Who moved the goalposts? – Scott’s Diabetes

Bill Polonsky:
I hope everyone’s seen the title of this, which is called “Who Moved the Goalposts?” And what we’re going to do today is a little different from our previous videos.

While in previous videos we’ve reviewed some of the research literature and gotten very, very specific about things where we see a problem and how to resolve it, today is something, well, it’s something that’s been bubbling up that isn’t exactly as concrete as I would like.

I wish it was that we could talk about it, but something’s going on that’s not quite right. And it’s this funny issue. And let me introduce it this way. You know, over the years, Susan and I, we’ve seen so many people who obviously are very distressed and burned out about their diabetes. And one of the major contributors that so many people talk about with us is that there’s so rarely do they ever get kind of an attaboy, so rarely do they ever get this feeling that, whew, I made it, that my efforts have worked, that they’ve paid off. That I’ve made it to a safe place with my diabetes and maybe I can relax a little bit.

Instead, we see many people saying, well, however well they’re doing, there’s a sense that I’m never actually quite well, I’m not quite actually doing well enough. And so they have to try harder and harder. And some are feeling like they never get there enough. So we’ve always pushed and pitched on this old idea that it’s important to have this conversation with your healthcare provider about you know, what’s your target at which you really can sit back and say, I’m safe. Is it an A1C of 7.0% under that? We know that the American Association of Clinical Endocrinologists says that an A1C of 6.5% or under is appropriate for more people. Certainly want to try to achieve those numbers without having any risk of having severe hypoglycemia. But we’ve seen that all of that seems to be falling away. And partly it seems to be failing away because our technology and our medications are getting so good.

So, because it’s so much easier, although it takes effort, to achieve better glycemic outcomes, better A1Cs, and higher levels of time and range, we know the international standards now say you can reach 70% time and range. And this is assuming you would only know that if you’re wearing a continuous glucose monitor, that means the amount of time you’re between 70 and 180 milligrams per deciliter commonly. So, you’re doing well if you reach 70% or higher.

But again, we see so many people and healthcare providers saying, you know, 70% is okay, but 80% would be even better. And oftentimes this is not based on any actual outcome data. And it’s just making me nervous. Are we really helping people to be safer and do better? Are we just driving people crazy? And so that’s what I wanna talk about.

It’s the sense that the goalposts have been moving, especially over the past few years. And what are we doing to folks? I mean, Scott, you’re living with this every day. Is this a good thing? Is it a bad thing? Susan, you’re seeing lots of people who come up with this. What do you guys think?