“Watershed” A1c Campaign: How Much Does It Really Help?

LogodccSo have you seen the new Know Your A1c national public education campaign? It’s supported by a coalition of all the big names in diabetes organizations — the ADA, JDRF, American Association of Diabetes Educators and the National Council of La Raza (the nation’s biggest Hispanic D-advocacy group) — and backed by a half-dozen major D-pharma players — Abbott, Bayer, LifeScan, Roche, Novartis, Novo Nordisk, and Sanofi-Aventis.

Expert observers say the campaign “signals a watershed for recognizing diabetes as a public health crisis,” bringing the condition “unprecedented public attention.” Watch the video of top D-consultant Kelly Close explaining its import HERE.

Personally, my first reaction was: The ADA and the JDRF working together? Now that IS a “watershed” move… Then I viewed the spot, and just loved the bit about the shrimp scampi. Funny approach! Thank goodness for that.

Of course, at the base of it, I think anything we can do to get people with diabetes aware of their own state of health is fabulous. Kudos to these organizations for reaching out to the masses this way.

But here’s what frustrates me a bit:

As Scott points out: “having a number is useless unless the patient has a relationship with a healthcare team, so merely pushing (people) to get the A1c test falls woefully short of what is really needed — comprehensive diabetes education combined with regular care and constant vigilance.

With diabetes, it’s always a focus on the darn numbers, often with far too little explanation of what these numbers really mean to a patient, or what the patient can actually DO to improve their numbers if they aren’t good.

Case-in-point:

While I was writing our Know Your Numbers book last summer, a friend of mine from college who was recently diagnosed with Type 2 called to ask me “an embarrassing question.” What he said was this:

“So they sent me home with this glucose meter… but my numbers are just high all the time… what I am supposed to do with these numbers, anyway?”

Wow. How ridiculous! This is a highly educated guy (with a master’s degree, running a university IT department), and even he didn’t get a decent explanation from his doctor of why or how to use the information his BG meter provides. But he was using his meter, and getting the numbers. So by some counts, he was “taking care of his diabetes.” Aaaarrgh!!

My fear is that the take-away from these new “Know Your A1c” spots will be the same age-old, one-shot fix-it mentality, as in “I got the test, so now I ‘took care’ of my diabetes.” If the result is out of range, the onus is totally on the patient to seek out the Diabetes Coalition online tips, and/or find a healthcare provider to help them. Presumably, the audience for these ads has some major barriers to both. So does the push just get the test alone really provide a valuable service?

I’m sure most of you reading DiabetesMine.com have a more holistic and proactive approach to your diabetes management. But you probably know at least a few relatives or friends who don’t. So what do you all think? Will a widespread “Know Your A1c” TV campaign be helpful for them, or just serve to feed the existing misconceptions about diabetes and how to take care it?

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25 Responses

  1. Eric Link
    Eric Link September 17, 2007 at 12:08 pm | | Reply

    Hi Amy -

    I think you are right, it is just a number and w/o context its usefulness is limited (is my A1c higher or lower than my last? Have I made changes that are reflected the way I expect in the number? etc…). In our programs, you’d be surprised how many people diagnosed w/ Type 2 Diabetes didn’t know what an A1c was. So for these folks it’s a huge improvement just to become aware what tools are out there. With our HomeCheck programs (http://www.healthcordia.com) we provide the world’s most accurate A1c test, certified diabetes educators and education as part of a comprehensive program. We also address the issue you mention “What do I do w/ these numbers?” that Type 2 folks face. This is an all too common problem and without knowing what to do w/ the numbers, testing is of little value for these people. We give them the tools they need to make testing useful and our outcomes have been great (>1% drop in A1c sustained as long as they are enrolled in the HomeCheck465 program).

  2. Albert
    Albert September 17, 2007 at 12:14 pm | | Reply

    Amy, I ran into this earlier today as well. It seems that raising awareness of knowing HOW to react to the ‘numbers’ is definitely an important step in overall diabetes care.

    I wonder if the whole A1C campaign can carry over to general diabetes awareness in the public eye. The commercials seem to illustrate the idea of warning signs quite well. Maybe if this kind of message was adjusted for the general population.

  3. mollyjade
    mollyjade September 17, 2007 at 1:27 pm | | Reply

    At least it will get people into the doctor’s office. Most insurance companies won’t let you just get a bloodtest without seeing the doctor.

  4. Michelle
    Michelle September 17, 2007 at 1:30 pm | | Reply

    My dad is one of those folks who was told to check his BG’s but not told what to do with those numbers – frustrating to say the least and until his dr takes it seriously my dad still proclaims he’s “borderline”. sigh.

    So while I think this A1C campaign is great, I somehow feel that it really is just another “tool” for the diabetes police to judge PWD.

  5. Nelson
    Nelson September 17, 2007 at 2:13 pm | | Reply

    I think most of us can agree that the medical profession can focus too much on numbers and too little on the person, probably due largely to time constraints. Should we raise the cost of health care further so we can get more time from our doctors? . . . Maybe.

    It’s hard to fix something if you don’t know it’s broken. You gotta start somewhere. “Know your A1C” makes for a memorable sound bite – potentially the most complex concept the pervayers of this campaign can put across effectivly to their target audience.

    Call me a geek or a nerd, but I don’t see a shortage of liturature out there to help me resolve my high A1C once I know it’s high. I suspect your friend, the master of IT, after getting over the initial shock, has probably found lots of good sources of information to help him lower his A1C and moreover take better care of his disease in general. He apparently did need to know his A1C before he was pushed into action. In your friends case, getting that number seems to have worked, even if the doctor didn’t.

  6. nonegiven
    nonegiven September 17, 2007 at 3:03 pm | | Reply

    dLife is a start. Maybe someone should put diabetes education classes on PBS.

  7. Keesha
    Keesha September 17, 2007 at 3:07 pm | | Reply

    This is my first visit to your site. (I have a cousin who is diabetic.) Thank you for a phenomenally well-done website! It is really easy to navigate and find what I’m looking for. I have had 5 brain and spine surgeries for Chiari Malformation and Ehlers-Danlos Syndrome, which makes it easy for sites to overwhelm me visually. I will definitely return here.

    Thank you again, and best wishes to you.

    Keesha
    http://chiarian.blogspot.com

  8. Big_Dave_T
    Big_Dave_T September 17, 2007 at 3:33 pm | | Reply

    I dunno. Smells too much of heavy pharma involvement and drug pushing. The video ad pictured uses the heart attack scare tactic when the connection between heart attacks and diabetes is more complicated than most ordinary folks and many doctors realize. Recent studies have shows that diabetes drugs may increase the chances of heart failure and heart attack.

    I did see an ad in this Sunday’s Parade magazine that pitched insulin as a way to better manage A1c. You had to look close to see it was really a pitch from a drug manufacturer. That’s what I don’t like about these “public health” campaigns. Lots of scare tactics. Little honesty.

  9. Challenge Diabetes
    Challenge Diabetes September 17, 2007 at 3:34 pm | | Reply

    Reduce Your Health Risk (a.k.a. Know Your A1c)

    Did you know that an accurate A1c is a reliable predictor of your risk for heart attack even if you dont have diabetes?
    Did you know that approximately one-third of all people with diabetes have not been diagnosed? They dont even know …

  10. Karen
    Karen September 17, 2007 at 5:17 pm | | Reply

    I work with a nurse who has Type II and did not even know what an A1C was until I talked to her about it. She started doing stricter control, then Type II meds, and then I suggested insulin, such as Lantus to help her get even better control. Well she is still on her Type II meds, tests when she thinks she is high, and is totally off her diet. She said the month before she sees the MD she will get better control, so that her A1C will look better. So yes she is now educated, but is now playing games. Even doctors of Type II patients, don’t stress the importance of tight control and gaining good A1C’s.

  11. Rachel
    Rachel September 17, 2007 at 6:21 pm | | Reply

    Yeah, it is quite easy to feel like, okay, here’s my A1C. Now what do I do to maintain it (or lower it)?

    For me, so far, it doesn’t matter whether I’m on oral meds or not, it doesn’t matter whether I’m exercising or not. Carb “addiction” is my biggest problem and without controlling that, I’m doomed to ever increasing A1C levels.

    It is rather frustrating to know there’s something out there that could help me more (in my case, counseling & maybe even insulin), but I don’t verbalize what my needs are anymore. It’s too easy to let it all happen.

  12. Vicki
    Vicki September 17, 2007 at 7:19 pm | | Reply

    Attitudes like those expressed by Rachel pain me greatly. Diabetes CAN be controlled. Carb cravings CAN be controlled.

    One of the hardest things about having diabetes is, you can ignore your high numbers for a long time and everything seems okay…but then one day it catches up with you. And then it’s too late, you can’t go back.

    Rachel, if you continue on like this, one day down the road you’re going to have (if you don’t already) very painful peripheral neuropathy. Or poor wound healing. Maybe amputations. Maybe blindness. Maybe kidney failure and need for dialysis. Maybe heart failure. Maybe ALL of those things.

    Do you REALLY want that to happen?

    BE proactive — please!

  13. Karen
    Karen September 17, 2007 at 8:00 pm | | Reply

    I think all of us with this disease know the complications, including Rachel, the nurse I work with and yes even me. I know all these things but will still after 41 years stretch the boundaries. We can hear and know all the dreaded outcomes, but that does not, for me at least, stop my carb cravings, know how it will affect my A1C’s, etc. I think instead of shouting the complications and recommending A1C tests, we need better counseling to find out what makes us enjoy eating so much. I think we need a campaign started on better eating habits, which some restaurants are now starting to do. It is such a complex life we lead and shouting the complications from the rooftops does not fix it. I have known what could and can happen to me, but often fall off the wagon anyway.

  14. travis
    travis September 17, 2007 at 8:25 pm | | Reply

    Did anyone watch the kelly close video and cringe upon hearing her say that “you can just see so much intelligence brought to this campaign by the companies…who care so much about patients- so it’s Abbott, Bayer, it’s J&J Lifescan, Roche…”

    Seems kind of scary how a “top D-consultant” is so easily convinced that companies such as J&J and Abbott could possibly have patients’ best interests at heart. This campaign may help some people take some charge of their health, but I don’t see how it’s any more than a glorified ad campaign masquerading as public service announcements.

  15. kelly
    kelly September 17, 2007 at 10:15 pm | | Reply

    hey there! I completely agree with Scott (and Bernard who also posted) and many others that just knowing the A1c isn’t enough and that people need to know what to do with the numbers (and, just, it’s plain hard). But we have to start somewhere, which i guess is why I’m psyched about this public service campaign. The Ad Council has done some amazing work historically (remember Smoky the Bear!) .. and this is only the first year of the campaign! There are two more whole years where there will be just as much work done on completely new ads … huge opportunities for more learning and i’m sure they’ll look at all your comments here and learn from them.

    i know there’s a big continuum as far as how everyone feels about industry and everyone is at a different place – I tend to be on the upbeat end – but i’m really grateful that so many are contributing toward this campaign and trying to make it good. Tom Boyer, who runs the Diabetes Care Coalition here in San Francisco, who put the entire initiative together, is an incredibly committed guy who truly wants to do the best for people.

    It’s pretty hard to create a campaign that every person with diabetes will love (here’s a new game! can you think of one? I loved “Live Life Without Limits about a decade ago…), but I think this one will help a lot of people — all those who don’t know their A1c’s but who will now at least inquire about it. In 15 or 30 seconds, there’s probably (!) no way an ad can cover all the bases of comprehensive diabetes care (or tell us exactly how to connect the dots), but it can get our attention. This campaign does just that, and it also reminds people with diabetes to see their doctor (or presumably diabetes educator!), who presumably will offer more detailed guidance.

    And the ads work, at least they have in some regional test campaigns. In one, awareness of what the term meant and of people’s own A1c’s were increased enormously, like 70%-80%. That’s a huge public health gain. Does that mean that all of those individuals will end up with great A1c’s? Of course not, but i guess on the other hand, if they don’t even know what A1c is, they’ll never have a chance.

  16. AmyT
    AmyT September 17, 2007 at 10:44 pm | | Reply

    Welcome, Keesha!

  17. Antigonos
    Antigonos September 18, 2007 at 1:12 am | | Reply

    The problem is that there are all sorts of people. I work with a large clinic population of women with gestational diabetes. Some will call me every single day, half hysterical, because their glucometer tells them they are 5 points above the “maximum”; others cheerfully confess they don’t bother with the diet “so what–if the baby’s too big I’ll have a C/S”. Try telling a mom of 9 that she MUST check her BS 7 times a day and eat a specific diet at specific times! She’s so busy running around it’s a miracle she eats at all. The amount of support needed is huge. I see no reason to think that ordinary diabetics don’t need the same. As a type 2 diabetic myself I see an almost total disconnect between my dietician (“here’s a diet sheet; follow it exactly”) and my endocrinologist (“take these meds”), and there’s no psychological support at all–and our HMO takes diabetes very seriously, even having specialist clinics for diabetics. But no one asks me what I like to eat, or when my job/lifestyle allows me to eat, or what effects the meds have on me, etc. I wonder what the average joe, not a medical professional like myself, makes of it all (my brother-in-law, also type 2, drinks diet drinks with his second helping of mashed potatoes, and thinks he’s “OK”…)

  18. riva
    riva September 18, 2007 at 6:25 am | | Reply

    The only thing I’d like to interject because almost everything has been said is, “If you’re cynical of this campaign, ask yourself why?” Because you’re just cynical of pharmaceutical companies – they can’t possibly want to help anyone, they’re only in it for profit? Or, people are too stupid to take away enough from this to know there’s something here they should be aware of? Check your own beliefs because that’s what creates your perspective, how you live, what you think etc etc.

    Yes, there should be emotional consideration about living with diabetes — this is what I write about. Yes, diabetics need more information, but at least making them aware of their A1c is a much needed start. Yes, we need to go beyond numbers, but let’s get patients into health care provider offices and let’s improve physician training. And, likely this is the first of several campaigns which will layer information. You can’t typically eat the whole apple in :30, but if you can give people a whiff and get their saliva going, that’s huge in this world of undereducated diabetics.

  19. riva
    riva September 18, 2007 at 6:48 am | | Reply

    There’s not much to add except maybe this: If you’re cynical, ask yourself why? Our experiences and beliefs color everything we do and say. You’re coming from a point of view before you even see something. Can you suspend your point of view and see something first without an opinion?

    For those having trouble putting your awareness that uncontrolled diabetes causes complications into action take a small step, Change one action for a week, see if you don’t feel better. One week, then a second week, but don’t even entertain the thought till you get there. Change happens one step at a time, one day at a time. Five years from now you’ll either be changed — or not. Do nothing and you’ll be the one on the stretcher, but don’t let that scare you, just use it as information.

    If you think pharmas are only out for profit, you’ll dismiss this campaign before you actually consider that people at pharmas may actually have two sides: wanting to make money and wanting to help people.

    Sure, we can say there’s not enough info in the ad, but it will come. Let’s get patients into health care provider offices first. If you think there’s not enough training for most health professionals about diabetes, I agree. If you think there’s not enough attention paid to coping and emotional issues regarding diabetes, I agree, it’s what I write about. But doing something constructive to change this, even if it’s just raising your voice works best when your intent comes from a constructive, rather than destructive place. Everything is energy. Energy affects everything.

    If you think this ad campaign should tell you everything in :30 about why you need to know your A1c, likely this is the first in a succession of ads. People can only take away 1-3 messages at any one time. I know, I was in advertising. No point littering, it only adds to confusion.

    Let’s get patients into doctor’s offices, doctors better trained, up the awareness of how emotions affect chronic illness, and if you agree, choose to be a part of that effort doing something constructive rather than destructive. Anything. This effort really needs as many of us as possible.

  20. RichW
    RichW September 18, 2007 at 8:07 am | | Reply

    Diabetes training by the medical profession is a national disgrace. I’ve yet to meet a first time diabetic that was properly trained the day they found out they were diabetic and were given a meter and prescriptions for pills or insulin and needles. No one seems to be aware that the new diabetic may kill themselves before they get to a trainer or an endocrinologist.

  21. Big_Dave_T
    Big_Dave_T September 18, 2007 at 9:07 am | | Reply

    I’ve already commented on this blog so forgive me for posting twice. But I wanted to respond to Riva’s comment about cynicism since it appeared to be directed at me, or those with my mind-set anyway.

    Yes, I’m cynical. But I think it’s a good thing. Cynicism is cousin to experience and education. For instance, when I checked on Riva’s website, I found out she was an A1c Champion. I’d never heard of this program, so I investigated. I found out it’s a program that involves people like Rita going out and educating people, like myself, who are working to control their diabetes.

    So if you were a cynic, like myself, would you suspect drug company involvement? Sure, and rightly so. The A1c Champion program is sponsored by Aventis, which markets the insulin brand Lantus. Lantus folks are heavily into promoting their product to their target population, the millions of Type 2 diabetes in this country, like myself. As a cynic, I’m guessing that Riva helps in that effort through her education.

    I’m not trying to discredit Riva’s efforts. I’m sure she’s doing constructive things for diabetics like myself. But saying that the pharma industry has my best interests at heart is, to me, like saying my boss has my best interests at heart.

    One other positive my cynicism does for me. I sure as hang am going to take control of my health through diet and exercise before I let myself be turned into just another cash cow/guinea pig for the pharmaceutical industry.

  22. riva
    riva September 18, 2007 at 9:14 am | | Reply

    Big Dave, I wasn’t talking to you particularly, but I will answer your concern. There are 4 A1c Champion programs: 2 branded, 2 unbranded. I only do the unbranded ones, meaning motivation and education, nothing to sell. And yes, people tell me all the time after I present that they learned something or something in them shifted, usually that they have to be responsible for their care, rather than leaving it up to their doctor. I don’t mind cynicism, I only mind it when it closes minds. I didn’t say pharmas have your best interest at heart, I just said don’t discount it, along with their profit-making.

  23. david simon
    david simon September 18, 2007 at 9:58 am | | Reply

    I have been diabetic since 1981. Yet, I recently found this site to be very real and upbeat and I still am learning things. Thanks. My a1c is 6 and consistantly around this area and I take very good care of my self. Have been insulin dependant the entire time. Eat correctly and excersize. It is not that hard. It is YOUR life. You decide. Thanks

  24. CrazyACpumper
    CrazyACpumper September 18, 2007 at 10:22 pm | | Reply

    Any awareness to Diabetes is good. But as you point out Amy (and throughout the comments) the Medical Field concentrates so much on numbers and formulas (as I have coined them over the years).

    I have a great relationship with my Edno but time constraints pushed on Doctors by bureaucratically run facilities seems to allow for only “textbook” reviews every 3 months (or less if you do not have insurance or the finances to truly take care of yourself).

    The true Need lies in health care. I cannot afford it right now and I have been trying to figure out what my state offers, what programs are out there and I am left with a need for a life sustaining drug and no money left over for the rest of my bills (let alone a Doctor visit).

    For the past 22 years I can tell you what my A1C was, when it changed and why. The problem is what to do about it and how for me (affectionately diagnosed as a Brittle Diabetic in 2000 by a specialist, or as I like to call it, nothing works).

    This disease affects every person in very different ways. We all react differently to insulin intake, types of food, medications for ailments, stress, emotions, etc. etc.

    And as of late, I feel the focus in the year 2007 is on Juvenile and Type 2 Diabetes (of which I am all for, do not misunderstand me, we are all in this together). Well, back in the 80s folks, they had no clue. And honestly, you can call my Endo on this one, they still don’t. Which furthers societies unfortunate misunderstanding of PWDs.

  25. Boroguy
    Boroguy December 4, 2007 at 7:46 pm | | Reply

    Having read the comments here about the A1c campaign.
    First off I have never seen the ads.
    My one problem with all of this, including knowing your numbers is that the majority of the physicians that I have seen, including an endocrinologist seem to use these numbers as “scare tactics”. You know that your A1c is far to high.
    Well I have to say that most of these doctor’s don’t really know there patients.
    If the doctor’s that have used these “scare tactics” on me had gotten to know me, they would have realized that these tactics are only going to make me irate and that I am not going to follow what they have to say.
    Maybe if they would sit down and talk to me, as a human, and not as one who is just taking up there time that things might change and I might not have what they consider to be a “bad attitude”.

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