Social Care Recommendations in National Diabetes Treatment Guidelines

Abstract

Purpose of Review An expanding body of research documents associations between socioeconomic circumstances and health outcomes, which has led health care institutions to invest in new activities to identify and address patients’ social circumstances in the context of care delivery. Despite growing national investment in these “social care” initiatives, the extent to which social care activities are routinely incorporated into care for patients with type II diabetes mellitus (T2D), specifically, is unknown. We conducted a scoping review of existing T2D treatment and management guidelines to explore whether and how these guidelines incorporate recommendations that reflect social care practice categories. Recent Findings We applied search terms to locate all T2D treatment and management guidelines for adults published in the US from 1977 to 2021. The search captured 158 national guidelines. We subsequently applied the National Academies of Science, Engineering, and Medicine framework to search each guideline for recommendations related to five social care activities: Awareness, Adjustment, Assistance, Advocacy, and Alignment. The majority of guidelines (122; 77%) did not recommend any social care activities. The remainder (36; 23%) referred to one or more social care activities. In the guidelines that referred to at least one type of social care activity, adjustments to medical treatment based on social risk were most common [34/36 (94%)]. Summary Recommended adjustments included decreasing medication costs to accommodate financial strain, changing literacy level or language of handouts, and providing virtual visits to accommodate transportation insecurity. Ensuring that practice guidelines more consistently reflect social care best practices may improve outcomes for patients living with T2D.

Clinical Care Adjustments Based on Socioeconomic Adversity

“…Although many care guidelines recognize the impact of social needs on pediatric health outcomes, they now need to suggest concrete, evidence-based recommendations about how to change care for children experiencing these barriers and can follow the examples set forth for adult populations with diabetes mellitus and hypertension. 8,9 Using updated guidelines, clinical decision support tools in electronic health records can then combine information from patients' social histories and medical histories to routinely recommend clinical care adjustments, such as lower cost and nonrefrigerated medications or follow-up care that accommodates transportation or digital access barriers, so that all encounters become opportunities to ensure pediatric care meets the needs of families experiencing socioeconomic barriers to health promotion and disease management. 10 Finally, to enable research and facilitate ongoing learning about what interventions lead to better child health, pediatric clinical teams must develop workflows to document both social risks and interventions taken to either reduce or mitigate the impacts of those risks on health.…”

“…Second, clinical care adjustments must be actively incorporated into pediatric care guidelines, and those guidelines should then be systematically disseminated using clinical decision support tools. Although many care guidelines recognize the impact of social needs on pediatric health outcomes, they now need to suggest concrete, evidence-based recommendations about how to change care for children experiencing these barriers and can follow the examples set forth for adult populations with diabetes mellitus and hypertension . Using updated guidelines, clinical decision support tools in electronic health records can then combine information from patients’ social histories and medical histories to routinely recommend clinical care adjustments, such as lower cost and nonrefrigerated medications or follow-up care that accommodates transportation or digital access barriers, so that all encounters become opportunities to ensure pediatric care meets the needs of families experiencing socioeconomic barriers to health promotion and disease management …”