Any discussion about "reclassification" tends to become
controversial quickly - I hope I don’t offend anyone with my comments,
that is certainly not my intention. Every person deserves access to the
treatment they need for their individual challenges. Unfortunately, at
least in the US, in our current healthcare system, a lot is driven by
the diagnosis code assigned by their physician. Any classification
change can lead to errors, delays, or at best additional stress to get
the correct coding to receive the necessary treatment. Still…
I don’t remember where or when, but I saw a similar (perhaps the
same?) proposal some time back. At the time, the proposal was presented
as a work in progress, since potential criteria for classification are
many. The requirement is to find a balance between ease of use - to
avoid healthcare provider confusion - and diagnostic/clinical
requirements - to correctly qualify treatment options. The current
article appears more developed.
As someone who has experienced some of what I call “Type 2
discrimination,” in regard to access to treatment options, I can see
the value in a classification system that aims to minimize this. As a
Type 2 dependent on insulin, I have had to fight a battle for nearly
every aspect of my treatment. I have been told by medical professionals
that a T2D cannot have hypoglycemia unawareness, will never get any
benefit from using a pump, and shouldn’t have to test more than once or
twice a day. I have been told to “just use less insulin” even if it
means that my BG is high all the time - because using less insulin is
more important. (I’m still trying to figure out what that last one even
MEANS!) I was also told that all my “symptoms” have to be
psychosomatic, since “T2s don’t have such symptoms.” Oh yes, I was told
that many of my problems are because I "choose to use insulin."
Really? A needle-phobic person like me WANTS to use needles?
From the insurance side, I’ve been told that pumps and CGM are
"unproven, experimental treatment" for my condition. I’ve gotten past
that, for now, but expect the same battle in July with the annual
formulary review, or if I have to change insurance providers.
Thankfully, the insulin prescription at least made test strip limits
higher than 2/day.
OK, maybe I encountered some idiotic so-called “healthcare
professionals,” but a lot of my problem with at resulted from the
oversimplification of the “Type 2” diagnosis. "Textbook medicine"
doesn’t make it easy for doctors to provide the kind of individualized
care that the multifaceted nature of Type 2 diabetes (and in its ways,
of Type 1 as well) presents. I was able to skip through some of the
potential quagmire initially because I have a smart, proactive PCP who
monitored the initial treatment selections closely, making changes
quickly until it became clear that insulin was the best option. (Ok, a
bit of persistence on my part helped, too.) I may otherwise have spent
months or longer on diet/exercise programs that wouldn’t work,
medications that made me ill and who knows what else.
Type 2, insulin deficient with hypoglycemia unawareness. Am I at risk
for DKA? I don’t know, and I sure don’t want to find out! I’ve had two
endocrinologists tell me that I’m their “most difficult (or complicated)
case.” I don’t see how that is so, though - I have no co-morbidities.
One last thing – When will someone make a commercial for a Type 2
diabetes treatment that includes only “patients” who appear to be at a healthy weight, instead of parading one obese T2D after another!?