During the Olympics and Paralympics, all eyes turn to the best of the best: incredible athletes who have dedicated their lives to the pursuit of greatness in hopes of earning one of the most sought-after titles in the world.
“Gold medalist” has a glorious ring to it, and the athletes who earn this honor have every right to be proud. But the mantra of the Olympic movement isn’t “get gold or go home in shame.” In fact, winning medals is only a small part of what it means to be an Olympian or Paralympian, especially since only a tiny fraction of the 10,500 Olympians and 4,400 Paralympians actually come away with hardware.
Instead, the official motto for the Olympic Games is “Faster, Higher, Stronger – Together,” encapsulating the pursuit of excellence in all its forms. Sometimes, that’s winning gold. Sometimes, it’s setting a personal best. And sometimes, it’s just qualifying for the Games in the first place, which is a feat most of us can only dream of.
Some of the most touching stories of passion and persistence come from athletes who have few realistic prospects of winning gold — stories that often only get a brief mention from commentators before attention turns back to the top performers — and it’s these narratives that carry with them a powerful lesson for those engaged in the similarly passion-driven work of health care.
As a podiatrist working closely with people with diabetes, I know that not all of my patients are going to find themselves in the first place all the time. They aren’t going to be 100% adherent to their medications, their diets, or their exercise plans. They aren’t going to be 15 minutes early to every appointment, paperwork in hand. And most of the time, that’s all right because I can clearly see that they are trying their best to achieve the goals that are within their grasp.
As health care providers, we need to do a much better job of celebrating the seemingly small victories alongside the big ones to support incremental, continuous progress, no matter what it looks like in comparison to others. This is the only way we can truly help our patients move faster, higher, and stronger toward their individual goals.
It’s time for health care providers, payers, technology companies, and regulators to reframe our thinking around how to recognize success while implementing best practices — outlined below — that embrace individualized achievements in adherence for people living with diabetes.
Integrate mental health care and SDOH services more deeply into chronic disease management
Every athlete knows that a strong mental game is crucial to success. It’s equally true with managing diabetes. People with diabetes are up to three times more likely than others to experience depression, but less than half typically get the treatment they need. Without adequate mental health care, people with diabetes are less likely to remain adherent to their care plans and, therefore, more likely to experience poor outcomes.
Care providers or outreach staff working directly with people with diabetes should be aware of the signs of depression, anxiety, or stress, including denial of the seriousness of their condition; procrastination with self-care; misplaced expressions of anger; or notable changes in engagement patterns — such as failure to regularly use a home monitoring device, fill a prescription, or return calls to the office.
The term “diabetes distress” is also increasingly being used by health care providers and patients to communicate the array of duties patients must take on to manage their diabetes properly. As health care providers, we have to act as the “coach” for patients, and we need to better read when to push and when to pull back on patient demands based on the level of distress exhibited.
These are also warnings that a person may be struggling with barriers related to the social determinants of health (SDOH), which are often the biggest factors in poor adherence and suboptimal outcomes.
Just like a staggered start on the track, every person begins their socioeconomic journey from a different point. Yet stakeholders are still struggling to collect meaningful data on those issues, and few have the structure in place to equitably address SDOH at its root so that the stagger evens out over time.
Simply making a few extra moments to complete an SDOH screening tool during a visit or sending the patient a mental health questionnaire to fill out at home can provide valuable insight into where the person is beginning their journey and what they need to perform at their own highest level.
When possible, provide screening materials in the patient’s preferred language and communication channel and follow up quickly with a human clinician trained in compassionate, culturally sensitive outreach to offer SDOH support or mental health resources that best suit the individual’s needs.
Invest in coaches and collaborators to assist with education and navigation
Diabetes management is the ultimate team sport, and providers should be treating it as such. People with diabetes require varying degrees of assistance with navigating the health system, often starting with foundational education about managing their condition.
The aforementioned information on SDOH barriers, combined with clinical and claims data, can help health plans and providers begin to stratify people by risk to ensure that individuals with complex needs are paired with a coach who can offer self-management tips, education on personal devices, and assistance with accessing the right resources at each point in the health journey.
The other key players in the team sport of diabetes are the Certified Diabetes Care and Education Specialists (CDCES). These experts are most often on the front lines of providing education to patients with diabetes, and their work plays a key role in ensuring patients thrive while still proactively managing their diabetes.
Making room in the budget for coaches, educators, and navigators like these can be challenging, which is why we must continue to work with payers and regulators to redesign the reimbursement environment to account for these critical players on the team.
Acknowledge positive trends over time, not just static outcomes
Many medals are won by thousandths of a second or fractions of a millimeter. While it might not seem entirely fair to the loser, there has to be a cutoff somewhere. The same is true for health care measurement systems that gauge adherence. These metrics typically define an 80% proportion of days covered with medication as a success, while 79.9% is deemed a failure.
But is it really? Considering that most people are only 50% to 60% adherent to their medications, 79.9% is still an impressive feat that will bring major benefits to the patient, particularly if they were only at 40% the year before.
All improvements are good improvements when it comes to adherence to diabetes management, even if the most heroic efforts in the world are only “good enough” for silver — or don’t yet lead to a place on the main podium at all. For example, a patient who is 70 pounds overweight and loses 5% of their body weight is still not at a “normal” weight, but this weight loss still has a significant effect on A1C. Celebrating successes of all sizes, like this example, can help patients avoid pitfalls and succeed on their journey to improve personal health.
To truly foster an environment where people with diabetes are given their best opportunity to thrive, we must provide the structure, support, resources, and genuine encouragement required to keep pushing toward each person’s version of excellence so they can build the skills, confidence, and capacity to become the best versions of themselves.
Gary Marc Rothenberg is a podiatrist.
