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Post by agedhippie on May 20, 2022 14:24:32 GMT -5
Also, there are times, to do the job, tools are required, or the correct tools are required. My theory. If people had a noninvasive glucose monitor, wearable, a certain amount of the population may start watching what happens when they eat and what they eat when it happens. ... I would really like a non-invasive glucose monitor, but for as long as I can remember it's been coming within the next 5 years... |
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Post by sayhey24 on May 20, 2022 15:07:05 GMT -5
Aged - I think you bring up a good point. You say coaching is a non-starter. This is probably true as Bill from VDex called them in another thread "the let’s say “smarter” as a shorthand, is less likely to believe the highly improbably story that his/her care is exactly the opposite of what it should be". I would say that is true for a lot of endos and experienced T1s. It also creates a distinction for new T1s and many T2s. Guys like Gary Scheiner have made a living coaching new T1s - integrateddiabetes.com/meet-our-staff/I think the T2s are a completely different situation. Many want the coaching but they have no idea what to do. They see the GP for 15 minutes, given a script for metformin and told to start losing some weight and take a walk. As time goes on they get worse. Their family is constantly bugging them and they do their best to ignore them. If you go to educational clinics for T2s you would think it is almost entirely a female disease as these sessions will usually be 80% female. The properly funded and marketed T2 coaching service which can stop progression has some potential. Actually most of Gary Scheiner's customers are experienced Type 1s precisely because IDS is very good, but not cheap. I know people who have used their services in the past. The reality is that getting people to pay for diabetes coaching requires motivation and largely that is lacking. Insurers notoriously underpay for endocrinology support staff and most endo departments run at a loss if they try to include clinics. VDEX works because the people coming to them are motivated enough to seek them out and they are prepared to pay if necessary. For the rest of the T2 population there is no visible penalty for non-compliance, and consequently compliance rates are awful. People will go to a couple of classes, be told to exercise, eat better, and improve their diet, and then move on. Actual coaching takes real money and the funding source for that is simply not there unless people pay themselves. Aged - have you been to Gary's office in Wynnewood? IDK the people I saw there did not seem very experienced. If they are the experienced ones then there is a HUGE market for the inexperienced. There is also a large amount of grant money for some groups which is not currently being tapped. I have been to a number of Penn run T2 clinics. I think the situation is different than what you may think. My experience and this is only my experience is most would be motivated if they knew what to do. In general these people want help. Nearly all that come to these clinics have never been told by their GPs to test their BG. As I said its usually 80% female because the guys are just going to tuff it out mostly because they don't know any better. The visible benefit if treated properly from day 1 would be there. First from the CGM, then from improved eye sight, then better weight control then significantly reducing their chance of heart attack and stroke. Before Covid I pulled together a lunchtime diabetes "open house" for a very large company. The health team at first was skeptical because they tried some other health topics in the past and got little participation. If Ben "Buzz" Harris wants to see "buzzing" he should have been at this. Well over 1k employees came on their lunchtime. The "health team" was blown away. We had about 15 booths including BGM testing. The local MainLineHealth hospital was represented. Of course my booth had a couple of big monitors showing several youtube videos including the "Coke Challenge". My booth was about "Future" diabetes treatments and was mostly about CGMs of which we had several kinds, monitoring software and afrezza. At the BGM booth I think they identified over 70 people who they recommended to see their doctors and I bet most did. For a fact I heard back from some about their experience. I guess what I am saying is don't sell the T2s off as a bunch of lazy unengaged people who are not going to do anything. My hope is and hope springs external is afrezza will find its way into the ADA SoC as step 2 and if so the afrezza and CGMs will get paid for by insurance. Coaching services on top will not be that expensive and in some cases will be paid for through grants. Some of the others can use their health savings accounts. Some larger employers are already covering these health coaching services. |
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