The Diabetes Management Industry Is Broken. Here’s How to Fix It.

Published in

NowPatient

6 min readMay 6, 2021

Managing diabetes is an unsolved problem. Day in, day out, people must use trial and error on average 180 times a day to keep their blood sugar in a range that minimises their risk of complications [1]. Many diet programs, apps, and devices claim that managing diabetes is easy — if you follow their strict rules. In reality, we just don’t know enough about the science of diabetes to understand how to perfectly mimic a pancreas. Despite working incredibly hard, nobody gets it right all the time. And yet people with diabetes still live amazing lives filled with travel, good food, and unpredictable schedules. Frustratingly, the diabetes industry ignores this and continues to build programs, products, and devices that ask people to chase perfection.

Sugar and Self-Worth

Have you ever heard someone look at a doughnut or other sweet treat and say “that’s diabetes on a plate”? Even if you know very little about the condition, it’s easy to see how diabetes is tangled up with our other cultural baggage around food and weight. We heavily stigmatise diabetes of all types and make unfair associations to sugar, obesity, and personal responsibility. Despite the hype, the science on what causes diabetes is incomplete, different for different people, and much more nuanced than simply sugar in, diabetes out [2]. But because this is the dominant story, people with diabetes are made to feel shame and helplessness around their condition.

The diabetes industry has capitalised on this intense food focus by building app after app that does little more than judge food, literally scoring meals as “red” or “green” based on their carbs and calorie content. Although diet is a tool that some people find useful in managing diabetes, the overwhelming message is that if you ate “perfectly” you would have perfect control of your sugar levels. In reality, blood sugar is affected by no less than 42 factors, not all of which are in your control [3]. Labelling food good or bad is a simplistic, unsustainable approach to eating for anybody, but particularly for those with a lifelong condition. The diabetes industry should help people to find a way of eating that works for them in the long run, and help with the outcome of whatever they choose. Pizza doesn’t have to be off limits, it just takes some skill to master.

Technology Isn’t a Cure-All

Just like food, technology can be weaponized against people with diabetes. A fairly recent but increasingly ubiquitous example is continuous glucose monitors (CGMs) like Dexcom’s G6 and Abbott’s Freestyle Libre. These devices give people unprecedented ability to track and judge what their blood sugar is doing at any moment and is absolutely life-saving technology, particularly overnight. However, there is increasing pressure for all people with diabetes to wear a CGM all the time. Healthcare professionals are starting to track Time In Range (TIR) — which can only be measured with a CGM — as a more insightful measure of overall sugar levels than A1C [4].

In Dexcom’s recent Super Bowl commercial, spokesman Nick Jonas asks “really?” at the idea of someone checking their blood sugar with a fingerprick device [5]. Well, yeah. CGMs need frequent calibration using fingerpricks, are often inaccurate, and can be uncomfortable to wear. They are also expensive and often difficult to access through insurers or national healthcare systems [6]. Knowing your sugar level all day every day can also add to the heavy mental load of diabetes [7]. With a CGM it can be hard to switch off from the numbers even for a moment.

While CGMs are undoubtedly game-changing, diabetes management fatigue is a real thing that too many diabetes companies don’t acknowledge. People who choose not to wear a CGM can still manage their blood sugar levels. We need to stop shaming people for choosing not to use the latest diabetes tech, or not having access to it. Instead let’s help people learn when and why they might find technology helpful, and make sure that it’s easy to use and affordable for those who want it.

Diabetes Goes Mainstream

As CGMs proliferate, blood sugar is becoming more mainstream among people without diabetes as a metric for fitness and wellbeing. For a long time, there’s been folk wisdom about “blood sugar spikes’’ from soda and sugary snacks and how that affects your energy levels and performance at work or school. Now diabetes devices are starting to become commercially available to people without the condition. Abbott is white-labelling the Freestyle Libre to startups like Levels and Supersapiens that sell the CGM and an accompanying app to help you optimise your fitness. There are also rumours that the Apple Watch will soon be able to estimate your blood sugar without a needle at all [8].

For people with diabetes this is bittersweet. On the one hand, increased awareness of blood sugar could reduce the stigma of wearing a monitoring device, improve cultural stereotypes about diabetes, lower the cost of CGMs over time, and drive demand for smaller, more comfortable sensors. But there will also certainly be a huge rise in online misinformation about blood sugar and a huge increase in pressure to have perfect sugar levels. It’s also unlikely that these systems would be available through insurance or other healthcare providers as they’re not medically regulated for managing diabetes. It feels particularly unfair that wealthy people without diabetes can buy CGMs when people whose lives could be hugely improved or even saved by this technology still can’t afford it.

Although developing medically-regulated technology is harder than repackaging diabetes tech for the masses, the diabetes industry (as well as the governments that regulate it) should continue to invest in easier diabetes management and finding a cure. The industry should also get better at psychologically supporting people and acknowledging how much work the condition actually takes. And underpinning all those efforts should be a fair and reasonable approach to pricing.

People-first diabetes management

Food, insulin, and tech are all just tools that people with diabetes can use to manage their complex condition. Any person’s approach to managing diabetes will change over time depending on their lifestyle and how they feel. Sometimes they might want to try eating low-carb and wearing a CGM, other days they might just want a naked shower and a pizza. And that’s fine.

Existing solutions for managing diabetes seem to revolve around ‘compliance’ — that if you could stuff every person with diabetes into the same perfect routine no one would ever go high or low again. But that’s just not how diabetes works; it’s different day-to-day, person-to-person. The only thing that will solve diabetes is a cure. In the meantime, the diabetes industry needs to focus on helping people to live the lives they want, making that help affordable and accessible, and supporting people through the good blood sugar days and the bad.

At Quin, we want to embody this new approach to diabetes management. Our app can help you remember to take regular doses, visualise what you’ve dosed and eaten recently, and recall your past experiences of eating particular foods alongside what happened to your blood sugar. It’s designed to fit into your life and support you through it — not to control or judge you. We’re at the beginning of a quest to change the way the industry approaches diabetes. If you’d like to learn more, please download the app for free today or get in contact with us at https://quintech.io/. We’d love to hear your experiences and feedback.