Hi, we're Reuters reporters investigating the worsening outcomes for Americans with diabetes despite billions spent on new treatments. Ask us anything!

u/Reuters Not an American, but will media once and for all distinguish between types when reporting? The types are always confused, and when one reads "Diabetes" in media it only means type 2, so all of us other types need to explain non-stop. As someone with such as platform as Reuters, it would be great to help educate people without diabetes and also to address psychosocial stigma associated with all types.

You should also consider cross-posting your question to the type 1 subs at: r/diabetes_t1 and r/Type1Diabetes but check sub rules first.

Just for edification, type 1 is autoimmune. Type 2 is insulin resistance. And there are several more types which are all very different diseases. Please be the first in media to acknowledge this and specify which type. A headline stating "diabetes" and no further explanation is meaningless, and only adds to misunderstanding, outcomes and stigma.

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Edit: please see language matters as well regarding terms used for people with diabetes of all types: https://www.languagemattersdiabetes.com/

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Edit 2: regarding Covid and any and all research data really, T1 and T2 are almost never distinguished yet we can have very different outcomes. It is impossible to wade through data stating "diabetes" when no reference is made to type.

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#wearenotwaiting

#insulin4all

We agree! We have tried in our reporting to differentiate between the two main types and offer a short explanation to readers. Type 1 diabetes is an autoimmune disease of unknown cause that requires lifelong insulin injections, because the pancreas stops producing insulin. Type 1 affects about 1.6 million people in the U.S. Type 2 is a chronic condition linked to genetics, weight gain and inactivity. People with type 2 diabetes don’t make enough insulin or don’t use it well. Diet and exercise can help manage the disease, but many also need medication that helps them use the insulin their bodies do produce. The vast majority of Americans with diabetes - over 30 million - have type 2 diabetes. In our reporting thus far, we’ve mainly been focused on type 2 diabetes. But we are always conscious of the difference! - RR

Thank you for this and reporting types; it's often a talking point bordering on intense frustration within the type 1 community.

Response to Edit 2: We completely agree. Many studies do not seem to differentiate between type 1 and type 2, and it would be so helpful, interesting and illuminating to know the difference in study findings. - RR.

I'm a primary care physician in West Virginia. These two years have been horrible for my diabetic patients. I had a slew of patients over the last year who were experiencing rapid weight loss, enough to get me concerned for malignancy, but the real reason? Their A1c, which had been at a comfortable 6-7% for years and managed on oral meds, was now 12% or more. I have had to start dozens of people on insulin in just the last few months.

Working in the land of Mountain Dew and pepperoni rolls brings its own challenges, but outside of (and often in spite of) those come-to-Jesus moments (heart attacks, amputations, diabetic comas, etc.), it seems almost impossible to change the eating habits of... well, almost anyone. I still haven't found the magical combination of words to convince people to trade out soda pop and sweet tea for water and sugar-free beverages.

Out of the people who DO change, what have you found to be the impetus? What is the reason people cite when they decide to make healthier choices and focus on weight loss? Is there a common thread among success stories you could share?

Thank you so much for your time!

Thanks for your comments and the question. Yes, we’ve interviewed a lot of people with diabetes and the doctors, nurses and diabetes educators that work with them. One thing that has stood out to us has been the amount of time people spend with patients on education and support. Diabetes imposes a heavy burden on patients, and they can feel incredibly overwhelmed and alone at times. We found that support and having someone to talk with can mean a lot. There are obviously still barriers to getting medication, supplies and devices even with good insurance. Some patients have enjoyed the benefits of telemedicine during the pandemic and having regular contact with providers without visiting a clinic. – CT

Why isn’t universal healthcare even being debated in congress even though it’s popular amongst the American people?

Universal health care gained momentum during the last presidential campaign. But enacting major health reforms through Congress has been difficult. There are many entrenched interests defending the status quo. There have been efforts in the current Congress to further expand Medicaid. – CT

Why do we still fat-shame and blame type 2 patients for their condition when there is more than ample evidence that insulin resistance is genetic?

Why do we focus so hard on the downright terrifying complications that are very rare to the point that it discourages the newly diagnosed from taking the action they need to make these complications avoidable?

Why do we so vastly understate the value of exercise in restoring insulin sensitivity?

Why don't we discuss the systemic issues in our food supply that make diabetes so prevalent in the homeless?

In my reporting, the stigma and patient blaming around diabetes has come up a lot. There’s also a fairly high rate of depression tied to diabetes. These areas aren’t always well addressed in our current health system when so many doctors are pressed for time, and diabetes patients must manage so much of their disease on their own. – CT

What I'd really like to know is why isn't anybody in the media talking about the fact that refined sugar is a leading cause of that disease, and several others diseases, and yet food companies sneak refined sugar in literally E-V-E-R-Y-T-H-I-N-G because they know it makes it more addictive. Hence more sales. Hence more diabetes. This insanity has been going on for decades. Why isn't that covered more? People aren't being educated properly by the media how to eat healthy and how difficult it is to eat healthy when practically every single type of man-made/prepackaged food on the store shelves nowadays has either toxic oils or refined sugar or both. Look for yourselves on the ingredients labels. You'll be hard-pressed to find anything nowadays without one or both of those but especially refined sugar added in any one of its various expertly veiled alternate names.

There have been some efforts by local governments to dissuade sales of sugary products, such as soda taxes. There are also transparency-focused regulations that require restaurants to add calorie and nutrition disclosures to their menus. These efforts are sometimes criticized as too heavy-handed and government intrusion, but they are directed at trying to de-incentivize the sales of sugary products or to provide the consumer with more information about what they are eating. - RR

Is there any hope of organizing a way for Medicare to lower prescription drug costs? My grandparents are drowning.

There are efforts in Congress now to better control drug costs in Medicare and limit out-of-pocket expenses for seniors. But it’s unclear what the final outcome will be. That issue isn’t going away. – CT

What are the leading causes for diabetes in americans?

Obviously obesity would be the top one, but I want to know if some specific food ingredients, like e.g. corn syrup, are responsible for the current diabetes epidemic in the US.

There are a variety of causes for type 2 diabetes, from genetics to weight gain to inactivity. It’s very different for each person. We wrote earlier this year about the increase in young people being diagnosed with diabetes. The research showed that the rate of young people ages 10 to 19 with type 2 diabetes increased by 95% over a 16-year period. The estimated rate of youth under age 20 with type 1 diabetes grew by 45%. Here’s the story: https://www.reuters.com/business/healthcare-pharmaceuticals/diabetes-surges-among-american-youth-study-shows-2021-08-24/ – CT

How do the drug companies get away with marketing campaigns that could kill people?

Drugmakers defend their advertising as a way to educate patients and medical professionals about new treatments that can help reduce the risk of long-term complications from diabetes. – CT

Do you think it'll get better when SGLT-2 and GLP-1 drugs go generic? I'm not American, but my prescription drug plan will only cover the new classes of drugs if my doctor fills out a form saying the older drugs don't work. Right now the older drugs keeping my A1C under 7% so I've held out on getting the form done.

When a drug becomes generic, it helps lower the cost of the medicine for the patient and the patient’s insurer (or the government health plan for patients outside of the U.S.). You should speak with your physician for any changes in your drug regimen. However, if the current generics are working for you now, that’s great. - RR

Thanks so much for all your comments and questions. We’re continuing to report on diabetes and welcome your ideas and feedback. We can reached at robin.respaut@tr.com and chad.terhune@tr.com – CT

Deaths from diabetes last year surged 17% to more than 100,000, we found. This grim toll is the result of failures that long predate the pandemic. Despite billions of dollars spent on new treatments, the prognosis for people with diabetes has been getting worse as the number of people with the disease has increased, especially among working-age and even younger people

What an absudly sensationalized sentence.

Do you think its possible that these patients are dying from diabetes related illnesses for some reason other than a corporate conspiracy? Maybe because they are poorly compliant on their medication regimens leading to increased A1c?

Your own reporting points out that hyperglycemic crisis is rampant in our society, particularly in the last 10 years. Then you subsequently criticize the medical profession for targeting low A1c. How do you address that juxtaposition?

Thanks for the comment. No patient is perfect and in our reporting we have shown that every person makes certain decisions about their medication, diet and lifestyle. But we found that our health-care system also makes it incredibly difficult for some diabetes patients to get the help and support they need.

On A1c, there are many that point out undertreatment remains a major problem. But our reporting also showed the dangers for some patients, particularly older adults, who remain focused on aggressive control. Many experts highlighted the need to reassess treatment targets as people age and their overall condition changes. – CT

How did you get into your profession?

I fell in love with journalism as editor of my high school newspaper. I majored in journalism in college and worked at my hometown paper, writing obituaries and covering local government to start with. Later, I became a business reporter and eventually focused on health care. It’s a privilege to talk with people and help tell their stories. – CT

After I graduated from college, I started working at my local newspaper, then moved to my local public radio station and eventually moved to New York to work for larger companies. I have an insatiable curiosity, and so my favorite part of the job is that I get to speak with many different people on all sorts of topics and issues. I’m always learning when I’m reporting. - RR

Both my brother and myself just recently received a diabetes diagnosis. Mine a year ago and his this week. Both of us have been given little to no help as an younger adult and learning to eat again. I took the class and was the youngest person in my group. I had amazing success on Rybelsus but to go through the approval process is hard. Not only that but Ozempic isn't covered at all. Is there a reason companies are not targeting this demographic with education and assistance?

The traditional diabetes classes have often drawn older adults in, and you point out the need to reach younger people in different ways. I have talked to diabetes educators who are trying innovative methods to reach people in new ways. The growth of meetings and classes over Zoom during the pandemic has helped some, especially when people are busy and can’t drive across town or catch two buses to get somewhere. There are also a lot more apps focused on diabetes management. – CT

Would it currently be cheaper just to move to another country with cheaper insulin?

Well, moving is a major life decision. But your question points to the immense frustration in America with the high cost of insulin compared to what the same insulin would cost in most other countries. Lawmakers continue to debate proposals in Washington and various state legislatures but it remains a pressing problem. The idea of the federal government negotiating drug prices in Medicare remains a controversial idea. – CT

Is there anything I can do as a non-healthcare worker to assist with this problem?

If you know someone with diabetes, you could check-in and ask how you can best support them. Diabetes is a long-term condition, and you can always ask how you can help be there for them. - RR

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We have found in our reporting that there is more focus on prescription drugs to help manage type 2 diabetes. Food - and especially access to healthy foods - is definitely important. There are some health plans that provide food-as-medicine programs, but they are not widely offered. - RR.