Why this Stonehenge attitude pervades this disease ( type 1 and type 2) totally escapes me.
Not me. It's clear as distilled water.
It's really pretty simple, and can be summed up in three words: Cost/benefit analysis. Something we all do, every day, constantly.
This analysis comes out, understandably, far different for a PWD regarding treating diabetes, than it does for a non-PWD regarding treating diabetes.
Simply put, the rest of society is not willing to spend the enormous resources necessary to aggressively manage diabetes and reduce serious complications, when current management practices certainly appear adequate to the non-PWD public.
What do they experience when they run across a diabetic? Someone who looks fine, with the treatment they're getting. Someone who, more often than not, is relatively dismissive of their disease (T2), or forcefully adamant that they're not disabled in any way, can do anything a non-PWD can do, and are not on death's door (many if not most T1s, and a lot of T2s).
So, what would you think if that same person then said, "but I'd like you to contribute to $10-15,000 in expensive gadgets, insulins, etc. so I can get my a1c ("whats that?") down from 7 to 6"?
About the same someone with psoriasis coming to me with the same sort of demand.
I understand that some may bristle at this rather frank, depressing post. I don't say any of it to criticize us, the PWD community. Rather, I'm trying to give some perspective from the other side, and be very up front about it.
Shaving a bit off a1c's, reducing complications for a portion of the portion of the PWD population that will get serious complications just doesn't win with the public when juxtaposed with the cost.
This was, tangentially, part of the point of my earlier, wet-blanket post. The public will take notice and get interested when a credible body of information becomes available directly comparing the cost differential between more expended up-front and less later on, vs. less up-front and more later on. When it can be shown that intensive management + reduced complications is substantially cheaper than lax management + current complication rates, we have a strong argument.
As I said before, we just don't have the data to make that case, and I can't really say that it's even true. I just don't know.
Finally, as cold and calculating as this may be, it's what the bean counters will do in making this analysis: The Time-Value-of-Money (TVM) must also be factored in to this. Even if the raw numbers come out in favor of strong early intervention, taking those same funds and investing/growing them over 3-4 decades may yield a net surplus after paying for treating the complications. In this case, guess what decision will be made?
The bottom line is this: As long as one is depending on someone else to pay for things for them, that other party will have a say in how their money gets spent, and it is guaranteed you won't agree with some, probably the majority of the decisions the benefactor makes.