Published time: 01 October 2020
Authors: David Kerr, Namino Glantz
Diabetes has long been mistaken as a tame problem. Following a recipe, playing chess, and doing open-heart surgery are tame problems. Tame problems can be solved by having engineers, clinicians, and scientists develop guidelines, algorithms, and systems that achieve easily measured outcomes that matter to these same stakeholders. For example, the longstanding and accepted approach in diabetes has been to empower experts to create algorithms, therapies, technologies, and models to manage glucose within controlled conditions, which are then offered to people with diabetes and their clinicians. Invariably, there is little effort to understand much about the anticipated users beyond their biology. This quantified approach also mistakenly assumes that if a variable cannot be measured, it is probably not important. These attempts to solve the problem of diabetes have, so far, been authoritative (eg, authorising self-proclaimed experts to develop clinical guidelines that are assumed to be adopted widely, or economic rationing of access to new devices and therapies by payers) or on the basis of free-market competition (eg, allowing pharmaceutical and medical device industries to develop independent approaches without collaboration). Needless to say, diabetes has not been solved, and that is because diabetes is not a tame problem.
Diabetes, like COVID-19, is a wicked problem