Diabetes, like COVID-19, is a wicked problem The concept of a wicked problem arose in the 1960's, based on the realization that purely scientific solutions to societal problems are doomed to fail Wicked problems are impossible to solve because of contradictory and changing requirements, the absence of equality, and ever-evolving social complexities Poverty, crime, and climate change are wicked problems COVID-19 is also a classic wicked problem, as evidenced by the unanticipated and disproportionate effect of the virus on minority racial and ethnic populations and individuals who have experienced health disparities A wicked problem persists in perpetuity because of incomplete information, multiple (often selfish) stakeholder interests, a large economic burden, and a ripple effect whereby every action triggers a reaction with other wicked problems For example, during the COVID-19 pandemic, the exclusion of undocumented residents from the funding given to US taxpayers by the federal government reduced their purchasing power amid a looming recession, contributing further to both the public health and economic crises in US states such as California There is a need to create a digital diabetes ecosystem that is equitable A digital diabetes ecosystem that can help to resolve diabetes as a wicked problem ideally should connect personal consumer (e g , food choices), physiological (e g , sleep patterns), behavioral (e g , physical activity), psychological (e g , mood), environmental (e g , air quality), and genetic data with an understanding of social preferences (e g , family meals vs eating alone) 9 This ecosystem should both be integrated with clinician workloads and have empathy with the user Creating an ecosystem will be an obstinate task, given that personal goals vary among individuals, and shift with time owing to the ripple effect of other wicked problems Finding the problem centre (i e , a modifiable driver of the problem), and choosing the type and timing of an intervention, can be challenging Technologies should be adaptive, adaptable, and affordable, both in terms of financial cost and personal burden for the user Primary care physicians already understand that diabetes is a wicked problem, and that data and algorithms alone are insufficient For scientists and engineers, illness affects the human condition in ways that can be frustratingly illogical and unpredictable Machines can be created to provide sincerity, but without compassion and empathy, their value for providing human-like interactions is markedly low Good clinicians are skilled at locating problems by finding where in a causal network the trouble truly lies and deciding what actions will actually work, thereby narrowing the gap between what is and what ought to be-the essence of addressing a wicked problem That is also the challenge, and opportunity, for the diabetes community
Diabetes, like COVID-19, is a wicked problem