I have the advantage of watching this for decades in terms of why it is difficult. And what's interesting about the question about why from a psychosocial point of view this is difficult is that there are parts of this that has changed over the years. I think the big thing is that it is more common now both in children and even more so in adults.
And so that has obviously made differences because it used to be nobody-- somebody who had type 1 diabetes didn't know anybody else who had it unless they went to a diabetes camp as a child. That's not the case anymore, especially with technology, people getting to know each other, but the big issue is it's just so much more common, going up at 3% a year around the world.
So that has changed. And obviously, from a psychosocial point of view, things have changed, one could argue, for the better because the grim statistics about microvascular disease has gotten better over the years, especially in the diabetes clinics where there is so much access to resources and technology and expertise.
Having said all of that, there are still some huge problems. We still see-- although I don't think we see it as commonly now, we see eating disorders, especially in young women and adolescent girls. We see eating disorders that manifest itself by intentionally withholding insulin. I mean, that's a really bad problem.
We still see more than our share of depression that is exacerbated by the diabetes. And I think part of it is to do well, even though we have all these better tools now than in the past, it is a lot of work. And a lot of people are not willing or able for a variety of reasons to do all that. Where I live in particular in Seattle, I am told, because of our weather, we have the highest amount of seasonal affective disorder and general depression than anywhere in the world. And the diabetes just adds to that. And that, of course, makes things more difficult.
We are very fortunate in that we have a psychiatrist and a psychologist here. And I have a very low threshold for referring when things come up, whether it is directly related to the diabetes, which is very common, or indirectly related to the diabetes-- something happening at home.
And it's really interesting what I've learned over the years. Again, I can speak from a place of experience in that when I see somebody who's generally doing well and they're not doing well, whether it's their glucose readings or their A1C-- we've become very sophisticated in figuring this out-- there's often something happening at home related to some psychosocial event.
Maybe it is a sick relative. Maybe it is marital problems. Maybe it is school problems for a younger person. Maybe it is a non-diabetes-related medical problem in that person. I just saw somebody yesterday who was just diagnosed with a malignancy, and she essentially stopped taking care of her diabetes even though it's a very treatable type of problem.
So it is so complicated. And I think the final thing I will just say is that because I've been doing this for so long in the same place, without even trying, I have become a geriatrician. And I always thought I was going to become a pediatrician, and here I am taking care of people much older than me. And I enjoy it.
But I should also say, the psychosocial aspects of the elderly as they get into their own cognitive issues, as they become depressed, especially when I see some of my patients are doing better than their friends or family members and are living into their 70's and 80's-- and what that does to them in terms of dealing with their diabetes.
I think the other point about this geriatric population is that there are many patients who have their diabetes in their older years who know they don't have the capability to do as well with their diabetes, nor, for that matter, do we want them to as we're so concerned about hypoglycemia. But they can't remember if they've taken their insulin or what happens a lot-- and it's a lot like taking away the car keys for somebody in their 80's, or I have a handful of people in their 90's. And the issue is taking away their insulin pump because it's very clear they can't operate it any longer.
Well, I think the fact that way back when-- the fact that we learn that if you treat somebody's depression, their diabetes control gets better. Now, that doesn't seem like all that big of a deal when you think about it. But at the time, it was-- this was 30 years ago. This was research that we did not know. And that's one of the reasons why I've become so sensitive to treating depression aggressively and making sure they're getting the right-- our patients are getting the right mental health needs.
I think one of the things is that mental health, especially now in this pandemic, it is an underappreciated problem that comes back and impacts one's ability to do their self-care. There are exceptions to that. But I think that that is a big, big deal.
I think the other thing about just the big, giant umbrella of psychosocial is that-- I think the pediatricians figured this out a lot sooner than those of us who do internal medicine and geriatric age groups-- is that this is a family disease. And from a social point of view, somebody who's doing this all on their own-- we do have people who do that, and they don't involve their family members.
But especially for somebody who's not doing well, what I will always do is I will always bring in the spouse-- or sometimes it's an adult child-- into the appointment so they can see how their loved one is struggling, because I'm with the patient, in the big scheme of things, a very tiny amount of the time, whereas the other person, especially if they're living with their family member-- and even if they're not-- it has a much greater impact when they know, because a lot of times, especially if somebody isn't doing well, they are ashamed that they are not doing well. And I try to take the shame out of it and try to bring this in as a family, a real family type of goal. And I have found that to be maybe the most important thing.
As far as advances in psychosocial research, I think that there is more we can do with technology. Everybody's coming up with an app, whether it's an app to get you to exercise more or an app that tracks your food or whatever. I would like to see an app that helps you with how you feel. Now, maybe there's an app out there, but I'm talking about how you feel psychologically, giving you a pat on the back when you do something well but not calling it failure when you don't.
I think that there is a lot we can do in terms of using technology, especially now. I mean, I'm being interviewed from the UK. I'm here in Seattle, Washington. And we are seven or eight time zones away. And we don't think anything of this anymore. We are now doing many if not most of our visits now with telemedicine. I don't know how this is going to look.
But I don't think that what I see on especially people with these challenges-- and it's really hard. There's the psychological and psychiatric challenges, and then there's all the social things that happen, which is part of everyday life, whether it's work, whether it's school, whether it's family. And I think that we can use technology better so we can reach more patients, because right now, if we're talking about 10.5% of Americans with diabetes, there aren't enough people like me and there aren't enough psychiatrists and psychologists. We have to sort of gear this up so we can take care of larger numbers of people than we do now.