It’s a broad, thought-provoking question posed by Dr. Partha Kar, Clinical Director of Diabetes at the National Health System (NHS) in England. In a recent blog post, Dr. Kar uses the “100 million pound” question to assess how diabetes spending might be different if patients had a greater role in deciding how government budgets are allocated.

With greater emphasis on patient perspectives in diabetes drug and device development and regulatory decision-making, Dr. Kar says, “The argument that those who live with it know more what to do with the money also falls a bit flat. When, say, a type 1 diabetes person has to make a call over a wider budget of diabetes, let’s face it, their knowledge of living with type 2 diabetes is the same as mine – nearly non-existent.”

The thought experiment reveals how interests like safety, affordability, technology, and prevention compete for attention. Given the heterogeneity in diabetes — type 1, type 2, prediabetes, gestational diabetes, and more — it is unsurprising that prioritization within health systems is a balancing act that leaves many groups feeling unheard. Not to mention the diverse opinion within each condition, which is why we prefer to talk about “patient perspectives” rather than “the patient perspective.”

Who should be making these choices, and perhaps more importantly, who should they listen to? How can we ensure greater representation in decision-making without getting caught in gridlock?

Some developments that we would like to see: improved treatment affordability and financial support, greater access to CGM, and more funding for diabetes prevention programs and diabetes educators. We could go on with our wish list, but we’d love to hear from you. Send us a message about what your priorities are, and what you think would be beneficial to the most people. Do these answers align?