The guru of diabetes behavior is of course Dr. William Polonsky, author of Diabetes Burnout and founder of the new Behavioral Diabetes Institute (and also a really nice guy!)

Between moderating panel sessions at this weekend's ADA Conference, Dr. Polonsky was kind enough to give me a moment to ask him about this phenomenon.

"So, diabetes is really unique this way, isn't it? Being the only disease that is managed more by the patient than by the doctor?" I asked (thinking myself quite clever).

"No, actually, it isn't," he said. "What about cancer? And heart disease? Patients have to be diligent about testing their blood pressure, and about their diet -- avoiding salt, for example. Actually, we're breaking ground here for other diseases by focusing on the behavioral side."

"Oh, I get it," I said (in another fit of articulation).

But I do get it! It's the old notion of "compliant" versus "non-compliant" patients turned inside-out. No matter what drugs and treatment plans are available, they will only work if the patient takes charge and uses them proactively.

This simple fact has had an immeasurable effect on countless clinical studies attempting to guage the success of medical therapies. For example, if you send a bunch of patients off with capsules they're supposed to swallow and a meal plan to follow, and then measure their blood pressure levels (or whatever's being studied) weeks or months later, how do you really know anything for sure? Did they really follow instructions? They may say so, but everybody likes to get an "A," right?

On the flipside, patients involved in studies where they're closely monitored tend to overachieve for the period while they're in the limelight. This well-documented occurrence is called the Hawthorne Effect.

The point is (yes, I'm getting to it!) that patients aren't just abstract "subjects" at which doctors can throw new drugs and devices. Rather, they are the key people who will make the medicine work. Like so many "new" concepts in medical science, common sense is finally coming to the surface here: patients' behavior matters at least as much as the treatments available!

(Anyone with brilliant ideas on how to motivate people to take better care of themselves can contact Dr. Polonsky's institute). Make sure to cc me at amy@diabetesmine.com as well!)