I think that diabetics are restructuring healthcare in the U.S. Is that too large of a claim? I don’t think so. Let me make my case.
1.) Diabetics have a particularly intimate relationship with tech.
That led to patient built Artificial Pancreas Systems. That was a real big deal and huge impact on FDA. We have (continued) development of learning algorithms from CGMs and fairly customizable personal medical devices. That’s pretty unusual across medicine. The fact that we have so much control over operation of these devices is different than other chronic illness groups. We are a unique situation that has led to unique and pretty profound movement.
2.) Diabetics have a huge dependence on Pharma.
This has DEFINITLEY led to exposure of some of the flaws inherent in the medical system. Diabetes, specifically, has led to an increase in government regulation of that entire industry. The insulin manufactures have been pulled in front of Congress. That’s no small act.
3.) PBM regulation (and perhaps their very existence) is a DIRECT result of diabetes
No one ever knew what a PBM was, except the diabetics. You all had to explain it to me here on the forum again and again.
4.) Insurance
This is where everything gets cloudy. Forever people liked to say, “Diabetes is bankrupting the US healthcare system.” Somewhere along the line, the script flipped and became, “The US healthcare system is bankrupting diabetics.” I think diabetics got sick of getting blamed for everything by the insurers. Everybody flipped the entire narrative. Nobody came for the insurers like the diabetics because they are so heavily dependent on it.
5.) The practice of medicine
Diabetes is unique because we provide most of our care and we have to because no Doc sits by our side continuously delivering care throughout the day. The benefit and the curse of having so much control/responsibility has led to forums like this one. I think that this forum has been profoundly influential of the paradigm of diabetes care.
6.) Legislation/Regulation
The diabetics have been coming for industry for a long time, relentlessly. This has ABSOLUTLEY prompted PBM regulation and “the diabetes financial problem” IS the lens through which the success of healthcare regulation and delivery is judged. Part of this is because of Type 2’s. There are sooo many type 2s in the U.S. They are a substantial proportion of the U.S. population. No other illness can say that. They account for so much of the significant, preventable disability that results from illness/lack effective care.
7.) Diabetics are a badass constituency.
They are super high functioning and capable segment of the community of chronic illness. I’ve always wondered if that’s because we die if we are not super high functioning. Working within serious constraints, I think leads to really creative and/or capable individuals. I dunno. Diabetics are just badass. I can’t explain it, but people of other chronic illnesses are also really badass. There’s something about working within constraints that’s good for ya’ somehow and builds some REALLY formidable individuals. People with disability really normal people look like mushy oatmeal. “Normals” just collapse under any obstacle. Diabetics are relentless survivors. We are very difficult to kill.
