IMPROVING CARE AND PROMOTING HEALTH IN POPULATIONS: STANDARDS OFMEDICALCAREINDIABETES-2022 - OF MEDICAL CARE IN DIABETES-2022
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S8 Diabetes Care Volume 45, Supplement 1, January 2022
1. Improving Care and Promoting American Diabetes Association
Professional Practice Committee*
Health in Populations: Standards
of Medical Care in Diabetes—2022
Diabetes Care 2022;45:S8–S16 | https://doi.org/10.2337/dc22-S001
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1. IMPROVING CARE AND PROMOTING HEALTH
The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes”
includes the ADA’s current clinical practice recommendations and is intended
to provide the components of diabetes care, general treatment goals and guide-
lines, and tools to evaluate quality of care. Members of the ADA Professional Prac-
tice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/
dc22-SPPC), are responsible for updating the Standards of Care annually, or more
frequently as warranted. For a detailed description of ADA standards, statements,
and reports, as well as the evidence-grading system for ADA’s clinical practice rec-
ommendations, please refer to the Standards of Care Introduction (https://doi
.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care
are invited to do so at professional.diabetes.org/SOC.
DIABETES AND POPULATION HEALTH
Recommendations
1.1 Ensure treatment decisions are timely, rely on evidence-based guidelines,
include social community support, and are made collaboratively with
patients based on individual preferences, prognoses, comorbidities, and
informed financial considerations. B
1.2 Align approaches to diabetes management with the Chronic Care Model.
This model emphasizes person-centered team care, integrated long-term
treatment approaches to diabetes and comorbidities, and ongoing collab-
orative communication and goal setting between all team members. A
1.3 Care systems should facilitate team-based care, including those knowl- *A complete list of members of the American
Diabetes Association Professional Practice
edgeable and experienced in diabetes management as part of the team,
Committee can be found at https://doi.org/
and utilization of patient registries, decision support tools, and commu- 10.2337/dc22-SPPC.
nity involvement to meet patient needs. B
Suggested citation: American Diabetes Asso-
1.4 Assess diabetes health care maintenance (see Table 4.1) using reliable ciation Professional Practice Committee. 1.
and relevant data metrics to improve processes of care and health out- Improving care and promoting health in
comes, with attention to care costs. B populations: Standards of Medical Care in
Diabetes—2022. Diabetes Care 2022;45(Suppl.
1):S8–S16
Population health is defined as “the health outcomes of a group of individuals, © 2021 by the American Diabetes Association.
including the distribution of health outcomes within the group”; these outcomes Readers may use this article as long as the
can be measured in terms of health outcomes (mortality, morbidity, health, and work is properly cited, the use is educational
and not for profit, and the work is not
functional status), disease burden (incidence and prevalence), and behavioral and altered. More information is available at
metabolic factors (exercise, diet, A1C, etc.) (1). Clinical practice recommendations https://diabetesjournals.org/journals/pages/
for health care providers are tools that can ultimately improve health across license.care.diabetesjournals.org Improving Care and Promoting Health in Populations S9
populations; however, for optimal out- Survey (NHANES), with younger adults, 4. Clinical information systems (using
comes, diabetes care must also be women, and non-Hispanic Black individ- registries that can provide patient-
individualized for each patient. Thus, uals less likely to meet treatment specific and population-based sup-
efforts to improve population health targets (4). Certain segments of the port to the care team)
will require a combination of policy- population, such as young adults and 5. Community resources and policies
level, system-level, and patient-level patients with complex comorbidities, (identifying or developing resources
approaches. With such an integrated financial or other social hardships, and/ to support healthy lifestyles)
approach in mind, the American Diabe- or limited English proficiency, face par- 6. Health systems (to create a quality-
tes Association (ADA) highlights the ticular challenges to goal-based care oriented culture)
importance of patient-centered care, (5–7). Even after adjusting for these
defined as care that considers individual A 5-year effectiveness study of the
patient factors, the persistent variability
patient comorbidities and prognoses; is CCM in 53,436 primary care patients
in the quality of diabetes care across
respectful of and responsive to patient with type 2 diabetes suggested that the
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providers and practice settings indicates
preferences, needs, and values; and use of this model of care delivery
that substantial system-level improve-
ensures that patient values guide all reduced the cumulative incidence of
ments are still needed.
clinical decisions (2). Furthermore, social diabetes-related complications and all-
Diabetes poses a significant financial
determinants of health (SDOH)—often cause mortality (10). Patients who were
burden to individuals and society. It is enrolled in the CCM experienced a
out of direct control of the individual estimated that the annual cost of diag-
and potentially representing lifelong reduction in cardiovascular disease risk
nosed diabetes in the U.S. in 2017 was by 56.6%, microvascular complications
risk—contribute to medical and psycho-
$327 billion, including $237 billion in by 11.9%, and mortality by 66.1% (10).
social outcomes and must be addressed
direct medical costs and $90 billion in In addition, the same study suggested
to improve all health outcomes (3). Clin-
reduced productivity. After adjusting that health care utilization was lower in
ical practice recommendations, whether
for inflation, the economic costs of dia- the CCM group, which resulted in
based on evidence or expert opinion,
betes increased by 26% from 2012 to health care savings of $7,294 per indi-
are intended to guide an overall
2017 (8). This is attributed to the vidual over the study period (11).
approach to care. The science and art of
increased prevalence of diabetes and Redefining the roles of the health
medicine come together when the clini-
the increased cost per person with dia- care delivery team and empowering
cian makes treatment recommendations
betes. Therefore, ongoing population patient self-management are funda-
for a patient who may not meet the eli-
health strategies are needed in order to mental to the successful implementa-
gibility criteria used in the studies on
reduce costs and provide optimized care. tion of the CCM (12). Collaborative,
which guidelines are based. Recognizing
multidisciplinary teams are best suited
that one size does not fit all, the stand-
Chronic Care Model to provide care for people with chronic
ards presented here provide guidance
Numerous interventions to improve conditions such as diabetes and to facili-
for when and how to adapt recommen-
adherence to the recommended stand- tate patients’ self-management (13–15).
dations for an individual. This section There are references to guide the imple-
provides guidance for providers as well ards have been implemented. However,
a major barrier to optimal care is a mentation of the CCM into diabetes
as health systems and policy makers. care delivery, including opportunities
delivery system that is often frag-
mented, lacks clinical information capa- and challenges (16).
Care Delivery Systems
The proportion of patients with diabe- bilities, duplicates services, and is
Strategies for System-Level Improvement
tes who achieve recommended A1C, poorly designed for the coordinated
Optimal diabetes management requires
blood pressure, and LDL cholesterol lev- delivery of chronic care. The Chronic
an organized, systematic approach and
els has fluctuated in recent years (4). Care Model (CCM) takes these factors
the involvement of a coordinated team
Glycemic control and control of choles- into consideration and is an effective
of dedicated health care professionals
terol through dietary intake remain framework for improving the quality of working in an environment where patient-
challenging. In 2013–2016, 64% of diabetes care (9). centered, high-quality care is a priority
adults with diagnosed diabetes met (7,17,18). While many diabetes processes
individualized A1C target levels, 70% Six Core Elements.The CCM includes six of care have improved nationally in the
achieved recommended blood pressure core elements to optimize the care of past decade, the overall quality of care
control, 57% met the LDL cholesterol patients with chronic disease: for patients with diabetes remains sub-
target level, and 85% were nonsmokers optimal (4). Efforts to increase the qual-
(4). Only 23% met targets for glycemic, 1. Delivery system design (moving ity of diabetes care include providing
blood pressure, and LDL cholesterol from a reactive to a proactive care care that is concordant with evidence-
measures while also avoiding smoking delivery system where planned visits based guidelines (19); expanding the role
(4). The mean A1C nationally among are coordinated through a team- of teams to implement more intensive
people with diabetes increased slightly based approach) disease management strategies (7,20,21);
from 7.3% in 2005–2008 to 7.5% in 2. Self-management support tracking medication-taking behavior at a
2013–2016 based on the National 3. Decision support (basing care on evi- systems level (22); redesigning the organi-
Health and Nutrition Examination dence-based, effective care guidelines) zation of the care process (23);S10 Improving Care and Promoting Health in Populations Diabetes Care Volume 45, Supplement 1, January 2022
implementing electronic health record Telemedicine needs of the intended populations,
tools (24,25); empowering and educating Telemedicine is a growing field that may including addressing the “digital divide,”
patients (26,27); removing financial bar- increase access to care for patients with i.e., access to the technology required
riers and reducing patient out-of-pocket diabetes. The American Telemedicine for implementation (51–54).
costs for diabetes education, eye exams, Association defines telemedicine as the For more information on DSMES, see
diabetes technology, and necessary medi- use of medical information exchanged Section 5, “Facilitating Behavior Change and
cations (7); assessing and addressing psy- from one site to another via electronic Well-being to Improve Health Outcomes”
chosocial issues (28,29); and identifying, communications to improve a patient’s (https://doi.org/10.2337/dc22-S005).
developing, and engaging community clinical health status. Telemedicine
resources and public policies that support includes a growing variety of applications Cost Considerations for Medication-Taking
healthy lifestyles (30). The National Dia- and services using two-way video, smart- Behaviors
betes Education Program maintains an phones, wireless tools, and other forms of The cost of diabetes medications and
online resource (https://www.cdc.gov/ telecommunications technology (44). devices is an ongoing barrier to achiev-
Downloaded from http://diabetesjournals.org/care/article-pdf/45/Supplement_1/S8/637531/dc22s001.pdf by guest on 11 January 2022
diabetes/professional-info/training Increasingly, evidence suggests that vari- ing glycemic goals. Up to 25% of
.html) to help health care professio- ous telemedicine modalities may facilitate patients who are prescribed insulin
nals design and implement more effec- reducing A1C in patients with type 2 dia- report cost-related insulin underuse
betes compared with usual care or in (55). Insulin underuse due to cost has
tive health care delivery systems for
addition to usual care (45), and findings also been termed cost-related medica-
those with diabetes. Given the pluralis-
suggest that telemedicine is a safe tion nonadherence. The cost of insulin
tic needs of patients with diabetes and
method of delivering type 1 diabetes care has continued to increase in recent
how the constant challenges they expe-
to rural patients (46). For rural populations years for reasons that are not entirely
rience vary over the course of disease
or those with limited physical access to clear. There are recommendations from
management (complex insulin regi-
health care, telemedicine has a growing the ADA Insulin Access and Affordability
mens, new technology, etc.), a diverse
body of evidence for its effectiveness, par- Working Group for approaches to this
team with complementary expertise is
ticularly with regard to glycemic control as issue from a systems level (56). Recom-
consistently recommended (31).
measured by A1C (47–49). Interactive mendations including concepts such as
strategies that facilitate communication cost-sharing for insured people with dia-
Care Teams
between providers and patients, including betes should be based on the lowest
The care team, which centers around
the use of web-based portals or text mes- price available, the list price for insulins
the patient, should avoid therapeutic
saging and those that incorporate medica- that closely reflects net price, and
inertia and prioritize timely and appro-
tion adjustment, appear more effective. health plans that ensure that people
priate intensification of behavior change
Telemedicine and other virtual environ- with diabetes can access insulin without
(diet and physical activity) and/or phar- ments can also be used to offer diabetes undue administrative burden or exces-
macologic therapy for patients who self-management education and clinical sive cost (56).
have not achieved the recommended support and remove geographic and The cost of medications (not only
metabolic targets (32–34). Strategies transportation barriers for patients living insulin) influences prescribing patterns
shown to improve care team behavior in underresourced areas or with disabil- and cost-related medication nonadher-
and thereby catalyze reductions in A1C, ities (50). However, there is limited ence because of patient burden and
blood pressure, and/or LDL cholesterol data available on the cost-effective- lack of secondary payer support (public
include engaging in explicit and collabo- ness of these strategies. and private insurance) for effective
rative goal setting with patients (35,36); approved glucose-lowering, cardio-
identifying and addressing language, Behaviors and Well-being vascular disease risk–reducing, and
numeracy, or cultural barriers to care Successful diabetes care also requires weight management therapeutics.
(37–39); integrating evidence-based a systematic approach to supporting Although not usually addressed as a
guidelines and clinical information tools patients’ behavior-change efforts. High- social determinant of health, financial
into the process of care (19,40,41); solic- quality diabetes self-management edu- barriers remain a major source of health
iting performance feedback, setting cation and support (DSMES) has been disparities, and costs should be a focus
reminders, and providing structured care shown to improve patient self-manage- of treatment goals (57). (See TAILORING
(e.g., guidelines, formal case manage- ment, satisfaction, and glucose out- TREATMENT FOR SOCIAL CONTEXT and TREATMENT
ment, and patient education resources) comes. National DSMES standards call CONSIDERATIONS.) Reduction in cost-related
(7); and incorporating care management for an integrated approach that includes medication nonadherence is associated
teams including nurses, dietitians, phar- clinical content and skills, behavioral with better biologic and psychologic out-
macists, and other providers (20,42). In strategies (goal setting, problem-solving), comes, including quality of life.
addition, initiatives such as the Patient- and engagement with psychosocial con-
Centered Medical Home show promise cerns (29). Increasingly, such support is Access to Care and Quality Improvement
for improving health outcomes by foster- being adapted for online platforms that The Affordable Care Act and Medicaid
ing comprehensive primary care and have the potential to improve patient expansion have resulted in increased
offering new opportunities for team- access to this important resource. These access to care for many individuals with
based chronic disease management (43). curriculums need to be tailored to the diabetes, emphasizing the protectioncare.diabetesjournals.org Improving Care and Promoting Health in Populations S11
of people with preexisting conditions, TAILORING TREATMENT FOR SDOH are not consistently recognized
health promotion, and disease prevention SOCIAL CONTEXT and often go undiscussed in the clinical
(58). In fact, health insurance coverage encounter (75). For example, a study by
Recommendations
increased from 84.7% in 2009 to 90.1% Piette et al. (84) found that among
1.5 Assess food insecurity, housing patients with chronic illnesses, two-
in 2016 for adults with diabetes aged
insecurity/homelessness, finan-
18–64 years. Coverage for those $65 thirds of those who reported not taking
cial barriers, and social capital/ medications as prescribed due to cost-
years remained nearly universal (59).
social community support to
Patients who have either private or public related medication nonadherence never
inform treatment decisions,
insurance coverage are more likely to shared this with their physician. In a
with referral to appropriate
meet quality indicators for diabetes care study using data from the National
local community resources. A
(60). As mandated by the Affordable Care Health Interview Survey (NHIS), Patel
1.6 Provide patients with self-man-
Act, the Agency for Healthcare Research et al. (75) found that one-half of adults
agement support from lay
with diabetes reported financial stress
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and Quality developed a National Quality health coaches, navigators, or
Strategy based on triple aims that include and one-fifth reported food insecurity.
community health workers
improving the health of a population, One population in which such issues
when available. A
overall quality and patient experience of must be considered is older adults,
care, and per capita cost (61,62). As where social difficulties may impair the
health care systems and practices adapt Health inequities related to diabetes quality of life and increase the risk of
to the changing landscape of health care, and its complications are well docu- functional dependency (85) (see Section
it will be important to integrate tradi- mented, are heavily influenced by 13, “Older Adults,” https://doi.org/10
SDOH, and have been associated with .2337/dc22-S013, for a detailed discus-
tional disease-specific metrics with meas-
greater risk for diabetes, higher popula- sion of social considerations in older
ures of patient experience, as well as
tion prevalence, and poorer diabetes adults). Creating systems-level mecha-
cost, in assessing the quality of diabetes
outcomes (72–76). SDOH are defined as nisms to screen for SDOH may help
care (63,64). Information and guidance
the economic, environmental, political, overcome structural barriers and
specific to quality improvement and prac-
and social conditions in which people communication gaps between patients
tice transformation for diabetes care is
live and are responsible for a major part and providers (75,86). In addition, brief,
available from the National Institute of
of health inequality worldwide (77). validated screening tools for some SDOH
Diabetes and Digestive and Kidney Dis-
Greater exposure to adverse SDOH over exist and could facilitate discussion
eases guidance on diabetes care and
the life course results in worse health around factors that significantly impact
quality (65). Using patient registries and
(78). The ADA recognizes the association treatment during the clinical encounter.
electronic health records, health sys-
between social and environmental fac- Below is a discussion of assessment and
tems can evaluate the quality of diabe-
tors and the prevention and treatment treatment considerations in the context
tes care being delivered and perform of diabetes and has issued a call for of food insecurity, homelessness, lim-
intervention cycles as part of quality research that seeks to better under- ited English proficiency, limited health
improvement strategies (66). Improve- stand how these social determinants literacy, and low literacy.
ment of health literacy and numeracy influence behaviors and how the rela-
is also a necessary component to imp- tionships between these variables might Food Insecurity
rove care (67,68). Critical to these be modified for the prevention and Food insecurity is the unreliable avail-
efforts is provider adherence to clini- management of diabetes (79,80). While ability of nutritious food and the inabil-
cal practice recommendations (see a comprehensive strategy to reduce dia- ity to consistently obtain food without
Table 4.1) and the use of accurate, betes-related health inequities in popu- resorting to socially unacceptable practi-
reliable data metrics that include lations has not been formally studied, ces. Over 18% of the U.S. population
sociodemographic variables to examine general recommendations from other reported food insecurity between 2005
health equity within and across popula- chronic disease management and pre- and 2014 (87). The rate is higher in
tions (69). vention models can be drawn upon to some racial/ethnic minority groups,
In addition to quality improvement inform systems-level strategies in diabe- including African American and Latino
efforts, other strategies that simultaneously tes (81). For example, the National populations, low-income households,
improve the quality of care and potentially Academy of Medicine has published a and homes headed by a single mother.
reduce costs are gaining momentum and framework for educating health care The rate of food insecurity in individuals
include reimbursement structures that, in professionals on the importance of with diabetes may be up to 20% (88).
contrast to visit-based billing, reward the SDOH (82). Furthermore, there are Additionally, the risk for type 2 diabetes
provision of appropriate and high-quality resources available for the inclusion of is increased twofold in those with food
care to achieve metabolic goals (70) standardized sociodemographic varia- insecurity (79) and has been associated
and incentives that accommodate person- bles in electronic medical records to with low adherence to taking medica-
alized care goals (7,71). (Also see COST CONSID- facilitate the measurement of health tions appropriately and recommended
ERATIONS FOR MEDICATION-TAKING BEHAVIOR, above, inequities as well as the impact of inter- self-care behaviors, depression, diabetes
regarding cost-related medication nonad- ventions designed to reduce those distress, and worse glycemic control
herence reduction.) inequities (63,82,83). when compared with individuals whoS12 Improving Care and Promoting Health in Populations Diabetes Care Volume 45, Supplement 1, January 2022
are food secure (89,90). Older adults homeless population is estimated to be health care. Without regular care, those
with food insecurity are more likely to around 8% (96). Additionally, patients with diabetes may suffer severe and
have emergency department visits and with diabetes who are homeless need often expensive complications that affect
hospitalizations compared with older secure places to keep their diabetes quality of life.
adults who do not report food insecu- supplies and refrigerator access to prop- Health care providers should be
rity (91). Risk for food insecurity can erly store their insulin and take it on a attuned to the working and living condi-
be assessed with a validated two-item regular schedule. The risk for homeless- tions of all patients. For example, if a
screening tool (91) that includes the ness can be ascertained using a brief migrant farmworker with diabetes pre-
statements: 1) “Within the past 12 risk assessment tool developed and sents for care, appropriate referrals
months we worried whether our food validated for use among veterans (97). should be initiated to social workers
would run out before we got money to Housing insecurity has also been shown and community resources, as available,
buy more” and 2) “Within the past 12 to be directly associated with a person’s to assist with removing barriers to care.
months the food we bought just didn’t ability to maintain their diabetes self-
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last, and we didn’t have money to get management (98). Given the potential Language Barriers
more.” An affirmative response to either challenges, providers who care for Providers who care for non–English
statement had a sensitivity of 97% and either homeless or housing-insecure speakers should develop or offer educa-
specificity of 83%. Interventions such as individuals should be familiar with tional programs and materials in multi-
food prescription programs are considered resources or have access to social work- ple languages with the specific goals of
promising practices to address food inse- ers who can facilitate stable housing for preventing diabetes and building diabe-
curity by integrating community resources their patients as a way to improve dia- tes awareness in people who cannot
into primary care settings and directly betes care (99). easily read or write in English. The
deal with food deserts in underserved National Standards for Culturally and
communities (92,93). Migrant and Seasonal Agricultural Linguistically Appropriate Services in
Workers
Health and Health Care (National CLAS
Treatment Considerations Migrant and seasonal agricultural work-
Standards) provide guidance on how
In those with diabetes and food insecu- ers may have a higher risk of type 2 dia-
health care providers can reduce lan-
rity, the priority is mitigating the increased betes than the overall population. While
guage barriers by improving their cul-
risk for uncontrolled hyperglycemia and migrant farmworker–specific data are
tural competency, addressing health
severe hypoglycemia. Reasons for the lacking, most agricultural workers in the
literacy, and ensuring communication
increased risk of hyperglycemia include U.S. are Latino, a population with a high
with language assistance (102). In addi-
the steady consumption of inexpensive rate of type 2 diabetes. In addition, liv-
tion, the National CLAS Standards web-
carbohydrate-rich processed foods, binge ing in severe poverty brings with it food
site (https://thinkculturalhealth.hhs.gov)
eating, financial constraints to filling dia- insecurity, high chronic stress, and
offers several resources and materials
betes medication prescriptions, and anxi- increased risk of diabetes; there is also
that can be used to improve the quality
ety/depression leading to poor diabetes an association between the use of cer-
tain pesticides and the incidence of dia- of care delivery to non–English-speaking
self-care behaviors. Hypoglycemia can
betes (100). patients (102).
occur as a result of inadequate or erratic
carbohydrate consumption following the Data from the Department of Labor
administration of sulfonylureas or insulin. indicate that there are 2.5–3 million Health Literacy and Numeracy
See Table 9.2 for drug-specific and agricultural workers in the U.S. These Health literacy is defined as the degree
patient factors, including cost and risk of agricultural workers travel throughout to which individuals have the capacity
hypoglycemia, which may be important the country, serving as the backbone for to obtain, process, and understand basic
considerations for adults with food inse- a multibillion-dollar agricultural industry. health information and services needed
curity and type 2 diabetes. Providers According to 2018 health center data, to make appropriate decisions (67).
should consider these factors when mak- 174 health centers across the U.S. Health literacy is strongly associated
ing treatment decisions in people with reported that they provided health care with patients being able to engage in
food insecurity and seek local resources services to 579,806 adult agricultural complex disease management and self-
that might help patients with diabetes patients, and 78,332 had encounters for care (103). Approximately 80 million
and their family members obtain nutri- diabetes (13.5%) (101). adults in the U.S. are estimated to have
tious food more regularly (94). Migrant farmworkers encounter limited or low health literacy (68). Clini-
numerous and overlapping barriers to cians and diabetes care and education
Homelessness and Housing receiving care. Migration, which may specialists should ensure they provide
Insecurity occur as frequently as every few weeks easy-to-understand information and
Homelessness/housing insecurity often for farmworkers, disrupts care. In addi- reduce unnecessary complexity when
accompanies many additional barriers tion, cultural and linguistic barriers, lack developing care plans with patients.
to diabetes self-management, including of transportation and money, lack Interventions addressing low health lit-
food insecurity, literacy and numeracy of available work hours, unfamiliarity eracy in populations with diabetes seem
deficiencies, lack of insurance, cognitive with new communities, lack of access to effective in improving diabetes out-
dysfunction, and mental health issues resources, and other barriers prevent comes, including ones focusing primarily
(95). The prevalence of diabetes in the migrant farmworkers from accessing on patient education, self-care training,care.diabetesjournals.org Improving Care and Promoting Health in Populations S13
or disease management. Combining CCM (9) with particular need to incorpo- 5. Kerr EA, Heisler M, Krein SL, et al. Beyond
easily adapted materials with formal rate relevant social support networks. comorbidity counts: how do comorbidity type
and severity influence diabetes patients’ treat-
diabetes education demonstrates effec- There is currently a paucity of evidence ment priorities and self-management? J Gen
tiveness on clinical and behavioral out- regarding enhancement of these resour- Intern Med 2007;22:1635–1640
comes in populations with low literacy ces for those most likely to benefit from 6. Fernandez A, Schillinger D, Warton EM, et al.
(104). However, evidence supporting such intervention strategies. Language barriers, physician-patient language
concordance, and glycemic control among
these strategies is largely limited to Health care community linkages are
insured Latinos with diabetes: the Diabetes Study
observational studies, and more research receiving increasing attention from the of Northern California (DISTANCE). J Gen Intern
is needed to investigate the most American Medical Association, the Med 2011;26:170–176
effective strategies for enhancing both Agency for Healthcare Research and 7. TRIAD Study Group. Health systems, patients
acquisition and retention of diabetes Quality, and others as a means of pro- factors, and quality of care for diabetes: a
synthesis of findings from the TRIAD study.
knowledge, as well as to examine dif- moting translation of clinical recommen-
Diabetes Care 2010;33:940–947
ferent media and strategies for deliv- dations for diet and physical activity in
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8. American Diabetes Association. Economic
ering interventions to patients (37). real-world settings (108). Community costs of diabetes in the U.S. in 2017. Diabetes
Health numeracy is also important in health workers (CHWs) (109), peer sup- Care 2018;41:917–928
porters (110–112), and lay leaders (113) 9. Stellefson M, Dipnarine K, Stopka C. The
diabetes prevention and management.
chronic care model and diabetes management in
Health numeracy requires primary may assist in the delivery of DSMES US primary care settings: a systematic review.
numeric skills, applied health numeracy, services (82,114), particularly in under- Prev Chronic Dis 2013;10:E26
and interpretive health numeracy. There served communities. A CHW is defined 10. Wan EYF, Fung CSC, Jiao FF, et al. Five-
is also an emotional component that by the American Public Health Associa- year effectiveness of the multidisciplinary Risk
Assessment and Management Programme–
affects a person’s ability to understand tion as a “frontline public health worker
Diabetes Mellitus (RAMP-DM) on diabetes-related
concepts of risk, probability, and commu- who is a trusted member of and/or has complications and health service uses—a popu-
nication of scientific evidence (105). Peo- an unusually close understanding of the lation-based and propensity-matched cohort
ple with prediabetes or diabetes often community served” (115). CHWs can be study. Diabetes Care 2018;41:49–59
part of a cost-effective, evidence-based 11. Jiao FF, Fung CSC, Wan EYF, et al. Five-year
need to perform numeric tasks such as
cost-effectiveness of the Multidisciplinary Risk
interpreting food labels and blood glu- strategy to improve the management of Assessment and Management Programme–
cose levels to make treatment decisions diabetes and cardiovascular risk factors Diabetes Mellitus (RAMP-DM). Diabetes Care
such as medication dosing. Thus, both in underserved communities and health 2018;41:250–257
health literacy and numeracy are neces- care systems (116). The CHW scope of 12. Coleman K, Austin BT, Brach C, Wagner EH.
practice in areas such as outreach and Evidence on the Chronic Care Model in the new
sary for enabling effective communication millennium. Health Aff (Millwood) 2009;28:
between patient and provider, arriving at communication, advocacy, social sup- 75–85
a treatment regimen, and making diabe- port, basic health education, referrals to 13. Piatt GA, Anderson RM, Brooks MM, et al.
tes self-management task decisions. If community clinics, etc., has been suc- 3-year follow-up of clinical and behavioral
cessful in providing social and primary improvements following a multifaceted diabetes
patients appear not to understand con-
care intervention: results of a randomized
cepts associated with treatment deci- preventive services to underserved pop-
controlled trial. Diabetes Educ 2010;36:301–309
sions, both can be assessed using ulations in rural and hard-to-reach com- 14. Katon WJ, Lin EHB, Von Korff M, et al.
standardized screening measures (106). munities. Even though CHWs’ core Collaborative care for patients with depression
Adjunctive education and support may competencies are not clinical in nature, and chronic illnesses. N Engl J Med 2010;
in some circumstances clinicians may 363:2611–2620
be indicated if limited health literacy and 15. Parchman ML, Zeber JE, Romero RR, Pugh
numeracy are barriers to optimal care delegate limited clinical tasks to CHWs. JA. Risk of coronary artery disease in type 2
decisions (28). If such is the case, these tasks must diabetes and the delivery of care consistent with
always be performed under the direc- the chronic care model in primary care settings: a
tion and supervision of the delegating STARNet study. Med Care 2007;45:1129–1134
Social Capital/Community Support
health professional and following state 16. Del Valle KL, McDonnell ME. Chronic care
Social capital, which comprises commu- management services for complex diabetes
nity and personal network instrumental health care laws and statutes (117). management: a practical overview. Curr Diab Rep
support, promotes better health, 2018;18:135
References 17. Tricco AC, Ivers NM, Grimshaw JM, et al.
whereas lack of social support is associ-
1. Kindig D, Stoddart G. What is population Effectiveness of quality improvement strategies
ated with poorer health outcomes in health? Am J Public Health 2003;93:380–383 on the management of diabetes: a systematic
individuals with diabetes (80). Of particu- 2. Institute of Medicine, Committee on Quality review and meta-analysis. Lancet 2012;379:
lar concern are the SDOH including rac- of Health Care in America. Crossing the Quality 2252–2261
ism and discrimination, which are likely Chasm: A New Health System for the 21st 18. Schmittdiel JA, Gopalan A, Lin MW, Banerjee
Century. Washington, DC, National Academies S, Chau CV, Adams AS. Population health
to be lifelong (107). These factors are
Press, 2001. PMID: 25057539 management for diabetes: health care system-
rarely addressed in routine treatment or 3. Haire-Joshu D, Hill-Briggs F. The next level approaches for improving quality and
disease management but may drive generation of diabetes translation: a path to addressing disparities. Curr Diab Rep 2017;17:31
underlying causes of nonadherence health equity. Annu Rev Public Health 2019;40: 19. O’Connor PJ, Bodkin NL, Fradkin J, et al.
to regimen behaviors and medication 391–410 Diabetes performance measures: current status
4. Kazemian P, Shebl FM, McCann N, Walensky and future directions. Diabetes Care 2011;34:
use. Identification or development RP, Wexler DJ. Evaluation of the cascade of 1651–1659
of community resources to support diabetes care in the United States, 2005–2016. 20. Jaffe MG, Lee GA, Young JD, Sidney S, Go AS.
healthy lifestyles is a core element of the JAMA Intern Med 2019;179:1376–1385 Improved blood pressure control associatedS14 Improving Care and Promoting Health in Populations Diabetes Care Volume 45, Supplement 1, January 2022
with a large-scale hypertension program. JAMA compared with current treatment guidelines. 51. Dack C, Ross J, Stevenson F, et al. A digital
2013;310:699–705 Diabetes Educ 2011;37:78–84 self-management intervention for adults with
21. Peikes D, Chen A, Schore J, Brown R. Effects 36. Tamhane S, Rodriguez-Gutierrez R, type 2 diabetes: combining theory, data and
of care coordination on hospitalization, quality of Hargraves I, Montori VM. Shared decision- participatory design to develop HeLP-Diabetes.
care, and health care expenditures among making in diabetes care. Curr Diab Rep Internet Interv 2019;17:100241
Medicare beneficiaries: 15 randomized trials. 2015;15:112 52. Lee M-K, Lee DY, Ahn H-Y, Park C-Y. A novel
JAMA 2009;301:603–618 37. Schillinger D, Piette J, Grumbach K, et al. user utility score for diabetes management using
22. Raebel MA, Schmittdiel J, Karter AJ, Closing the loop: physician communication with tailored mobile coaching: secondary analysis of a
Konieczny JL, Steiner JF. Standardizing termi- diabetic patients who have low health literacy. randomized controlled trial. JMIR Mhealth
nology and definitions of medication adherence Arch Intern Med 2003;163:83–90 Uhealth 2021;9:e17573
and persistence in research employing electronic 38. Rosal MC, Ockene IS, Restrepo A, et al. 53. Dening J, Islam SMS, George E, Maddison R.
databases. Med Care 2013;51(Suppl. 3):S11–S21 Randomized trial of a literacy-sensitive, culturally Web-based interventions for dietary behavior in
23. Feifer C, Nemeth L, Nietert PJ, et al. Different tailored diabetes self-management intervention adults with type 2 diabetes: systematic review of
paths to high-quality care: three archetypes of for low-income Latinos: Latinos en Control. randomized controlled trials. J Med Internet Res
top-performing practice sites. Ann Fam Med Diabetes Care 2011;34:838–844 2020;22:e16437
Downloaded from http://diabetesjournals.org/care/article-pdf/45/Supplement_1/S8/637531/dc22s001.pdf by guest on 11 January 2022
2007;5:233–241 39. Osborn CY, Cavanaugh K, Wallston KA, et al. 54. Omar MA, Hasan S, Palaian S, Mahameed S.
24. Reed M, Huang J, Graetz I, et al. Outpatient Health literacy explains racial disparities in The impact of a self-management educational
electronic health records and the clinical care diabetes medication adherence. J Health program coordinated through WhatsApp on
and outcomes of patients with diabetes mellitus. Commun 2011;16(Suppl. 3):268–278 diabetes control. Pharm Pract (Granada) 2020;
Ann Intern Med 2012;157:482–489 40. Garg AX, Adhikari NKJ, McDonald H, et al. 18:1841
25. Cebul RD, Love TE, Jain AK, Hebert CJ. Effects of computerized clinical decision support 55. Herkert D, Vijayakumar P, Luo J, et al. Cost-
Electronic health records and quality of diabetes systems on practitioner performance and patient related insulin underuse among patients with
care. N Engl J Med 2011;365:825–833 outcomes: a systematic review. JAMA 2005;293: diabetes. JAMA Intern Med 2019;179:112–114
26. Battersby M, Von Korff M, Schaefer J, et al. 1223–1238 56. Cefalu WT, Dawes DE, Gavlak G, et al.;
Twelve evidence-based principles for imple- 41. Smith SA, Shah ND, Bryant SC, et al.; Evidens Insulin Access and Affordability Working Group.
menting self-management support in primary Research Group. Chronic care model and shared Insulin Access and Affordability Working Group:
care. Jt Comm J Qual Patient Saf 2010;36: care in diabetes: randomized trial of an electronic conclusions and recommendations. Diabetes
561–570 decision support system. Mayo Clin Proc Care 2018;41:1299–1311
27. Grant RW, Wald JS, Schnipper JL, et al. 2008;83:747–757 57. Taylor SI. The high cost of diabetes drugs:
Practice-linked online personal health records for 42. Stone RA, Rao RH, Sevick MA, et al. Active disparate impact on the most vulnerable
type 2 diabetes mellitus: a randomized controlled care management supported by home patients. Diabetes Care 2020;43:2330–2332
trial. Arch Intern Med 2008;168:1776–1782 telemonitoring in veterans with type 2 diabetes: 58. Myerson R, Laiteerapong N. The Affordable
28. Young-Hyman D, de Groot M, Hill-Briggs F, the DiaTel randomized controlled trial. Diabetes Care Act and diabetes diagnosis and care:
Gonzalez JS, Hood K, Peyrot M. Psychosocial care Care 2010;33:478–484 exploring the potential impacts. Curr Diab Rep
for people with diabetes: a position statement of 43. Bojadzievski T, Gabbay RA. Patient-centered 2016;16:27
the American Diabetes Association. Diabetes medical home and diabetes. Diabetes Care 59. Casagrande SS, McEwen LN, Herman WH.
Care 2016;39:2126–2140 2011;34:1047–1053 Changes in health insurance coverage under the
29. Beck J, Greenwood DA, Blanton L, et al.; 44. Telligen and gpTRAC (Great Plains Telehealth Affordable Care Act: a national sample of U.S.
2017 Standards Revision Task Force. 2017 Resource & Assistance Center). Telehealth Start- adults with diabetes, 2009 and 2016. Diabetes
national standards for diabetes self-management Up and Resource Guide Version 1.1, October Care 2018;41:956–962
education and support. Diabetes Care 2017;40: 2014. Accessed 9 August 2021. Available from 60. Doucette ED, Salas J, Scherrer JF. Insurance
1409–1419 https://www.healthit.gov/sites/default/files/ coverage and diabetes quality indicators among
30. Pullen-Smith B, Carter-Edwards L, Leathers telehealthguide_final_0.pdf patients in NHANES. Am J Manag Care 2016;
KH. Community health ambassadors: a model for 45. Lee SWH, Chan CKY, Chua SS, Chaiya- 22:484–490
engaging community leaders to promote better kunapruk N. Comparative effectiveness of 61. Stiefel M, Nolan K. Measuring the triple aim:
health in North Carolina. J Public Health Manag telemedicine strategies on type 2 diabetes a call for action. Popul Health Manag 2013;16:
Pract 2008;14(Suppl. ):S73–S81 management: a systematic review and network 219–220
31. Handlow NE, Nolton B, Winter SE, Wessel meta-analysis. Sci Rep 2017;7:12680 62. Agency for Healthcare Research and Quality.
CM, Pennock J. 180-LB: Impact of a multi- 46. Xu T, Pujara S, Sutton S, Rhee M. About the National Quality Strategy. Content
disciplinary diabetes care team in primary care Telemedicine in the management of type 1 last reviewed March 2017. Accessed 4 October
settings on glycemic control (Late-breaking diabetes. Prev Chronic Dis 2018;15:170168 2021. Available from https://www.ahrq.gov/
poster presentation). Diabetes 2019; 68(Suppl. 47. Faruque LI, Wiebe N, Ehteshami-Afshar A, workingforquality/about/index.html
1). Accessed 4 October 2021. Available from et al.; Alberta Kidney Disease Network. Effect 63. National Quality Forum. National voluntary
https://doi.org/10.2337/db19-180-LB of telemedicine on glycated hemoglobin in consensus standards for ambulatory care—
32. Davidson MB. How our current medical care diabetes: a systematic review and meta-analysis measuring healthcare disparities. 2008. Accessed
system fails people with diabetes: lack of timely, of randomized trials. CMAJ 2017;189:E341–E364 4 October 2021. Available from https://www
appropriate clinical decisions. Diabetes Care 48. Marcolino MS, Maia JX, Alkmim MBM, .qualityforum.org/Publications/2008/03/National_
2009;32:370–372 Boersma E, Ribeiro AL. Telemedicine application Voluntary_Consensus_Standards_for_Ambulatory_
33. Selby JV, Uratsu CS, Fireman B, et al. in the care of diabetes patients: systematic Care%E2%80%94Measuring_Healthcare_Disparities
Treatment intensification and risk factor control: review and meta-analysis. PLoS One 2013;8: .aspx
toward more clinically relevant quality measures. e79246 64. Burstin H, Johnson K. Getting to better
Med Care 2009;47:395–402 49. Heitkemper EM, Mamykina L, Travers J, care and outcomes for diabetes through measu-
34. Raebel MA, Ellis JL, Schroeder EB, et al. Smaldone A. Do health information techno- rement. Evidence-based diabetes manage-
Intensification of antihyperglycemic therapy logy self-management interventions improve ment. Am J Manag Care 2016;22(SP4):SP145–
among patients with incident diabetes: a glycemic control in medically underserved adults SP146
Surveillance Prevention and Management of with diabetes? A systematic review and meta- 65. National Institute of Diabetes and Dige-
Diabetes Mellitus (SUPREME-DM) study. Pharma- analysis. J Am Med Inform Assoc 2017;24: stive and Kidney Diseases. Diabetes for health
coepidemiol Drug Saf 2014;23:699–710 1024–1035 professionals. Accesssed 9 August 2021.
35. Grant RW, Pabon-Nau L, Ross KM, Youatt EJ, 50. Reagan L, Pereira K, Jefferson V, et al. Available from https://www.niddk.nih.gov/
Pandiscio JC, Park ER. Diabetes oral medication Diabetes self-management training in a virtual health-information/professionals/clinical-tools-
initiation and intensification: patient views environment. Diabetes Educ 2017;43:413–421 patient-management/diabetescare.diabetesjournals.org Improving Care and Promoting Health in Populations S15
66. O’Connor PJ, Sperl-Hillen JM, Fazio CJ, recommendations for the framework and format 97. Montgomery AE, Fargo JD, Kane V, Culhane
Averbeck BM, Rank BH, Margolis KL. Outpatient of Healthy People 2020. Accessed 4 October DP. Development and validation of an
diabetes clinical decision support: current status 2021. Available from https://www.healthy instrument to assess imminent risk of
and future directions. Diabet Med 2016;33: people.gov/2010/hp2020/advisory/PhaseI/ homelessness among veterans. Public Health
734–741 default.htm Rep 2014;129:428–436
67. Institute of Medicine, Committee on Health 82. National Academies of Sciences, Engineer- 98. Stahre M, VanEenwyk J, Siegel P, Njai R.
Literacy. Health Literacy: A Prescription to End ing, and Medicine. A Framework for Educating Housing insecurity and the association with health
Confusion. Nielsen-Bohlman L, Panzer AM, Kindig Health Professionals to Address the Social outcomes and unhealthy behaviors, Washington
DA, Eds. Washington, DC, National Academies Determinants of Health. Washington, DC, National State, 2011. Prev Chronic Dis 2015;12:E109
Press, 2004. PMID: 25009856 Academies Press, 2016. PMID: 27854400 99. Baxter AJ, Tweed EJ, Katikireddi SV, Thomson
68. Schaffler J, Leung K, Tremblay S, et al. The 83. Chin MH, Clarke AR, Nocon RS, et al. A H. Effects of Housing First approaches on health
effectiveness of self-management interventions roadmap and best practices for organizations to and well-being of adults who are homeless or
for individuals with low health literacy and/or reduce racial and ethnic disparities in health care. at risk of homelessness: systematic review and
low income: a descriptive systematic review. J J Gen Intern Med 2012;27:992–1000 meta-analysis of randomised controlled trials.
Gen Intern Med 2018;33:510–523 84. Piette JD, Heisler M, Wagner TH. Cost- J Epidemiol Community Health 2019;73:379–
Downloaded from http://diabetesjournals.org/care/article-pdf/45/Supplement_1/S8/637531/dc22s001.pdf by guest on 11 January 2022
69. Centers for Medicare & Medicaid Services. related medication underuse among chronically 387
CMS equity plan for Medicare. Accessed 4 ill adults: the treatments people forgo, how 100. Evangelou E, Ntritsos G, Chondrogiorgi M,
October 2021. Available from https://www.cms often, and who is at risk. Am J Public Health et al. Exposure to pesticides and diabetes: a
.gov/About-CMS/Agency-Information/OMH/ 2004;94:1782–1787 systematic review and meta-analysis. Environ Int
equity-initiatives/equity-plan.html 85. Laiteerapong N, Karter AJ, Liu JY, et al. 2016;91:60–68
70. Rosenthal MB, Cutler DM, Feder J. The ACO Correlates of quality of life in older adults with 101. Health Resources & Services Admini-
rules—striking the balance between participation diabetes: the Diabetes & Aging Study. Diabetes stration. 2020 Health Center Data. Accessed 4
and transformative potential. N Engl J Med Care 2011;34:1749–1753 October 2021. Available from https://data.hrsa
2011;365:e6 86. O’Gurek DT, Henke C. A practical approach .gov/tools/data-reporting/program-data/national
71. Washington AE, Lipstein SH. The Patient- to screening for social determinants of health. 102. U.S. Department of Health & Human
Centered Outcomes Research Institute—pro- Fam Pract Manag 2018;25:7–12 Services. National Standards for Culturally and
moting better information, decisions, and health. 87. Walker RJ, Grusnick J, Garacci E, Mendez C, Linguistically Appropriate Services (CLAS) in
N Engl J Med 2011;365:e31 Egede LE. Trends in food insecurity in the USA for Health and Health Care. Accessed 4 October
72. Hutchinson RN, Shin S. Systematic review of individuals with prediabetes, undiagnosed 2021. Available from https://www.thinkcultural
health disparities for cardiovascular diseases and diabetes, and diagnosed diabetes. J Gen Intern health.hhs.gov/assets/pdfs/enhancednational
associated factors among American Indian and classtandards.pdf
Med 2019;34:33–35
Alaska Native populations. PLoS One 2014;9: 103. Aaby A, Friis K, Christensen B, Rowlands G,
88. Berkowitz SA, Karter AJ, Corbie-Smith G, et al.
e80973 Maindal HT. Health literacy is associated with
Food insecurity, food “deserts,” and glycemic
73. Borschuk AP, Everhart RS. Health disparities health behaviour and self-reported health: a
control in patients with diabetes: a longitudinal
among youth with type 1 diabetes: a systematic large population-based study in individuals
analysis. Diabetes Care 2018;41:1188–1195
review of the current literature. Fam Syst Health with cardiovascular disease. Eur J Prev Cardiol
89. Heerman WJ, Wallston KA, Osborn CY, et al.
2015;33:297–313 2017;24:1880–1888
Food insecurity is associated with diabetes self-
74. Walker RJ, Strom Williams J, Egede LE. 104. White RO, Eden S, Wallston KA, et al.
care behaviours and glycaemic control. Diabet
Influence of race, ethnicity and social Health communication, self-care, and treatment
Med 2016;33:844–850
determinants of health on diabetes outcomes. satisfaction among low-income diabetes patients
90. Silverman J, Krieger J, Kiefer M, Hebert P,
Am J Med Sci 2016;351:366–373 in a public health setting. Patient Educ Couns
Robinson J, Nelson K. The relationship between
75. Patel MR, Piette JD, Resnicow K, Kowalski- 2015;98:144–149
food insecurity and depression, diabetes distress
Dobson T, Heisler M. Social determinants of 105. Schapira MM, Fletcher KE, Gilligan MA,
health, cost-related nonadherence, and cost- and medication adherence among low-income et al. A framework for health numeracy: how
reducing behaviors among adults with diabetes: patients with poorly-controlled diabetes. J Gen patients use quantitative skills in health care. J
findings from the National Health Interview Intern Med 2015;30:1476–1480 Health Commun 2008;13:501–517
Survey. Med Care 2016;54:796–803 91. Hager ER, Quigg AM, Black MM, et al. 106. Carpenter CR, Kaphingst KA, Goodman MS,
76. Steve SL, Tung EL, Schlichtman JJ, Peek ME. Development and validity of a 2-item screen to Lin MJ, Melson AT, Griffey RT. Feasibility and
Social disorder in adults with type 2 diabetes: identify families at risk for food insecurity. diagnostic accuracy of brief health literacy and
building on race, place, and poverty. Curr Diab Pediatrics 2010;126:e26–e32 numeracy screening instruments in an urban
Rep 2016;16:72 92. Goddu AP, Roberson TS, Raffel KE, Chin MH, emergency department. Acad Emerg Med
77. Commission on Social Determinants of Peek ME. Food Rx: a community-university 2014;21:137–146
Health. Closing the gap in a generation: health partnership to prescribe healthy eating on the 107. Williams DR, Lawrence JA, Davis BA. Racism
equity through action on the social determinants South Side of Chicago. J Prev Interv Community and Health: Evidence and Needed Research.
of health. Geneva, World Health Organization, 2015;43:148–162 Annu Rev Public Health 2019;40:105–125
2008. Accessed 4 October 2021. Available from 93. Feinberg AT, Hess A, Passaretti M, 108. Agency for Healthcare Research and
https://www.who.int/social_determinants/final_ Coolbaugh S, Lee TH. Prescribing food as a Quality. Clinical-community linkages. Content last
report/csdh_finalreport_2008.pdf specialty drug. NEJM Catalyst. 10 April 2018. reviewed December 2016. Accessed 4 October
78. Dixon B, Pe~ na M-M, Taveras EM. Lifecourse Accessed 4 October 2021. Available from https:// 2021. Available from https://www.ahrq.gov/
approach to racial/ethnic disparities in childhood catalyst.nejm.org/doi/abs/10.1056/CAT.18.0212 professionals/prevention-chronic-care/improve/
obesity. Adv Nutr 2012;3:73–82 94. Seligman HK, Schillinger D. Hunger and community/index.html
79. Hill JO, Galloway JM, Goley A, et al. Scientific socioeconomic disparities in chronic disease. N 109. Egbujie BA, Delobelle PA, Levitt N, Puoane
statement: socioecological determinants of Engl J Med 2010;363:6–9 T, Sanders D, van Wyk B. Role of community
prediabetes and type 2 diabetes. Diabetes Care 95. White BM, Logan A, Magwood GS. Access to health workers in type 2 diabetes mellitus self-
2013;36:2430–2439 diabetes care for populations experiencing management: a scoping review. Plos One
80. Hill-Briggs F, Adler NE, Berkowitz SA, et al. homelessness: an integrated review. Curr Diab 2018;13:e01998424
Social determinants of health and diabetes: a Rep 2016;16:112 110. Heisler M, Vijan S, Makki F, Piette JD.
scientific review. Diabetes Care 2020;44:258– 96. Bernstein RS, Meurer LN, Plumb EJ, Jackson Diabetes control with reciprocal peer support
279 JL. Diabetes and hypertension prevalence in versus nurse care management: a randomized
81. The Secretary’s Advisory Committee on homeless adults in the United States: a trial. Ann Intern Med 2010;153:507–515
National Health Promotion and Disease Pre- systematic review and meta-analysis. Am J Public 111. Long JA, Jahnle EC, Richardson DM,
vention Objectives for 2020. Phase I report: Health 2015;105:e46–e60 Loewenstein G, Volpp KG. Peer mentoring andS16 Improving Care and Promoting Health in Populations Diabetes Care Volume 45, Supplement 1, January 2022
financial incentives to improve glucose control in 114. Piatt GA, Rodgers EA, Xue L, Zgibor JC. 116. Guide to Community Preventive Services.
African American veterans: a randomized trial. Integration and utilization of peer leaders for Community health workers help patients
Ann Intern Med 2012;156:416–424 diabetes self-management support: results from manage diabetes. Page last updated 2018.
112. Fisher EB, Boothroyd RI, Elstad EA, et al. Project SEED (Support, Education, and Evaluation Accessed 4 October 2021. Available from
Peer support of complex health behaviors in in Diabetes). Diabetes Educ 2018;44:373–382 https://www.thecommunityguide.org/content/
prevention and disease management with 115. Rosenthal EL, Rush CH, Allen CG. Under- community-health-workers-help-patients-manage-
special reference to diabetes: systematic reviews. standing scope and competencies: a contem- diabetes
Clin Diabetes Endocrinol 2017;3:4 porary look at the United States community 117. The Network for Public Health Law. Legal
113. Foster G, Taylor SJC, Eldridge SE, Ramsay J, health worker field. CHW Central, 2016. considerations for community health workers
Griffiths CJ. Self-management education pro- Accessed 4 October 2021. Available from https:// and their employers. Accessed 4 October 2021.
grammes by lay leaders for people with chronic www.chwcentral.org/understanding-scope-and- Available from https://www.networkforphl.org/
conditions. Cochrane Database Syst Rev 2007;4: competencies-contemporary-look-united-states- wp-content/uploads/2020/01/Legal-Considerations-
CD005108 community-health-worker-field Community-Health-Workers.pdf
Downloaded from http://diabetesjournals.org/care/article-pdf/45/Supplement_1/S8/637531/dc22s001.pdf by guest on 11 January 2022You can also read
