Diabetes is a massive health problem; in 2010, diabetes was the U.S.’s 7th leading cause of death. Although this disease affects 9% of the entire population, treatment still isn’t catering to the patient and his or her needs. According to a white paper created by BLDG Health, the current conversation around the diabetes epidemic in the U.S focuses on fear-driven tactics and generic language (i.e., eat this, not that; exercise more regularly.) The paper continues, “These directives and generalizations lack specificity and empathy for people living with the disease and do little to empower, motivate, or properly educate them.”
Present programs focus on treating the disease and its symptoms, a form of treatment referred to as “patient-centered care.” But it should be focusing on treating the person as an individual with his or her own nuances, pain points, and motivations, a type of treatment popularly referred to as “person-focused care.”
Diabetes treatments must become “person-focused,” going past simply managing the disease and instead taking a holistic approach, incorporating all aspects of a person’s life into an individualized treatment. In order to better understand diabetes from the patient viewpoint, we invited four people with diabetes to join us at our office and discuss their perspective on the disease.
An emotional diagnosis
Our panel shared that when they were first diagnosed, they largely experienced denial or felt guilty about the diagnosis. A major factor fueling this denial is the reality that many diabetics do not present any symptoms, making it easier to ignore a diagnosis and put off treatment. Naeem, a type-2 diabetic, recalls, “It’s kind of a weird disease because it’s cumulative. It’s not like, ‘Hey, if I had these three donuts, I’m going to feel terrible right away.’ It’s two, three days later, or even years later that this cumulative effect takes hold. So you find yourself in a kind of denial.”
Uncovering patient motivation
In order to repair this system, diabetes treatments must be able to connect the patient to the disease by helping them relate to the eventual repercussions of their actions as well as their own intrinsic motivations. Patients enter diabetes treatments for a variety of reasons. Some may join because of the pressure of a loved one or the recommendation of a doctor; but some users may need no push at all. For example, Sanford, a 47 year old, prediabetic, immediately connected with the urgency of his condition, saying, “I want to be alive, I want to walk my daughter down the aisle when she gets married. You know, I want to be alive.”
When a patient’s desire to get healthy comes from intrinsic motivation they’re typically better able to stay the course. But not all users will immediately connect with an intrinsic motivator. In order to create a successful treatment program, the program must be able to help users discover these motivations and remind patients of them when they most feel like quitting.
Creating a safe space: The role of health coaches
Aside from the need to emotionally connect the patient to their disease and their motivation for getting healthy, programs must create a safe space, free of judgment, where individuals feel comfortable learning about the disease. John, a type 1 diabetic, describes the emotionality of the disease, saying, “You feel guilty all the time. You think, ‘I really should be doing this — eating salad, eggs, no carbs,’ when in reality, you’re not.”
Health coaches will play a significant role in building this space for users in the initial stages of of the program. The principal trait of any coach should be empathy, according to Dr. Andreas Michaelides, Chief of Psychology at Noom. “Coaches must be tuned in to the individual struggles and difficult transitions each of their clients face. This helps them to create an experience tailor-made to that client’s specific situation,” he says.
Overhauling old-fashioned resources
Existing diabetes resources come off as tone deaf in today’s ecosystem of customized programs and tools. The current method to treating the disease takes an outdated, textbook approach using antiquated tools that can be difficult for patients to use long-term. Describing some of the resources provided by typical treatments, John says, “Some of the resources they give you…this Calorie King book. It’s a tiny little thing that has every food imaginable in it. It’s useless. Who’s going to pick through that? Because this disease isn’t a week long thing. This is forever, and forever is a terribly long time.”
One size does not fit all
In addition to the anachronous resources, diabetes education takes a “one-size-fits-all” approach. Every patient receives the same material, giving the same advice. But every patient is unique and must be treated as such. Health coverage, social or religious obligations, family structure, individual careers, and variable work hours are all important factors that can affect a patient’s life and, therefore, treatment. Lifestyle needs to play a large role in the treatment plan for each individual patient. Again, coaches will play a vital role in making this come to life. Coaches can connect with each patient, creating an individualized program to fit their lifestyle, while technology can help to make this a realization across populations.
Throughout this conversation, a few themes became clear, but the overarching message that this reinforced for us is that diabetes patients need to be treated as people first. Every individual comes into a treatment program with unique emotions, experiences, and lifestyles. These factors must come into play when creating an individualized program. By acknowledging the patient first, and personalizing the message to them, programs can create lasting relationships with users, motivating long-term and sustainable behavior change.