Three assumptions at the outset: As individuals, we all want what is best for our health, and we want to live long, healthy and productive lives to the best of our abilities. Our health care providers entered their respective professions to help people achieve the above goals. There are no bad actors in the patient/health care provider couplet.
Systems Issues:
But sometimes systems issues get in the way of things. Take the concept of population health (PH) for example: the goal of PH is to improve care and outcomes while reducing overall spending. Two very noble goals, and, for a publicly funded system like the NHS, careful use of limited fiscal resources in one area increases capacity across the system.
In order to demonstrate responsible stewardship of public funds, care must be evidence-based, and outcomes, or proxy measures for outcomes, must be measured. The Quality Outcomes Framework (QOF) establishes the quality measures, and GP’s are incentivized to meet these targets. So, GP’s assume downside risk: if a patient does not meet specific biometric targets, funding for the GP’s practice will be less, and, as a consequence, patients may suffer.
Is it any wonder, under these pressures, that GP’s take the safe approach? They have seen their patients fail with ‘lifestyle measures’ again and again (especially as patients are advised to eat according to the Eat Well plate). So, the only rational approach in their world is to control what they can control and introduce medications early, and escalate them as necessary. Under these systemic pressures, Type 2 Diabetes can only be a progressive disease.
What are we doing at the Individual Level to Counter these Systemic Barriers?
As individuals, we have a very large role to play in co-producing our health, especially where T2DM is concerned. No health care provider can give us health, it must be co-produced. We all have a part to play, and our inputs matter very much to our health outcomes! However, we are all different, and our different personality types will mean that we will all approach our T2DM journey differently.
It is probably easiest for those of us who are detail-orientated. There is a lot of measuring and controlling, graphs and spreadsheets, and our trusted meters/CGM’s ensure that we have short feedback loops to keep us motivated. This works for our personalities. We are also inclined to do the necessary research, and, because traditional dietary advice has not worked for us in the past, we try to find out why. We know that we have been diligent in following the standard advice. It has failed us, we have not failed it.
So, we discover that the dietary advice we have been given over the past 40 years is based on flawed science (yes, there was at least one bad actor). We also discover there are pioneering health care providers who are leading the charge in showing that there is a different way to approach this disease – Dr. Jason Fung, Dr. David Unwin, Dr. Sarah Hallberg, Dr. Malcolm Kendrick, Dr. Lars-Erik Litsfeldt, Professor Tim Noakes, to name but a few. We discover health professionals who are facing strong push back from powerful special interests. And we also discover professionals who have a very powerful platform to drive appropriate dietary advice for our condition, Dr. John Schoonbee at Swiss Re for example.
We are also joined in our journey by others who use their unique skill set to approach this vexing problem - Is T2DM really a progressive disease, or one which can be managed through dietary means? Ivor Cummins, an engineer with expertise in complex problem solving and root cause analysis is but one example. On our forum we have members who think outside the box, and conduct their own n=1 experiments which they share with us on the forum.
And the forum itself: it provides us as individuals with the platform to share our experiences and to give and receive support from our peers. It also provides a platform for data capture so that the knowledge we collectively create may be shared with the wider community. And the knowledge we are collectively creating indicates - at least to me - that T2DM does not have to be a progressive disease.
Systems Issues:
But sometimes systems issues get in the way of things. Take the concept of population health (PH) for example: the goal of PH is to improve care and outcomes while reducing overall spending. Two very noble goals, and, for a publicly funded system like the NHS, careful use of limited fiscal resources in one area increases capacity across the system.
In order to demonstrate responsible stewardship of public funds, care must be evidence-based, and outcomes, or proxy measures for outcomes, must be measured. The Quality Outcomes Framework (QOF) establishes the quality measures, and GP’s are incentivized to meet these targets. So, GP’s assume downside risk: if a patient does not meet specific biometric targets, funding for the GP’s practice will be less, and, as a consequence, patients may suffer.
Is it any wonder, under these pressures, that GP’s take the safe approach? They have seen their patients fail with ‘lifestyle measures’ again and again (especially as patients are advised to eat according to the Eat Well plate). So, the only rational approach in their world is to control what they can control and introduce medications early, and escalate them as necessary. Under these systemic pressures, Type 2 Diabetes can only be a progressive disease.
What are we doing at the Individual Level to Counter these Systemic Barriers?
As individuals, we have a very large role to play in co-producing our health, especially where T2DM is concerned. No health care provider can give us health, it must be co-produced. We all have a part to play, and our inputs matter very much to our health outcomes! However, we are all different, and our different personality types will mean that we will all approach our T2DM journey differently.
It is probably easiest for those of us who are detail-orientated. There is a lot of measuring and controlling, graphs and spreadsheets, and our trusted meters/CGM’s ensure that we have short feedback loops to keep us motivated. This works for our personalities. We are also inclined to do the necessary research, and, because traditional dietary advice has not worked for us in the past, we try to find out why. We know that we have been diligent in following the standard advice. It has failed us, we have not failed it.
So, we discover that the dietary advice we have been given over the past 40 years is based on flawed science (yes, there was at least one bad actor). We also discover there are pioneering health care providers who are leading the charge in showing that there is a different way to approach this disease – Dr. Jason Fung, Dr. David Unwin, Dr. Sarah Hallberg, Dr. Malcolm Kendrick, Dr. Lars-Erik Litsfeldt, Professor Tim Noakes, to name but a few. We discover health professionals who are facing strong push back from powerful special interests. And we also discover professionals who have a very powerful platform to drive appropriate dietary advice for our condition, Dr. John Schoonbee at Swiss Re for example.
We are also joined in our journey by others who use their unique skill set to approach this vexing problem - Is T2DM really a progressive disease, or one which can be managed through dietary means? Ivor Cummins, an engineer with expertise in complex problem solving and root cause analysis is but one example. On our forum we have members who think outside the box, and conduct their own n=1 experiments which they share with us on the forum.
And the forum itself: it provides us as individuals with the platform to share our experiences and to give and receive support from our peers. It also provides a platform for data capture so that the knowledge we collectively create may be shared with the wider community. And the knowledge we are collectively creating indicates - at least to me - that T2DM does not have to be a progressive disease.
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