Diabetes Conversation Maps

At the training session I asked one of the facilitators from Healthy Interactions whether she had any proof of that statement. Instead, she replied that the reason for including it is so that patients wouldn’t feel bad about having to start on insulin. While I can appreciate that, I don’t believe the statement is true.

Worse, I think that when people with type 2 diabetes believe that it is true, it becomes a self-fulfilling prophesy. I recently wrote about exactly this issue here.

After the training, the lead facilitator and I exchanged email messages. “In the Life with Diabetes book, where much of the map content comes from in addition to American Diabetes Association-appointed subject matter experts,” she wrote, “it states that, ‘Because pancreatic function declines over time, insulin is often needed to achieve blood glucose goals.’” She provided three links and added that, “The main goal of this map is to communicate that diabetes as a chronic diseases that progresses if not effectively managed.”

I wrote right back to her that their goal is certainly appropriate. But it needs to be matched by one that gives a positive reason for people with diabetes to manage their disease by telling them that complications are not inevitable, if they control their diabetes.

I don’t doubt, as one of the links she sent me says, that “In most cases the disease eventually progresses.” That’s because typically diabetes is not well controlled. I remember an ADA doctor telling me that the average A1C in this country is about 8.5 - 9. That is not control, and with levels like that I am sure that the disease will progress.

I also don’t doubt that the beta cells in people with uncontrolled diabetes will eventually not be able to do what they need to do, either because there are fewer such cells or because they become too few to overcome insulin resistance. But there is no proof that this is the result among people with well controlled diabetes.

“It is not inevitable that we will not be able to control our blood glucose levels,” I concluded. “Patients need that encouragement. If not, the negative message of this map unmatched by a positive one can become a self-fulling prophesy. That’s not anything that you or I want. Do you think that you will be able to revise map #4 accordingly?”

I figured that it was my responsibility at least to try, not having any idea how the people at Healthy Interactions (who often just call it “Healthyi”) would take my advocacy journalism. Then, I was delighted to hear back from Peter Gorman, the president of the company.

“You make some excellent points,” he emailed me, “and that’s exactly what the Conversation Maps are intended to do – generate rich, meaningful conversations where people with diabetes can learn from one another. Of course, this discussion is guided by a healthcare professional. I have yet to hear that the Conversation Maps lead to a negative and discouraging conversation. On the contrary, the conversations as a result of going through a session often leave people with diabetes with significantly more hope and understanding of how they can manage their disease.