“You Have to Be a Little Bit Creative”: Alyson Myers on Caring for Patients With Type 1 Diabetes Living Paycheck to Paycheck

Managing type 1 diabetes is hard enough, but for patients living on the economic margins, life itself is the biggest barrier to care. In this candid conversation, Alyson Myers, MD, who often works with low-income patients, describes the real-world obstacles her patients face: unpredictable work schedules, outdated phones that can’t connect to continuous glucose monitors (CGMs), and no time to make it to the doctor’s office. She makes the case for expanding telehealth so patients can attend appointments on a break from work and for meeting patients where they are technologically and financially rather than assuming they can simply upgrade their devices. She also highlights the value of pharmacist partnerships in diabetes care, arguing that having an additional clinician focused specifically on glucose management between physician visits leads to measurably better patient outcomes.

Q: From your clinical experience, what are the most significant barriers that prevent adults with type 1 diabetes from accessing consistent, high-quality care, and where do you see pharmacists having the greatest potential to help close those gaps?

Alyson Myers, MD: As somebody who works in an area where access to care is not great, and I have a lot of people who are on the lower end of the socioeconomic spectrum, I can say the biggest thing that makes care hard for people with type one diabetes is life. I have numerous patients who work—and they sometimes have to work multiple jobs to survive. When you have to work to survive, living paycheck to paycheck, you don’t really have time to go to the doctor’s office. So more access to tele-visits and allowing people to maybe have an appointment while they’re at work, where they can just take their break and talk to their provider, as well as having access to Bluetooth technology, would make a real difference.

One of my patients is a porter in a building. Luckily for him, the way his hours are now, he can come in before he goes to work. But before he got his official position, they used to change his schedule all the time. For what I think was 6 months or a year, he could be asked to work anytime, any day, and so he missed a lot of appointments. Now, granted, I have him on a CGM, but his phone is an old phone, so he can’t use it. He also doesn’t like technology—even though he’s not an older man, he’s in his 40s—so he has a phone that’s not compatible, and he just doesn’t really want to be bothered with upgrading. When you are living paycheck to paycheck, I can’t say, “Oh, go get a new phone.” We have to deal with life circumstances and understand that everyone does not have the same economic status. When you’re dealing with people in that low socioeconomic bracket, you sometimes have to be a little bit creative in trying to meet them where they are.

Q: With newer technologies like CGMs and automated insulin delivery systems becoming more central to T1D management, how can pharmacists better support patients in understanding, initiating, and troubleshooting these tools between physician visits?

Myers: I think the pharmacist is great. We get slotted for a 20-minute visit. Trying to read someone’s CGM data, make pump adjustments, make sure they have all their refills, go through their labs, and just check in with them—it’s nearly impossible to do all of that in 20 minutes. So I think having a backup, whether it be a pharmacist, a nurse, or a dietitian, between visits always makes things better. Obviously, the pharmacist has the ability to prescribe certain things, which can also be an added benefit; in some places they’re able to do that. I definitely think that having that adjuvant therapy makes a difference. I have seen it in my patients: their outcomes are doing better because the pharmacist can actually focus a little bit more on the glucose than we can, since we have to deal with their blood pressure, their lipids, filling out forms if they need FMLA, or whatnot. So it’s always nice to have that partnership — they can sometimes do a little bit more than we can do on our own.