Managing type 1 diabetes: have faith in patients

I share Kar’s frustration at the stalling of the roll-out of non-invasive glucose monitoring for type 1 diabetes.1 In fact, I have put down my daughter’s blood spattered school dress in order to write this reply; I had been attempting to sew on name labels and can testify that repeatedly pricking your finger hurts and is deeply unpleasant.

The patients with diabetes seen in the acute medical unit are usually in diabetic crisis. Often, regular finger prick glucose monitoring does not work for them, for a variety of reasons. We have a non-invasive, reliable way of monitoring glycaemic control with strong evidence behind it, and yet more obstacles are placed in the way of access.

Adult learning theory tells us that there are different learning styles and therefore patients will need to access educational content in different ways. A “one-size-fits-all” approach neglects the needs of those who learn differently. Many of our patients are now facing “choices” regarding heating or eating or neither. Factoring further hospital visits to their specialist was presumably not in their budget.

Obstacles create inequalities. Ensuring all diabetic patients wishing to take up flash technology complete the same educational content in the same format is not equality. Equality is not about treating people the same but rather making reasonable efforts to ensure that everyone is treated fairly, their needs are appropriately met, and the factors that limit individuals’ opportunities are challenged.

Adopting a one-size-fits-all approach is infantilising and demonstrates ignorance regarding adult learning theory. Doctor does not always know best. We must have faith that our patients will access this education as they see fit and trust them to contact us if they need support. Obstacle courses belong in school playgrounds, not in access to healthcare.