetic when I was 8.

I took one shot a day until I was 30. I was more careful about what I ate until I hit the teen years. I remember eating huge banana splits with fries. In my early 20’s I remember eating multiple donuts, and I remember being very thirsty.

I kept this up until my eyes started flashing when I was 30. Once told I had the beginnings of retinopathy, I went to a endo and had my first ever A1c. It was 10. I think many people diagnosed with diabetes don’t let it interfere too much with their lifestyle until their body is affected. If they are very lucky lowering their A1c’s can reverse their diabetic complications.

Once I got below 7 I started healing, once I got to a non diabetic A1c, everything eventually healed and the complications stopped happening.

At 69, and having had type 1 for 61 yrs, I feel very good and have no complications, except for two heart stents. Maybe my years of horrible control caught up with me, I am not sure.

For years now, I have really watched what I eat. I don’t even indulge with birthday cake at my birthday. The only time I eat a forbidden treat is when I am low. I almost never give insulin in order to indulge. I gave up pizza years ago and I no longer eat regular desserts.

I would say that my life is somewhat compromised, but not having a high A1c is extremely important to me. I do miss not being able to go out to dinner, but the food we make is very tasty and extremely healthy. We both enjoy being thin.

I am also very fond of control and of doing medical research, so once I realized I could somewhat control my outcome, I became a very good diabetic.

After the faulty ACCORD study was released, I had two doctors try to convince me to raise my A1c. I refused because a very low A1c has served me very well.

I haven’t had a doctor try to tell me how to control my diabetes in 30 yrs. They only look at my A1c’s.

My present GP is retiring and I need a new doctor. When I interview them, I will tell them about my A1c history, and explain that all I need from them is insulin prescriptions. How can they argue with me?
61 yrs with no complications, except for 10 yr old heart stents and high LDL. Raising my A1c isn’t going to lower my 116 LDL. I can’t imagine having a doctor trying to control my diabetes. That would be ridiculous.

I don’t bottom out with lows and very seldom need help. I feel very fortunate.