Why Do We Need National Diabetes Awareness Month?
November has come to a close, marking the end of National Diabetes Awareness Month (NDAM). Of course, November isn’t just NDAM; diabetes also shares the spotlight with other conditions and causes, including osteoporosis, lung cancer, and—as you surely know if you have any mustached young men in your life—prostate cancer and men’s health.
Like many people, I find the number of awareness months and days overwhelming. It feels impossible to absorb all the information surrounding these well-intentioned initiatives, or to support all of them financially. That’s why I had a hard time deciding how to acknowledge NDAM on my blog.
Knowing I wouldn’t have anyone’s attention for long, I asked myself: What’s the most important thing people should know about diabetes?
After much thought, I realized there was one popular diabetes myth that I’d like to help bust:
The Myth: Only people with diabetes who “don’t take care of themselves” develop complications.
The Fact: Maintaining normal blood sugar levels significantly reduces the risk of diabetes complications. However, there is much more to blood sugar management than just individual effort.
Breaking Down the Myth
There are two ideas at play in this myth:
- There’s an inverse relationship between blood sugar control and health. That is, poor control increases risk for complications, and good control decreases this risk.
- Anyone who doesn’t maintain good blood sugar control isn’t trying hard enough.
The first idea is true, the second demonstrably false—which is exactly what makes this misconception so insidious. The most convincing lies, after all, are the ones with an element of truth.
Having good blood sugar control does reduce an individual’s risk of developing complications of diabetes, including neuropathy, retinopathy, and kidney disease. (Note the use of reduces here, not eliminates.)
This relationship was not clear to scientists until as recently as 1993, when the Diabetes Control and Complications Trial (DCCT) (1982–1993) came to a close. This large study intended to test the hypothesis that by keeping blood sugar levels as close to a non-diabetic range as possible through intensive insulin therapy, individuals with type 1 diabetes could prevent or delay microvascular complications. Up until this point, conventional insulin therapy had mostly focused on keeping patients alive rather than on glycemic control.
The results of the DCCT were so clear that the study was stopped early to allow patients in the control group to begin an intensive insulin therapy regime. Over a period of just 6.5 years, intensive therapy was shown to “delay . . . and slow the progression of clinically important retinopathy, including vision-threatening lesions, nephropathy [kidney disease], and neuropathy, by a range of 35 to more than 70 percent.”
The DCCT inspired countless further studies that supported the original study’s findings, ultimately revolutionizing the standard of care for type 1 and type 2 diabetes. At the end of their paper, the DCCT authors noted:
“Intensive therapy was successfully carried out in the present trial by an expert team of diabetologists, nurses, dietitians, and behavioral specialists, and the time, effort, and cost required were considerable. Because the resources needed are not widely available, new strategies are needed to adapt methods of intensive treatment for use in the general community at less cost and effort. Meanwhile, the health care system should provide the support necessary to make intensive therapy available to those patients who will benefit.”
The Diabetes Control and Complications Trial Research Group (1993).
This is where the second part of the myth comes in. After all, do you think that in just 27 years, all of the problems associated with adherence to intensive insulin regimens have been solved?
No, of course they haven’t.
What You Really Need to Know
Many people have been living with diabetes since long before the DCCT concluded in 1993. And many were diagnosed after but still haven’t fully benefited from the findings of this research.
The truth is that millions of people with diabetes “don’t take care of themselves.” Not because they don’t want to, but because they can’t. Some don’t know how, and many are up against other barriers. Without access to accurate information, comprehensive healthcare, medication, technology, and adequate finances, blood sugar management is an impossible task. Emotional support from family and friends, practical support from employers, and other mental health support is also key.
Even for those who are fortunate to have all the resources they need, blood sugar management is hard. Daily life takes a toll on the body, and for people with diabetes, this toll is largely measured in blood sugar levels. I believe in individual accountability when it comes to health, and not just for people with diabetes. To a certain point, it’s up to each of us to make good choices for ourselves. But some things are simply outside of a person’s control—and accountability is not the same as blame.
To blame complications on a lack of effort or caring is to diminish the experiences of everyone living with diabetes: those who don’t have the resources they need, those who don’t understand their condition, those working from bad information, and those who try their best but still “fail.”
Besides all that, the last thing anyone needs when they’re facing a scary, potentially life-altering medical condition is to be shamed for it. It’s not helpful, productive, or kind. What people really need is to be supported, without judgement or assumptions, throughout their entire journey with diabetes, beginning to end.
That, to me, is what NDAM is all about.