What is the everyday reality of living with diabetes? It can be complex, personal and sometimes even misunderstood by others. The 2018 theme for American Diabetes Month is “Everyday Reality” and explores the 24/7 truth of diabetes self-management from the point of view of those with diabetes or those caring for someone with the disease. My reality was a surprising diagnosis of Type 1 diabetes in my mid 30’s. At the time, my diagnosis and the way it would impact my life was overwhelming. The personalized guidance and education that I received from my diabetes educator, Cecilia, made the difference in my confidence in learning to live and manage this disease. Unfortunately, not everyone has the support they need to successfully learn how to live with diabetes. This prompted my desire to create Fit4D, a diabetes coaching service utilizing technology to scale the ability of certified diabetes educators (CDEs) who are diabetes expert clinicians to connect with those that need support the most.
In celebrating Diabetes Awareness Day, November 14th, here are five things you should know about the realities of managing diabetes.
1. REASONS FOR POORLY CONTROLLED DIABETES ARE COMPLEX
Diabetes is a chronic disease impacting an estimated 30.3 million Americans. By 2050 it is projected that 1 in 3 adults will be diagnosed with diabetes. At the moment there is no cure. It is a disease that demands frequent decisions about food, physical activity, medications and reacting to blood glucose trends. It has been estimated that a person with diabetes is making on average around 300 decisions daily about their disease management. That’s 300 decisions that are diabetes focused in addition to all the other daily decision-making. Supporting an individual in developing strategies to better manage diabetes and the decision-making process needs to be personalized, everyone’s life is very different. The diagnosis may be the same but barriers to care including financial, psychosocial and even health literacy differ. A one-size fits all model to education cannot adequately address all these personal differences. That’s why Fit4D’s technology platform focuses on scaling the human touch. The model allows for personalization in the process of education, each person with diabetes works with the same CDE throughout the program. This creates a relationship that makes identifying adherence barriers that are affecting the success of diabetes management easier.
2. THE MAJORITY OF INDIVIDUALS WITH DIABETES HAVE NOT HAD ANY TYPE OF FORMAL TRAINING/EDUCATION
Numerous studies have demonstrated the benefit of diabetes self-management education (DSME), including improved clinical and quality of life outcomes as well as reducing hospital admission and readmission. The problem? Many individuals with diabetes do not receive any formal education. Less than 7% of those with private insurance and only five percent of Medicare beneficiaries used their DSME benefit within the first year after their diabetes diagnosis. Traditional models of education often lack the convenience, accessibility and flexibility that many individuals with diabetes need. To help mitigate some of the challenges with traditional models of education, Fit4D’s technology platform allow CDE coaches to connect with individuals using their preferred modality (phone, email, text, etc.) during time-frames that work for them. This naturally complements existing care management programs and enhances the ability to receive ongoing care and support.
3. FIFTY PERCENT OF INDIVIDUALS WITH CHRONIC DISEASES DON’T TAKE MEDICATION AS PRESCRIBED 
Medication management can be a very important aspect of diabetes management. Yet, it is estimated that about 50 percent of those living with a chronic illness do not take their medication as prescribed. The reasons contributing to this lack of adherence are complex and can be attributed to challenges related to the patient, healthcare providers and healthcare system. Complex barriers require the personal touch of a CDE who can work with individuals on the modifiable barriers to medication adherence such as improving health literacy and addressing challenges related to cost of medications.
4. DIABETES IS EXPENSIVE TO MANAGE
The burden of the cost of diabetes management impacts not only the individual but also the healthcare industry. According to the American Diabetes Association the total cost of diagnosed diabetes in the U.S. was $327 billion— of that number, $237 billion in direct medical costs and $90 billion from reduced productivity.  People with diabetes spend an average of $16,750 on medical expenses and about $9,600 is linked to diabetes.8 The driver of reducing costs for the individual and healthcare industry is proactively reaching out, driving engagement and providing personalized guidance to address barriers to care.
5. THERE IS HOPE. DIABETES EDUCATION IS EFFECTIVE.
There is hope, diabetes education has proven to be effective. According to the American Association of
 Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2017.
 Boyle, J. P., Thompson, T. J., Gregg, E. W., Barker, L. E., & Williamson, D. F. (2010). Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence. Population health metrics, 8, 29. doi:10.1186/1478-7954-8-29
 The Diabetes Epidemic: The Latest on Treatment and Prevention. Nov 14, 2017. https://www.youtube.com/watch?v=ST45EcJ82a0
 Healthy People 2020. Washington, DC: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. October 2018. Available from:https://www.healthypeople.gov/2020/topics-objectives/topic/diabetes
 Li R, Shrestha SS, Lipman R, Burrows NR, Kolb LE, Rutledge S.; Centers for Disease Control and Prevention. Diabetes self-management education and training among privately insured persons with newly diagnosed diabetes—United States, 2011–2012. MMWR Morb Mortal Wkly Rep 2014;63:1045–1049
 Strawbridge LM, Lloyd JT, Meadow A, Riley GF, Howell BL. Use of Medicare’s diabetes self-management training benefit. Health Educ Behav 2015;42:530–538
 Brown, M, Bussel J. Medication adherence: WHO cares? Mayo Clin Proc. 2011;86 (4):304-314
 American Association of Diabetes Educators. Benefits of Diabetes Education. https://www.diabeteseducator.org/practice/provider-resources/benefits-of-diabetes-educatio