Complex Diabetes: Managing Medical and Social Issues

Every Friday, 8:00 – 9:00 AM

Diabetes is the eighth leading cause of death in Illinois (IDPH, 2022). Rates of both diabetes and prediabetes in Illinois are higher than the national averages. About 12% of Illinois adults have been diagnosed with diabetes and an additional 12% have been diagnosed with prediabetes, with 90-95% of all cases attributed to Type-2 diabetes (T2D) (IDPH, 2024). Diabetes prevalence among Black populations is 18% and Hispanic populations (14%), compared to a prevalence of 11% among non-Hispanic White populations. Racial disparities have also been identified in relation to diabetes treatment. Hiesler et al (2003) found that Black diabetes patients were significantly less likely to have had their LDL checked within the past 2 years or to have had a dilated eye exam, compared to their White counterparts. Shenolikar et al (2006) found medication adherence to be 12% lower among Black T2D patients as compared to White patients. Primary care medical homes at community health centers are well positioned to be the most effective path to delivering accessible and culturally appropriate complex chronic disease care, such as in the case of diabetes. Several qualitative studies have identified barriers to effective diabetes treatment in primary care, including limited resources and environmental constraints, limited skills and knowledge in diabetes management, challenges in keeping up with changing recommendations, lack of comfort or familiarity in initiating insulin regimens, and difficulty with patient compliance (Nam et al, 2011; Rushforth et al, 2016).  In addition, social factors (e.g. income, education, housing, food insecurity) play a role in the development and progression of T2D, complicating care and management (Hill, Nielsen, and Fox, 2013). This series aims to provide PCPs with practical knowledge and skills that will help them implement and sustain evidence-based practices and navigate the complexities of diabetes care and management for both type 1 and type 2, including information and skills about delivering comprehensive diabetes care in resource-constrained communities, and integrating medical and social care delivery in healthcare settings.

Topics for Case-Based Learning and Discussion Include:

• Glucose-mediated insulin release
• Atypical Diabetes (Classifying DM in patients with atypical presentation)
• Engaging Patients, Motivational Interviewing, Shared Decision Making
• Real-world food recommendations
• Current Trends in Glucose Monitoring
• Medication Management for T2D, Non-insulin therapies
• Initiating Insulin Therapy for Patients with Type 1 DM, Prescription Writing Tips, and Carbohydrate Counting
• Initiating Insulin Therapy in T2D: Newly diagnosed Patients and Those with Progression of Long-Standing Disease
• Pumps/Insulin Pens/Non-insulin Injectable Medications
• Tailoring diabetes management  for resource-limited settings
• Diabetes and behavioral health: Promoting healthy coping & problem solving
• Symptoms and Treatment of Hypoglycemia
• Saving Toes, Feet, and Ankles
• Management and diagnosis of pre-diabetes & obesity and non-surgical weight loss (lifestyle and medications)