Why Don’t More Patients With Diabetes Grasp The Seriousness Of Their Disease?

I am often in profound disbelief at how my patients with diabetes and the lay public as well do not understand the destructive nature of diabetes. I discuss this with all my patients with diabetes at each and every visit. I cannot count how many times patients have told me they do not have diabetes because they take a shot of insulin or they can eat what they want because they take a pill.

Is their ignorance a consequence of my failure as their doctor not instructing or impressing upon them how their diabetes can destroy their bodies and lead to an untimely death?

The Centers for Disease Control and Prevention estimates that by 2050, one in three people in the United States will have diabetes.¹ That is so baffling to me as a physician because we know so much of the pathophysiology of obesity leading to diabetes and the destructive force of diabetes through oxidative stress and chronic inflammation. Why do the public and patients not understand, grasp and retain these concepts?

This past weekend, I was terribly saddened by the death of two of my longtime patients with diabetes. They both had terrible gangrenous infections that required guillotine amputations and multiple debridements with multiple high-powered antibiotics as well to get the wounds clean. It required the greatest skill of my vascular surgical colleagues to restore blood flow since these patients each had no flow below their knees. These patients also needed a multitude of other physician specialists to addess the impact of diabetes on their bodies.

Three to five days after their revascularizations, both patients suffered massive myocardial infarctions and had to be on ventilators. They both subsequently passed away after multiple organ failures.

My point is that these patients had gangrenous open wounds with massive infection for weeks prior to coming to see me. Why would they wait so long for me to see them? Why would they fear coming to the doctor? Did they think if they ignored their problems, they would go away? If they do not acknowledge the problem, do patients think the problem ceases to exist?

I feel like a failure that I have not impressed upon these patients how destructive diabetes can be, how patients need to control and treat this disease every day of their lives or they are going to die. Our group prides itself on its ability to teach our patients to appreciate what diabetes can and will do to them if they ignore its potential for serious consequences. “Diabetic apathy” is the term I use to describe patients’ destructive ignorance of the urgency to obtain wellness through medication, nutrition and exercise in order to control the onslaught of diabetes.

Where then is this disconnect? Where is the sense of urgency and completeness these patients need in order to arm themselves with knowledge and preparedness to face the reality of amputation, suffering and death that this butcher will cause them?

More than 100 million people have diabetes and pre-diabetes right now in the U.S.¹ If we, the entire medical community, do not do a better job at educating this population and the lay public in general about the equal opportunity destroyer of diabetes, which kills more people than most cancers combined, then we better start building a lot more cemeteries for we are going to run out of ground very fast.

Reference

1. Centers for Disease Control and Prevention. ^{National Diabetes Statistics Report, 2017}. Available at https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf .