Diabetes Evolutions: The Office Visit

The logbook was the thing. That little sheaf of pages, divided into box after box after box. Inside, filled-in blood glucose numbers from one day to the next, one time to the next.

You would carry the logbook into your endocrinologist’s office. He or she would shuffle through the numbers, sometimes averaging them out with a pocket calculator.

How accurate were those logbook numbers? They didn’t ask, and on occasion they weren’t the truest version of reality. I would shave some points of high values, add in a reading or two that might have been missing.

Whatever the case, it all came out in the A1C, right?

I was lucky to find an integrated clinic for my middle school and high school years, a one-stop shop where all of my diabetic needs could be attended to, four times a year. My mother and I would drive the 20 minutes to the office, where I would get my blood drawn, give a urine sample, fill out a sample diet page, and meet with both an educator and endocrinologist.

For the last few weeks, I’ve gone digging through my memories of diabetic supplies and treatment, past and present. This week I’m talking about visits to the diabetic specialist’s office, which has changed in certain ways but remained stubbornly consistent in others.

These days, of course, everything is different. I go to a one-stop shop where all of my diabetic needs can be attended to, four times a year. I drive 40 minutes to the office, where I will get my blood drawn, sometimes give a urine sample, fill out a questionnaire and meet with an educator or endocrinologist.

Hm, actually those two things aren’t so separate, are they?

I’ve tried other approaches in the intervening years. At one point, I saw an educator monthly, while visiting my primary care provider twice a year. At other points, I’ve experimented with fancy clinics located out-of-state.

In most cases, though, I found what I assume most people with diabetes find — as good as doctors or educators are, they’re at best a support. They can’t actually solve our day to day challenges. They can prescribe useful medications, of course, and analyze readouts from pumps or CGMs, but you’re still only seeing them for an hour every few months.

The office visit seems like the area of diabetes care most overdue for a refresh, if you ask me. Anyone handling this condition would benefit from more frequent monitoring, and from health care professionals invested in their daily lives.

 

There’s little in the system now that incentivizes such close collaboration. Doctors need to see a high volume of patients to make their economic work, and increasing costs in the health care system discourage frequent visits for patients.

Technology offers a clear opportunity, but it also self-selects those who are already motivated to care about their diabetes. If you’re willing to log onto a program or website every few days to check how you’re doing, you may not need the extra help that would be beneficial for others. Such are the contradictions and frustrations of care.

So we’re still at the quarterly visits, still at the labs, still at the awkward conversations about good fats and carbohydrates. It’s not the worst place to be. But after so many years going through it, I wonder if it couldn’t be more.