Let’s Treat the WHOLE Patient

David G. Marrero, PhD, President, Health Care & Education, American Diabetes Association

David G. Marrero, PhD, President, Health Care & Education, American Diabetes Association

When we talk about stopping diabetes, we usually focus on medical treatments and lifestyle changes that are required to manage the disease: eating well, exercising regularly, taking insulin or other medication, monitoring blood glucose, screening for complications and so on. And for very good reason—we know these measures save and improve the lives of people with diabetes.

Yes, we have made amazing strides in the clinical management of diabetes and the technology of treatment. But we need to play a game of “catch up” when it comes to the psychosocial aspects of this disease. I’m talking about mental health problems such as depression and diabetes distress, which are far too prevalent. They arise from the constant, and at times overwhelming, responsibilities of self-managing a chronic disease like diabetes.

A little about me: I have lived with type 1 diabetes for nearly 38 years. I was a graduate student when I was diagnosed in the 1970s, and my quest for diabetes information took me to the library. There was no literature on how to really cope with diabetes emotionally, behaviorally, psychologically. This area of research was poorly funded then, and it remains underfunded now.

Thus began my career as a diabetes researcher. For example, I have studied how children with diabetes struggle with the transition to adulthood, where continuity in diabetes management is so often lost, and how to improve it. My team is developing an app that would help young adults with diabetes learn how to handle new situations straight from peers who have “been there.” Like, how do you handle diabetes and alcohol consumption once you come of age—without letting it hinder your social life?

How can the American Diabetes Association influence this shift to treating the whole patient with diabetes—mind, body and soul?

1. I would like to work with organizations such as the American Psychological Association to train and certify psychologists to better help people adapt to life with diabetes. That means both recognizing and treating these specific mental health issues.

2. As a leader in cutting-edge diabetes research, the Association can fund new studies on behavioral and psychosocial issues. So far, we have focused more on basic and clinical science.

3. Many emotional issues come from the stress of finding and affording high-quality diabetes care. I would like to collaborate with other organizations that deal with diabetes treatment to improve services and access to new technology. I’m a big believer in emerging technologies and how it can connect people to improve their health. From insurance coverage and reimbursements, to data-sharing among diabetes devices, there are a lot of ways the United States can make good diabetes care more accessible to the people who so need it.

4. One of the greatest things the Association does is give voice to those denied their rights because of diabetes—in other words, fighting discrimination. It starts with educating employers, schools, policymakers, law enforcement and the general public about the needs of people with diabetes. As understanding and acceptance improves, the people we serve will face less stigma and fewer barriers to a normal life. They can check their blood glucose in public. They can comfortably ask for accommodations on the job. They can be Safe at School—and so much more.

Yes, these are lofty goals for my year as President. But these steps would go a long way toward our vision of a life free of diabetes and all of its burdens.

David G. Marrero, PhD
President, Health Care & Education, 2015
American Diabetes Association

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13 Responses to Let’s Treat the WHOLE Patient

  1. William Schlosser, DMD says:

    Thanks for aiming high Dr. Marrero! Our family embraces your goals and wish you and your team the best.

    Bill Schlosser
    father of TID son, Noah

  2. Diana Floress says:

    Thank you Dr. Marrero! You touched on just about everything that we are struggling with and looking for someone to talk to about T1D and children. My 9 year old granddaughter just struggles with all aspects of T1D. We are looking for a counselor she can talk to about the diabetes distress. Thank you for bringing these important things to our attention.

  3. Pradip Shah says:

    Sir I am impressed with your great fillings for diabetes patient as I am also one of them .iam a diabetic 2 type and being in that position since 7 years from the day I was diagnosed and happy to follow a lot of your advice on management of this chronical disease which can only be prevented and save the situation of this sickness.
    The only problem I have been having is the cost of medicine and regular check ups depending on which hospital I visit.
    Please any help can be well come to make me move.
    Thank you.

  4. John Morris says:

    Good point David. Although I believe it is much difficult for healthcare providers to provide such services. Every change is hard to bring. They may not even have enough resources to look at all the aspects pointed by you.

    Anyway, we run a healthcare blog on Diabetes to encourage people to know the risks and make an effort – http://www.diabeteszone.org. We are conducting a conference on Feb 21, 2015 in in New Jersey and wanted to invite you. Drop me a mail if you are interested.

  5. Joyce Sanders says:

    I’m 42 years into this disease, since 16. Managing Diabetes is like trying to find calm in a forever changing pool of water. (Your the pool). over the past 42 years I have suffered many side effects of Diabetes but none as debilitating as the turmoil in my own mind. Mental Health issues need to be addressed. Diabetes touches every aspect of life, marriage, childbearing, work, cost of health care, every aspect. Life can become less of a blessing and more like a hell. Thank you for bringing this to the forefront.

  6. I agree that the technical aspects are over emphasized and that emotional considerations are not adequately addressed. My revolution came through therapy and counseling which helped me find new ways of managing life’s problems (one of which was diabetes). Acceptance and self empowerment did far more to help me make myself a priority and take ownership of my diabetes management. IMHO the psychiatric world wanted to lable me as depressed, when the reality was I just needed some new coping skills. I don’t have mental illness. I was just overwhelmed at first. I firmly believe every diabetic needs to do some “inner work” so they can face and cope with the emotions that come with living with diabetes.

  7. Wish you all the best, David.

  8. Berdj Joseph Rassam says:

    You are totally right – it should be all about treating the whole patient.

  9. Mia Boyd says:

    Thanks for the information. I think it’s awesome that you guys treat the whole patient when it comes to those with diabetes. I want to make sure I find someone that treats diabetes the same way. Do you have tips as to how to find someone who does just that?

  10. Anonymous says:

    Thank you Dr. Marrero for your nice post. Its really good post about diabetes. Its so informative and helpful. A diabetes patient can know many thing from your post.

  11. Russel says:

    Not sure why there aren’t more people doing work like this. You really seem to be aiming to make a difference here. I’m glad and hope your team can find more support along the way.

  12. rebecca danis says:

    I have had Type 1 diabetes for 34 years (since I was 17 and now am 52). I go to SF General Hospital (a county hospital) in San Francisco. I am an indigent patient. Now I do not go to appointments, but only get prescribed medication. I don’t go to appointments anymore because the medical staff are very cold emotionally and their attitude and behavior and cold clinical behavior toward me upsets me so much when I go for an appt. that I have an anxiety attack every time after I leave. And then when I get anxious and upset my blood sugar goes up to between 400 and 500mg/dl, even without eating anything and no matter how much insulin I take, my blood sugar will not go down below 400mg/dl and it takes about 2 days before I can get my blood sugar lower again.

    I have fibromyalgia as well and it was so painful that I could not even sit down and it was bothering me more than my high blood sugar and the doctor at the hospital laughed at me and told me that my pain would go away as soon as I got my blood sugar down. Which was mean and dismissive of my pain, plus inaccurate because there are many people without diabetes, with normal blood sugar who have bad fibromyalgia pain.

    I know that high blood sugar can increase inflammation and make things worse, but it was not the cause of my fibromyalgia. I have since discovered that I also have a mutation (CBS 699 homozygous) that makes it so my body cannot break down sulfurous chemicals in food, and I have a COMT mutation that also impairs my ability to break down phophorus in foods, so since I have cut all high sulfur and high phosphorus foods out of my diet, all of my fibromyalgia pain has gone away. I still have trouble with my blood sugar and my A1C is around 9.5, but I eat a mostly organic paleo diet of lean meat, organic potatoes and olive oil and coconut oil and romaine lettuce salads and avocado, and probably because of that I do not have any complications from having type 1 diabetes for 34 years with a fairly high A1C over most of the time. If I eat butter or any saturated fat, my toes get numb immediately. If I stay away from those long chain saturated fatty acids, I have no problem at all with neuropathy.

    At any rate, I get tired of being dismissed by medical professionals because of my high blood sugars and A1C. If I go in with a UTI, they tell me I wouldn’t have it if my blood sugar was lower and proceed to lecture me and shame me and not just treat my UTI as they would if I was a regular person. And you know what? Once I got my gene mapping and found out that I have genetic problems processing sulfur and phosphorus foods, and once I started lowering sulfur and phosphorus in my diet, I stopped getting UTI’s and I used to get them all the time.

    I guess my point is is that I don’t like how the medical staff has been mean and dismissive to me, and lecturing me about how my health would be perfect if my blood sugars were in a good range (how come non diabetic people have health problems then? ) so now I would have to be on death’s door to even go seek any type of medical help because I just can’t take their treatment of me. So I just call in when I need a refill of my insulin and blood sugar strips because I can’t take the stress of a doctor visit.

    If you have money and can pay for your care, and I used to, doctors are nicer and respectful. When you have to rely on public assistance for medical care, they are not nice and just want to focus on insulin and dosage and that’s it and any other concerns you have are laughed off. And these doctors are from UCSF who work at SF general. Their behavior is abusive, and it is not ok.

  13. Susan Ross says:

    I was just diagnosed with T1 at the age of 56…there is little to no support/literature to help adults cope with the newly found disease that has originally been seen as a juvenile issue. The doctors seems callus and even people in your immediate circle don’t seem to care..”you’re an adult, Im sure you’ll figure it out.” This is a chronic disease that overnight will consume most of the thoughts of every given day. What to eat, when to bolus, when to take your blood sugar, is it high, low or stable? There needs to be more attention afforded to training and supporting the growing number of adults acquiring T1…we need help and most of all, understanding. It’s not something we “choose” to do to ourselves-autoimmune diseases are pretty much unpreventable. More education, more grace and more teaching PLEASE?!!

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