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oriented culture)\nA 5-year effectiveness study of the\nCCM in 53,436 people with type 2 diabe-tes in the primary care setting suggestedthat the use of this model of care deliv-\nery reduced the cumulative incidence\nof diabetes-related complications andall-cause mortality (11). Individuals who\nwere enrolled in the CC... | [
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were enrolled in the CCM experienced a\nreduction in cardiovascular disease riskby 56.6%, microvascular complications by11.9%, and mortality by 66.1% (11). In\naddition, another study suggested that\nhealth care utilization was lower in theCCM group, which resulted in health care\nsavings of $7,294 per individual over ... | [
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savings of $7,294 per individual over the\nstudy period (12).\nRedefining the roles of the health care\ndelivery team and empowering self-\nmanagement of people with diabetes\nare fundamental to the successful imple-mentation of the CCM (13). Collabora-tive, interprofessional teams are best\nsuited to provide care for p... | [
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suited to provide care for people with\nchronic conditions such as diabetes andto facilitate individuals ’self-management\n(14–16). There are references to guide\nthe implementation of the CCM into dia-betes care delivery, including opportuni-ties and challenges (17).\nStrategies for System-Level Improvement | [
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Strategies for System-Level Improvement\nOptimal diabetes management requiresan organized, systematic approach andthe involvement of a coordinated team\nof dedicated health care professionals\nworking in an environment where per-son-centered, high-quality care is a pri-ority (7,17 –19). While many diabetes | [
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care processes have improved nation-ally in the past decade, the overallS12 Improving Care and Promoting Health in Populations Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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quality of care for people with diabetes\nremains suboptimal (4). Efforts to in-crease the quality of diabetes care includeproviding care that is concordant withevidence-based guidelines (20); expanding\nthe role of teams to implement more in- | [
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the role of teams to implement more in-\ntensive disease management strategies(7,16,21,22); tracking medication-takingbehavior at a systems level (23); rede-\nsigning the organization of the care pro-\ncess (24); implementing electronic healthrecord (EHR) tools (25,26); empoweringand educating people with diabetes | [
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(27,28); removing financial barriers and\nreducing patient out-of-pocket costs for\ndiabetes education, eye exams, diabetestechnology, and essential medications\n(7,29); leveraging telehealth capabilities | [
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(7,29); leveraging telehealth capabilities\nto improve access to care (30); assess-ing and addressing psychosocial issues(31,32); and identifying, developing, andengaging community resources and pub-\nlic policies that support healthy lifestyles | [
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lic policies that support healthy lifestyles\n(33). The National Diabetes Education Pro-gram maintains an online resource (cdc.gov/diabetes/professional-info/training.\nhtml) to help health care professionals\ndesign and implement more effectivehealth care delivery systems for thosewith diabetes. Given the pluralistic ... | [
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of people with diabetes and that the\nconstant challenges they experience varyover the course of disease management(complex insulin treatment plans, new\ntechnology, etc.), a diverse team with\ncomplementary expertise is consistentlyrecommended (34).\nCare Teams\nThe care team, which centers around\nthe person with dia... | [
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the person with diabetes, should avoid\ntherapeutic inertia and prioritize timelyand appropriate intensi fication of be-\nhavior change (nutrition and physicalactivity) and/or pharmacologic therapy\nfor individuals who have not achieved\nthe recommended metabolic goals (35 –37). | [
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the recommended metabolic goals (35 –37).\nStrategies shown to improve care teambehavior and thereby catalyze reductions\nin A1C, blood pressure, and/or LDL cho-\nlesterol include engaging in explicit andcollaborative goal setting with peoplewith diabetes (38,39); integrating evi-\ndence-based guidelines and clinical i... | [
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dence-based guidelines and clinical infor-\nmation tools into the process of care(20,40,41); identifying and addressinglanguage, numeracy, or cultural barriersto care (41 –43); soliciting performance | [
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feedback, setting reminders, and providingstructured care (e.g., guidelines, formalcase management, and patient educationresources) (7); and incorporating caremanagement teams including nurses,dietitians, pharmacists, and other healthcare professionals (21,42). In addition,\ninitiatives such as the Patient-Centered | [
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initiatives such as the Patient-Centered\nMedical Home can improve health out-comes by fostering comprehensive pri-mary care and offering new opportunities\nfor team-based chronic disease manage-\nment (43,44).\nTelehealth\nTelehealth is a growing field that may in-\ncrease access to care for people with diabe-\ntes. Th... | [
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tes. The American Telemedicine Association\ndefines telemedicine as the use of medical\ninformation exchanged from one site to an-other via electronic communications to\nimprove a patient ’s clinical health status.\nTelehealth includes a growing variety of\napplications and services using two-wayvideo, smartphones, wire... | [
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other forms of telecommunications tech-\nnology (45). Often used interchangeablywith telemedicine, telehealth describes abroader range of digital health services inhealth care delivery (46). This includes\nsynchronous, asynchronous, and remote\npatient monitoring.\nTelehealth should be used comple- | [
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patient monitoring.\nTelehealth should be used comple-\nmentary to in-person visits to optimizeglycemic management in people with un-\nmanaged diabetes (47). Increasingly, evi-\ndence suggests that various telehealthmodalities may facilitate reducing A1C inpeople with type 2 diabetes compared\nwith usual care or in add... | [
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with usual care or in addition to usual\ncare (48), and findings suggest that tele-\nmedicine is a safe method of deliveringcare for people with type 1 diabetes in\nrural areas (49). For rural populations\nor those with limited physical access tohealth care, telemedicine has a growingbody of evidence for its effectivene... | [
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particularly with regard to glycemic man-\nagement as measured by A1C (30,50 –52).\nIn addition, evidence supports the effec-tiveness of telehealth in diabetes, hyper-tension, and dyslipidemia interventions\n(53) as well as the telehealth delivery of | [
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(53) as well as the telehealth delivery of\nmotivational interviewing (54). Interactivestrategies that facilitate communicationbetween health care professionals and\npeople with diabetes, including the use of\nweb-based portals or text messaging andthose that incorporate medication adjust-ment, appear more effective. T... | [
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and other virtual environments can also be\nused to offer diabetes self-managementeducation and clinical support and removegeographic and transportation barriers forindividuals living in under-resourced areas\nor with disabilities (55). Telehealth resour-\nces can also have a role in addressing the\nSDOH in young adult... | [
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SDOH in young adults with diabetes (56).\nHowever, limited data are available on theeffectiveness across different populations\n(57).\nBehaviors and Well-being\nSuccessful diabetes care also requires a sys-tematic approach to supporting the behavior-\nchange efforts of people with diabetes.High-quality diabetes self-ma... | [
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education and support (DSMES) has\nbeen shown to improve patient self-\nmanagement, satisfaction, and glucose\noutcomes. National DSMES standards callfor an integrated approach that includes\nclinical content and skills, behavioral strat-\negies (goal setting, problem-solving), and\nengagement with psychosocial concern... | [
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engagement with psychosocial concerns.\nIncreasingly, such support is being adapted\nfor online platforms that have the poten-\ntial to promote patient access to this im-portant resource. These curriculums need\nto be tailored to the needs of the intended\npopulations, including addressing the\n“digital divide, ”i.e., ... | [
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“digital divide, ”i.e., access to the technol-\nogy required for implementation (58 –61).\nFor more information on DSMES, see\nSection 5, “Facilitating Positive Health\nBehaviors and Well-being to Improve\nHealth Outcomes. ”\nCost Considerations for Medication-Taking\nBehaviors\nThe cost of diabetes medications and de- | [
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Behaviors\nThe cost of diabetes medications and de-\nvices is an ongoing barrier to achieving\nglycemic goals. Up to 25% of peoplewith diabetes who are prescribed insulin\nreport cost-related insulin underuse (62).\nInsulin underuse due to cost has also\nbeen termed “cost-related medication\nnon-adherence ”(here referr... | [
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non-adherence ”(here referred to as cost-\nrelated barriers to medication use). There\nare recommendations from the ADA Insu-lin Access and Affordab ility Working\nGroup for approaches to this issue from asystems level (63). Recommendations in-\ncluding concepts such as cost-sharing for | [
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cluding concepts such as cost-sharing for\ninsured people with diabetes should bebased on the lowest price available, the\nlist price for insulins that closely re flects\nthe net price, and health plans that ensurepeople with diabetes can access insulin\nwithout undue administrative burden or\nexcessive cost (63). In 20... | [
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excessive cost (63). In 2023, three major\ninsulin manufacturers lowered the pricesdiabetesjournals.org/care Improving Care and Promoting Health in Populations S13\n©AmericanDiabetesAssociation | [
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of insulin, which may help reduce the fi-\nnancial burden of diabetes management,\nalthough costs for insulin delivery and glu-cose monitoring remain high. People withdiabetes should be screened for financial\nburden of treatment, cost-related bar-riers to medication use, and rationing ofother essential services due to m... | [
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The cost of medications (not only insu-\nlin) in fluences prescribing patterns and\nmedication use because of burden on theperson with diabetes and lack of second-ary payer support (public and private\ninsurance) for effective approved glu- | [
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insurance) for effective approved glu-\ncose-lowering, cardiovascular diseaserisk-reducing, and weight managementtherapeutics. Financial barriers remain a\nmajor source of health disparities, and\ncosts should be a focus of treatment goals(65). (See\nTAILORING TREATMENT FOR SOCIAL CON-\nTEXTand TREATMENT CONSIDERATIONS... | [
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TEXTand TREATMENT CONSIDERATIONS .) Reduction\nin cost-related barriers to medication useis associated with better biologic and psy-chologic outcomes, including quality oflife (66).\nAccess to Care and Quality Improvement | [
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Access to Care and Quality Improvement\nThe Affordable Care Act and Medicaid ex-pansion have increased access to care formany individuals with diabetes, empha-s i z i n gt h ep r o t e c t i o no fp e o p l ew i t hp r e -existing conditions, health promotion, and\ndisease prevention (67). In fact, health in- | [
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disease prevention (67). In fact, health in-\nsurance coverage increased from 84.7% in2009 to 90.1% in 2016 for adults with dia-betes aged 18 –64 years. As of early 2022,\nmore than 35 million people in the U.S.were enrolled in some form of AffordableCare Act– related health insurance (68).\nCoverage for those aged $65... | [
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Coverage for those aged $65 years re-\nmained nearly universal (69). People withdiabetes who have either private or publicinsurance coverage are more likely tomeet quality indicators for diabetes care\n(70). As mandated by the Affordable Care | [
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(70). As mandated by the Affordable Care\nAct, the Agency for Healthcare Researchand Quality developed a National QualityStrategy based on triple aims that includeimproving the health of a population,\noverall quality and patient experience of | [
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overall quality and patient experience of\ncare, and per capita cost (71,72). As healthcare systems and practices adapt to thechanging landscape of health care, it will\nbe important to integrate traditional dis-\nease-speci ficm e t r i c sw i t hm e a s u r e so f\npatient experience, as well as cost, inassessing the ... | [
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(73,74). Information and guidance spe-\ncific to quality improvement and practicetransformation for diabetes care are avail-\nable from the National Institute of Diabe-\ntes and Digestive and Kidney Diseases\nguidance on diabetes care and quality\n(75) Using patient registries and EHRs,\nhealth systems can evaluate the ... | [
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health systems can evaluate the quality\nof diabetes care being delivered and per-\nform intervention cycles as part of qualityimprovement strategies (76). Improve-\nment of health literacy and numeracy is\nalso a necessary component to improve\ncare (77,78). Critical to these efforts is\nhealth professional adherence ... | [
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health professional adherence to clinical\npractice recommendations ( Table 4.1 )\nand the use of accurate, reliable datametrics that include sociodemographic\nvariables to examine health equity within\nand across populations (79).\nIn addition to quality improvement ef-\nforts, other strategies that simultaneously | [
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forts, other strategies that simultaneously\nimprove the quality of care and potentially\nreduce costs are gaining momentum and\ninclude reimbursement structures that, in\ncontrast to visit-based billing, reward the\nprovision of appropriate and high-quality\ncare to achieve metabolic goals (80), value- | [
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care to achieve metabolic goals (80), value-\nbased payments, and incentives that ac-commodate personalized care goals (7,81).\n(Also see\nCOST CONSIDERATIONS FOR MEDICATION -\nTAKING BEHAVIORS ,a b o v e ,r e g a r d i n gc o s t -\nrelated barriers to medication use.)\nTAILORING TREATMENT FOR\nSOCIAL CONTEXT\nRecomme... | [
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TAILORING TREATMENT FOR\nSOCIAL CONTEXT\nRecommendations\n1.5Assess food insecurity, housing inse-\ncurity/homelessness, financial barriers,\nand social capital/social community\nsupport to inform treatment deci-sions, with referral to appropriate lo-cal community resources. A\n1.6Provide people with diabetes with | [
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1.6Provide people with diabetes with\nadditional self-management supportfrom lay health coaches, navigators,or community health workers whenavailable. A\n1.7Consider the involvement of com-\nmunity health workers to support themanagement of diabetes and cardio-vascular risk factors, especially in un-derserved communiti... | [
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Health inequities related to diabetes and\nits complications are well documented,\nare heavily in fluenced by SDOH, and havebeen associated with greater risk for dia-\nbetes, higher population prevalence, andpoorer diabetes outcomes (82 –86). SDOH\nare defi ned as the economic, environ-\nmental, political, and social con... | [
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mental, political, and social conditions in\nwhich people live and are responsible for\na major part of health inequality world-wide (87). Greater exposure to adverseSDOH over the life course results in poor\nhealth (88). The ADA recognizes the asso- | [
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health (88). The ADA recognizes the asso-\nciation between social and environmentalfactors and the prevention and treatmentof diabetes and has issued a call for re-search that seeks to better understand\nhow social determinants in fluence behav-\niors and how the relationships between\nthese variables might be modi fied ... | [
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these variables might be modi fied for the\nprevention and management of diabetes\n(89,90). While a comprehensive strategy\nto reduce diabetes-related health inequi-ties in populations has not been formallystudied, general recommendations fromother chronic disease management and\nprevention models can be drawn upon to | [
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0.00738035... |
prevention models can be drawn upon to\ninform systems-level strategies in diabetes(91). For example, the National Academyof Medicine has published a framework\nfor educating health care professionals on\nthe importance of SDOH (92). Further-more, there are resources available forthe inclusion of standardized sociodemo... | [
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graphic variables in EHRs to facilitate the\nmeasurement of health inequities andthe impact of interventions designed toreduce those inequities (74,92,93).\nSDOH are not consistently recognized\nand often go undiscussed in the clinicalencounter (85). Among people with chronicillnesses, two-thirds of those who re-ported... | [
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scribed due to cost-related barriers to\nmedication use never shared this withtheir physician (94). A study using datafrom the National Health Interview Survey(NHIS) (85) found that one-half of adults\nwith diabetes reported financial stress\nand one- fifth reported food insecurity. A\nCanadian study noted an association... | [
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Canadian study noted an association of\none or more adverse SDOH and health\ncare utilization and poor diabetes out-\ncomes in high-risk children with type 1 di-abetes (94). It is therefore important forpeople with diabetes to be screened forSDOH during clinical encounters and be\nreferred to appropriate clinical and c... | [
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referred to appropriate clinical and com-\nmunity resources to address these needs.Health systems may bene fitf r o mc o m p i l -\ning an inventory of such resources to fa-\ncilitate referrals at the point of care. | [
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0.04175... |
cilitate referrals at the point of care.\nPolicies and payment models that supportS14 Improving Care and Promoting Health in Populations Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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addressing SDOH, both within and outside\nthe health care setting, are needed to en-\nsure that these efforts are both feasibleand sustainable. One example of a state-wide payment model that incentivizesvalue-based care, addressing SDOH and-\nfunding community-based health care pro- | [
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0.026086585596203804,
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0.07662475109100342,
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funding community-based health care pro-\nfessionals, is the Maryland Total Cost ofCare Model, although it is currently limitedby a narrow focus such as preventing dia-betes rather than overall diabetes carequality (95,96).\nAnother population in which such is-\nsues must be considered is older adults,for whom social d... | [
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... |
quality of life and increase the risk offunctional dependency (97) (see Section13,“Older Adults,” for a detailed discus-\nsion of social considerations in older\nadults). Creating systems-level mechanisms | [
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0.10803072899580002,
0.04482578858733177,
0.0315... |
adults). Creating systems-level mechanisms\nto screen for SDOH may help overcomestructural barriers and communication gapsbetween people with diabetes and healthcare professionals (85,98). Pilot studies\nhave proven the effectiveness of identify- | [
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0.04792946204543114,
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0.004326194990426302,
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0.03372... |
have proven the effectiveness of identify-\ning SDOH by using validated screeningtools (99). In addition, brief, validatedscreening tools for some SDOH exist andcould facilitate discussion around factorsthat signi ficantly impact treatment during | [
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the clinical encounter. Below is a discus-sion of assessment and treatment consid-erations in the context of food insecurity,homelessness, limited English pro ficiency,\nlimited health literacy, and low literacy.\nFood Insecurity\nFood insecurity is the unreliable avail-ability of nutritious food and the inability | [
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0.06384333968162537,
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0.11259399354457855,
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0.03157355636358261,
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0.09342384338378906,
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0.027207771316170692,
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to consistently obtain food without re-\nsorting to socially unacceptable practi-ces. Over 18% of the U.S. populationreported food insecurity between 2005and 2014 (100). The rate is higher in\nsome racial and ethnic minority groups, | [
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0.14046473801136017,
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0.0033722033258527517,
-0.035... |
some racial and ethnic minority groups,\nincluding African American and Latinopopulations, low-income households, andhomes headed by single mothers. Thefood insecurity rate in individuals withdiabetes may be up to 20% (101). Addi-\ntionally, the risk for type 2 diabetes is | [
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tionally, the risk for type 2 diabetes is\nincreased twofold in those with food in-security (89) and has been associatedwith lower engagement in self-care be-haviors and medication use, depression,diabetes distress, and worse glycemic\nmanagement when compared with individ-\nuals who are food secure (102 –104). Older | [
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uals who are food secure (102 –104). Older\nadults with food insecurity are more likelyto have emergency department visits and\nhospitalizations compared with olderadults who do not report food insecurity\n(105). Risk for food insecurity can be as-\nsessed with a validated two-item screening\ntool (106) that includes t... | [
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tool (106) that includes the following state-\nments: 1)“Within the past 12 months, we\nworried whether our food would run out\nbefore we got money to buy more ”and\n2)“Within the past 12 months the food we\nbought just didn’ t last, and we didn ’th a v e\nmoney to get more. ”An af firmative re- | [
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money to get more. ”An af firmative re-\nsponse to either statement had a sensitivityof 97% and speci ficity of 83%. Interventions\nsuch as food prescription programs are con-sidered promising to address food insecu-\nrity by integrating community resourcesinto primary care settings and directly deal-\ning with food dese... | [
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ing with food deserts in underserved com-\nmunities (107,108).\nTreatment Considerations\nIn those with diabetes and food insecurity,the priority is mitigating the increased riskfor uncontrolled hyperglycemia and se-\nvere hypoglycemia. The reasons for the\nincreased risk of hyperglycemia include\nthe steady consumptio... | [
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the steady consumption of inexpensive\ncarbohydrate-rich processed foods, bingeeating, financial constraints to filling dia-\nbetes medication prescriptions, and anxietyand depression leading to poor diabetes\nself-care behaviors. Hypoglycemia can\noccur due to inadequate or erratic car-bohydrate consumption following th... | [
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administration of sulfonylureas or insu-\nlin. See Tables 9.2 –9.4for drug-speci fic\nand patient factors, including cost andrisk of hypoglycemia, which may be im-portant considerations for adults with\nfood insecurity and type 2 diabetes.\nHealth care professionals should con-\nsider these factors when making treat- | [
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sider these factors when making treat-\nment decisions for people with foodinsecurity and seek local resources to\nhelp people with diabetes and their fam-\nily members obtain nutritious food more\nregularly (109).\nHomelessness and Housing\nInsecurity\nHomelessness and housing insecurity of- | [
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Insecurity\nHomelessness and housing insecurity of-\nten accompany other barriers that limitdiabetes self-management. Food insecu-\nrity, lack of insurance, cognitive impair-\nment, behavioral health de ficiencies, and\nlow literacy and numeracy skills are alsofactors (110). The prevalence of diabetesin the homeless pop... | [
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to be around 8% (111). Additionally, peoplewith diabetes who are homeless need se-\ncure places to keep their diabetes suppliesand refrigerator access to properly store\ntheir insulin and take it on a regular sched-\nule. The risk for homelessness can be ascer-\ntained using a brief risk assessment tool | [
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tained using a brief risk assessment tool\ndeveloped and validated for use amongveterans (112). Housing insecurity has also\nbeen shown to be directly associated with\nap e r s o n ’s ability to maintain their diabetes\nself-management (113). Given the poten-tial challenges, health care professionalswho care for either... | [
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insecure individuals should be familiar with\nresources or have access to social workers\nwho can facilitate stable housing for these\nindividuals as a way to improve diabetescare (114).\nMigrant and Seasonal Agricultural\nWorkers\nMigrant and seasonal agricultural workers\nmay have a higher risk of type 2 diabetes | [
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may have a higher risk of type 2 diabetes\nthan the overall population. While migrantfarmworker –specific data are lacking, most\nagricultural workers in the U.S. are Latino, apopulation with a high rate of type 2 diabe-\ntes. In addition, living in severe poverty\nbrings with it food in-security, high chronicstress, an... | [
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there is also an association between the\nuse of certain pesticides and the incidence\nof diabetes (115).\nData from the Department of Labor in-\ndicate that there are 2.5 –3 million agricul-\ntural workers in the U.S. These agricultural\nworkers travel throughout the country,serving as the backbone for a multibillion- | [
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dollar agricultural industry. According to\n2021 health center data, 175 health cen-\nters across the U.S. reported that they\nprovided health care services to 893,260adult agricultural patients, and 91,124\nhad encounters for diabetes (10.2%) (116).\nMigrant farmworkers encounter numer- | [
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Migrant farmworkers encounter numer-\nous and overlapping barriers to receivingcare. Migration, which may occur as fre-\nquently as every few weeks for farm-workers, disrupts care. In addition, cultural\nand linguistic barriers, lack of transporta-\ntion and money, lack of available work\nhours, unfamiliarity with new ... | [
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hours, unfamiliarity with new communi-\nties, lack of access to resources, and otherbarriers prevent migrant farmworkers\nfrom accessing health care. Without regu-\nlar care, those with diabetes may suffer se-\nvere and often expensive complications\nthat affect quality of life. Nontraditionalcare delivery models, incl... | [
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tegrated health and telehealth, can bediabetesjournals.org/care Improving Care and Promoting Health in Populations S15\n©AmericanDiabetesAssociation | [
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... |
leveraged to improve access to high qual-\nity care.\nHealth care professionals should be at-\ntuned to all patients ’working and living\nconditions. For example, if a migrant farm- | [
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conditions. For example, if a migrant farm-\nworker with diabetes presents for care,appropriate referrals should be initiatedto social workers and community resour-ces, as available, to assist with removingbarriers to care.\nLanguage Barriers\nHealth care professionals who care for\nnon– English speakers should develop... | [
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non– English speakers should develop or\noffer educational programs and materials\nin culturally adaptive languages speci fic\nto these individuals with the speci ficg o a l s\nof preventing diabetes and building dia-betes awareness in people who cannoteasily read or write in English. The Na-tional Standards for Cultural... | [
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0.0388... |
guistically Appropriate Services in Health\nand Health Care (National CLAS Stand-ards) provide guidance on how healthcare professionals can reduce languagebarriers by improving their cultural com-petency, addressing health literacy, andensuring communication with language\nassistance (117). In addition, the National | [
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assistance (117). In addition, the National\nCLAS Standards website offers several re-sources and materials that can be used toimprove the quality of care delivery tonon–English-speaking individuals (117).\nHealth Literacy and Numeracy\nHealth literacy is de fined as the degree to | [
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Health literacy is de fined as the degree to\nwhich individuals have the capacity to ob-tain, process, and understand basic healthinformation and services needed to make\nappropriate decisions (77). Health literacy | [
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appropriate decisions (77). Health literacy\nis strongly associated with patients engag-ing in complex disease management andself-care (118). Approximately 80 millionadults in the U.S. are estimated to havelimited or low health literacy (78). Clini-cians and diabetes care and education\nspecialists should ensure they p... | [
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specialists should ensure they provide\neasy-to-understand information and re-duce unnecessary complexity when de-veloping care plans with people withdiabetes. Interventions addressing lowhealth literacy in populations with diabe-tes seem effective in improving diabetesoutcomes, including ones focusing primar- | [
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ily on patient education, self-care training, | [
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0.00... |
or disease management. Combining easilyadapted materials with formal diabeteseducation demonstrates effectivenesson clinical and behavioral outcomes inpopulations with low literacy (119). How-ever, evidence supporting these strategiesis largely limited to observational studies.More research is needed to investigatethe ... | [
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research is needed to investigatethe most effective strategies for en-hancing both acquisition and retentionof diabetes knowledge and examine | [
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different media and strategies for de-\nlivering interventions to people withdiabetes (120).\nHealth numeracy is also essential in\ndiabetes prevention and management.Health numeracy requires primary nu-meric skills, applied health numeracy, and\ninterpretive health numeracy. An emo-\ntional component also affects a pe... | [
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tional component also affects a person ’s\nability to understand concepts of risk,probability, and communication of scien-tific evidence (121). People with predia-\nbetes or diabetes often need to performnumeric tasks such as interpreting food\nlabels and blood glucose levels to make | [
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labels and blood glucose levels to make\ntreatment decisions such as medicationdosing. Thus, both health literacy and nu-meracy are necessary for enabling effec-tive communication between people withdiabetes and health professionals, arrivingat a treatment plan, and making diabetes\nself-management task decisions. If p... | [
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self-management task decisions. If peo-\nple with diabetes appear not to under-stand concepts associated with treatmentdecisions, both can be assessed using stan-dardized screening measures (122). Ad-junctive education and support may beindicated if limited health literacy and nu-\nmeracy are barriers to optimal care d... | [
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meracy are barriers to optimal care deci-\nsions (31).\nSocial Capital and Community\nSupport\nSocial capital, which comprises community\nand personal network instrumental sup-\nport, promotes better health, whereas | [
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-0.071... |
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