Armchair quarterbacks in metabolic health

Here’s another installment of my posts on all things diabetes and metabolic health.? For those of you who missed the first two, here’s the link here and here.?

Dear Monday morning Quarterbacks in the clinical fields - let’s take a beat and reflect. From 2020 until now, we have watched the scientific process fold out in real time with COVID-19 and it’s been hard to follow and admittedly - painful to watch.? Every time there is new evidence, some will take it as the final masterpiece and not an ingredient in making a full picture decision. To do the scientific method justice, you have to run many experiments and get all sides of the story.??

Let’s say you are baking a cake and you run the same recipe several times - exactly - and you get different results - what are the variables here? The ingredients (are they all the same brands), the measuring tools (are they validated), the mixer (same or different - timing and method), the oven (temperature verified and monitored for consistency), and YOU - the person making the cake - what are you doing each time you do this and is it exactly the same each time?? If this is an unfamiliar process to you, I highly recommend rewatching old episodes of America’s Test Kitchen, as I think it has taken cooking science to a new level and makes the scientific method tasty.? But enough about my love for Chris Kimball and his reliably delicious recipes.?

Lately, there has been so much press about new obesity drugs in type 2 diabetes and use for weight loss.? I personally love these drugs and highly recommend reading up on them for use in your patients. There has been a true misunderstanding of what all this means. I’ve heard some - non clinical- people state that the need for insulin will go away or the need for CGMs will go away (see post here about why this is crazy untrue). Pardon me, but if I get my clinical advice from any non clinical armchair quarterback playing the stock market then - shame on me. We must consider the source. Remembering that each nugget of new evidence is a piece of a larger puzzle. It may not tell you everything, but it will tell you something about a part of the whole picture. Or it may tell you to go look elsewhere - all very valuable feedback. But what any single clinical trial doesn’t do is make other solutions obsolete.?

Here’s my example. I make a fabulous chocolate cake (we’re pretending here so use your imagination - I don’t bake).? It’s so good in fact that we may not need any other form of chocolate on the market because everyone will love the same thing and everyone can eat this exact same thing. Are you following? That’s crazy cakes (ha - pun intended). I personally love chocolate in all forms and would sincerely be devastated if this occurred. But the most amazing chocolate cake does not obliterate the need for other forms of chocolate - loads of people can’t eat dairy or gluten - are they out of luck (because I’m using all the butter, flour and cream in this very pretend cooking scenario)? While chocolate cake is a gross oversimplification - it is necessary when talking to armchair quarterbacks who do not understand the pathophysiology of the diseases they are critiquing.?

Having a solution for weight loss, insulin resistance and type 2 diabetes does not obliterate the necessity for diabetes medical devices or other solutions. I strongly urge the medical device community to come to partner with these solutions and figure out how they work best together. What are the considerations for care and reducing other medications when beginning one of these new drugs? What are the best practices for using the two together??Time for a clinical trial, maybe?

The strongest leaders do not dismiss others - they work together and admire each other's strengths. Both medical device technology like CGMs and Insulin Pumps have strengths beyond what a GLP or GLP/GIP can offer and vice versa. So lead by example and start some valuable collaboration so people can understand more pieces of this puzzle. YOUR solution is not defunct because something else can do a great job. Team up and work together here, I and the rest of the people with diabetes will be grateful you took the initiative and stopped letting armchair quarterbacks run your plays.?