by Peter J. Nebergall, PhD


For many years, we have been telling you that "education is critical for diabetes management." You might even be growing tired of our endless repetition of "you need to know..." But don't, OK?

In medicine, unlike physics or higher math, we start with the results (like "you have diabetes!") and work back toward the causal factors, the underlying principles. It's like detective work, where you start with the obvious evidence, then determine the cause, and finally deal with it.

Our understanding of diabetes has substantially improved in the last few decades. An experienced medical professional, 20 years out of school, might be as much as 20 years removed from "state of the art"--and "state of the art" is where we find the breakthroughs that save life and limb.

The "bridge" between the experimenters" on the cutting edge" of diabetes research and everyone else is education. We all need it. Clinicians need the latest tools, procedures and test results. Diabetics need to know what they should be doing now, in order to best manage their condition and forestall its possible ramifications. And diabetes educators, whose job is to make folks aware of the appropriate tools, need to keep abreast of the fast-moving pace of change.

And change has been coming fast. The Diabetes Control and Complications Trial (DCCT) in 1993 proved that intensive self-management, "tight control," with blood sugars as close to non-diabetic "normal" as possible, is the best way to deter ramifications. New understanding of the nature of sugar as a carbohydrate, as reflected in the 1995 "Exchange List," has brought greater ease to diabetic meal planning. Steady improvement in home blood glucose monitoring equipment, coupled with greatly-increased distribution, has placed another important tool in far more hands. (You can buy meters and strips at Wal-Mart!)

New research has brought us Acarbose, Metformin, Rezulin (troglitazone), new sulfonylureas, Humalog insulin (lispro), and other medications to alleviate or deter complications. More "investigational" medications are constantly undergoing clinical tests--and some of them will find their their way onto pharmacy shelves.

The efficacy of various surgical procedures is constantly being monitored. Sometimes new findings overturn "the old wisdom." Balloon angioplasty, to open clogged veins, is less invasive than "bypass heart surgery," but for many individuals with diabetic heart disease, the traditional "heart bypass" operation brings greater success, in the form of long-term survival statistics, the ones that matter.

Now, back to you, your family doctor, and your diabetes clinic. It's human nature to "get set in your ways." We learn our particular tasks, whether they are those of self- management, diagnosis, or long-term treatment, and there we sit. We have "better things to do." We would go on giving the same answers to the same questions, because when we learned them, they were the Right Answers.

But they are no longer. Not only do our bodies change, requiring constant readjustment of the balancing act that is diabetes self-management, but the most appropriate therapies, the best options, are constantly being upgraded or replaced. New and better ways are coming out all the time. We all want the best possible options. How are we supposed to find out about these things?

This is the true purpose of diabetes education.