Treating Diabetes

http://www.nytimes.com/2016/10/21/opinion/treating-diabetes.html

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To the Editor:

Re “I Have Diabetes. Am I to Blame?,” by Rivers Solomon (“Disability” series, nytimes.com, Oct. 12):

Based on years of treating people living with diabetes, we have seen their tireless efforts at self-management lead to the motivational roadblocks of blame and shame, driven by the great American myth that more self-discipline and willpower will reign. As Ms. Solomon eloquently notes, these are elusive qualities that sabotage motivation and engagement in treatment.

Medical professionals have often added to this torment by implying that patients can achieve idealized targets if they just try harder. We propose an alternative strategy, where the focus shifts from fortifying self-control to changing one’s environment and setting realistic goals to make it as easy as possible to manage the complex demands of diabetes.

To those with diabetes, we suggest that persisting with the daily grind of taking care of diabetes stems from the inspiration of more important non-diabetes life goals, like a promotion at work or walking down the aisle at your daughter’s wedding, rather than anything intrinsically rewarding about checking blood glucose levels several times every day.

We need to empower those with diabetes to make these human connections to events, milestones and staying healthy so they can live the life they deserve and enjoy it with their loved ones. Trying to motivate patients with guilt or shame is counterproductive and unsuccessful.

ROBERT A. GABBAY

JOHN F. ZREBIEC

Boston

Dr. Gabbay is chief medical officer and senior vice president of the Joslin Diabetes Center. Mr. Zrebiec is chief of behavioral health services at the center.