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Medical Journal
15th Jan, 2026
Diabetes Journals
Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes an initiative to reduce the incidence of diabetic ketoacidosis in children with type 1 diabetes at high risk for complications.
Optimal management of hyperglycemia during illness has been hindered by a lack of comprehensive sick-day guidance, particularly for adults with diabetes. Managing glycemia can be challenging during illness because of adaptive counterregulatory hormonal changes, acute stress of illness, altered dietary intake, and effects of medications. People with diabetes may be at risk for severe hypoglycemia and hyperglycemic crisis during illness unless mitigated by close monitoring and medication adjustment. This article provides practical guidance to health care professionals and people with diabetes for safe glycemic management during illness, including considerations for insulin and noninsulin medications, use of insulin technologies, prevention of hypoglycemia and ketoacidosis, steroid use, and pregnancy.
Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes an initiative to improve the rate of lipid profile screening in youth with type 2 diabetes at a tertiary children’s hospital in Southern California.
This article describes a pharmacist-led deprescribing initiative to reduce the incidence of inappropriate rapid-acting insulin use among admitted older adults at an acute care community hospital. Inappropriate use was defined as at least one episode of severe hypoglycemia (blood glucose < 40 mg/dL) within 24 hours of insulin lispro administration, two or more episodes of hypoglycemia (blood glucose < 70 but > 40 mg/dL) within 24 hours of insulin lispro administration, or five or more held administrations of insulin lispro because of euglycemia in a 48-hour period. The initiative led to a 66% observed relative reduction of inappropriate rapid-acting insulin use over 7 months.
Tirzepatide, a dual glucose-dependent insulinotropic polypeptide (GIP)/glucagon-like peptide 1 (GLP-1) receptor agonist, improves weight, hyperglycemia, hypertension, and hypertriglyceridemia (1), all of which are risk factors for diabetic neuropathy (2). The SURPASS-CVOT trial recently demonstrated that tirzepatide reduces cardiorenal events in patients with type 2 diabetes and atherosclerotic cardiovascular disease (3). Furthermore, a recent real-world analysis demonstrated a reduction in major adverse limb events with tirzepatide (4), suggesting that it may improve neuropathy.
Free medical clinics across the United States contribute to the broader health care safety net by offering primary care services to the 25.6 million uninsured and underinsured individuals seeking acute and chronic disease management ( 1, 2 ). Diabetes is particularly prevalent among these populations. The Centers for Disease Control and Prevention reported that, between 2019 and 2021, the prevalence of diabetes in people with a family income-to-poverty ratio <100% was 13.1%, compared with 5.1% among those with a family income-to-poverty ratio ≥500% ( 3 ). The stark difference in diabetes prevalence between low- and high-income individuals emphasizes the need to improve equitable health outcomes ( 1 ).
This article describes and evaluates a multipronged strategy to expand use of the Diabetes Prevention Program (DPP) and diabetes self-management education and support (DSMES) services across a large academic health system. Strategies included streamlining referral processes, embedding diabetes educators in primary care, leveraging consistent leadership messaging, and building partnerships with community organizations. These interventions led to substantial increases in referrals, with 10.8% of 4,397 patients enrolling in DPP and 35.9% of 10,210 enrolling in DSMES. Coordinated, multilevel interventions can effectively increase engagement in these underutilized, evidence-based diabetes care programs.
This study explored the immediate concerns of people at the time of type 2 diabetes diagnosis by comparing perspectives from 18 adults with a recent diagnosis and eight clinicians. Four key themes emerged: 1) concerns about diabetes and its management, 2) communication challenges at diagnosis, 3) inconsistent identification of concerns, and 4) discrepancies between clinicians’ actions and patients’ satisfaction. The findings highlight the need for improved communication, longer consultations, and personalized support during diagnosis to enhance patient satisfaction and engagement in care.
This qualitative study explored the self-management behaviors, challenges, motivations, and information needs of low-income people with type 2 diabetes. Four themes emerged: 1 ) low-income adults are navigating behavioral modification amid challenges; 2 ) low-income adults need comprehensive and personalized education for proficient self-management; 3 ) digital health tools are desirable; and 4 ) fear, support, and health aspirations drive self-management engagement. The findings of this study underscore the need for improved clinician awareness of evidence-based diabetes education and support programs and for innovative approaches to bridge the gap between low-income patients’ educational needs and their access to such services.
This article reports on the feasibility and effectiveness of a 12-week program, including a low-calorie diet using a diabetes-specific nutritional formula meal replacement, a digitally enabled self-management app, and coaching, on measurable outcomes of weight, BMI, A1C levels, and blood pressure in adults with type 2 diabetes and excess body weight. Participation in the program reduced body weight by a mean 11 ± 6.5 kg, BMI by 3.7 ± 2.2 kg/m2, A1C by 1%, systolic blood pressure by 4.5 ± 16.1 mmHg, and diastolic blood pressure by 5.8 ± 16.9 mmHg (all P
Prior to the 1940s, type 2 diabetes was considered a rare disease in American Indian and Alaska Native (AI/AN) individuals. However, because of multiple complex factors, it rapidly progressed and became endemic within a matter of decades. Despite community-led interventions to prevent diabetes onset and progression, AI/AN individuals are disproportionately affected by diabetes and remain grossly underrepresented in diabetes treatment research. To provide equitable health care for AI/ANs with diabetes, clinicians should develop an understanding of important socioeconomic and environmental factors that influence health outcomes.
The use of gabapentin, a first-line drug for diabetic peripheral neuropathy (DPN), is limited by its side effects, leading to more frequent use of vitamin B as an alternative. This randomized controlled trial of 237 patients with diabetes and at least probable DPN assessed pain outcomes using the Revised Thai Short-Form McGill Pain Questionnaire, Visual Analog Scale, Present Pain Intensity, and monofilament risk score at baseline and 4 and 12 weeks. Gabapentin showed superior improvement across all measures compared with vitamin B1-6-12 and B12, supporting its role as first-line therapy. However, vitamin B1-6-12 remains a cost-effective alternative with lower side effect, warranting further economic evaluation.
Medication adherence is a barrier to achieving glycemic goals among Medicaid recipients with diabetes. The Diabetes Quality Improvement Program Collaborative recruited 19 primary care practices serving a high volume of Medicaid patients in Ohio with the goal of reducing the percentage of adults with type 2 diabetes with A1C >9.0% through a 1-year intervention. The mean medication possession ratio (MPR) improved from 71.6% during the pre-intervention period to 74.1% at year 1 post-intervention—a relative improvement of 3.4%. Factors associated with a lower MPR included younger age, identifying as non-Hispanic Black or Hispanic, and a pre-intervention A1C >9.0%. Although the initiative modestly improved medication adherence, addressing persistent disparities and expanding prescribing of therapies with cardiorenal benefits will be necessary to improve diabetes outcomes in the Medicaid population.
This randomized clinical trial compared the effects of Ganoderma lucidum and kombucha mushrooms on glycemic control in patients with type 2 diabetes. After the intervention, there were significant differences among the G. lucidum, kombucha mushroom, and control groups in fasting blood glucose, 2-hour postprandial glucose, and A1C. In the G. lucidum and kombucha mushroom groups, these measures all decreased significantly from baseline to after the intervention. The use of both G. lucidum and kombucha mushrooms was effective in glycemic control, and there was no significant difference in effectiveness between the two. Further studies of different doses and longer follow-up periods may clarify the best use of these substances.
It has been my honor to serve as Editor-in-Chief of Clinical Diabetes for the past 9 years and as an Associate Editor for the previous 5 years. The journal has published important research relevant to primary care clinicians in addition to a wealth of practical information to enhance the quality of care for people with diabetes. I am grateful to our many authors, as well as our dedicated Editorial Board, the American Diabetes Association’s (ADA’s) Scholarly Publishing team, and the many peer reviewers who helped us ensure that the material we published was relevant and evidence-based.
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