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Implementation and delivery of group consultations for young people with diabetes in socioeconomically deprived, ethnically diverse settings | BMC Medicine

Diabetes News

Developing good value and life-stage oriented care

Introducing group consultations to the diabetes service in the two hospital implementation sites was not straightforward and required careful local experimentation. The appropriate balance between clinical and educational content became a matter of debate, as clinicians were concerned that the typical group consultations format (with standard one-to-one consultations in a group context) would alienate young people who already had low levels of engagement. Instead, they opted for a flexible approach primarily prioritising group interaction on clinically relevant topics, with individual needs addressed indirectly as part of group discussion, rather than replicating one-to-one consultations in the group setting. This also meant that group consultations were not implemented as a substitute to individual clinics but were used purposefully to augment and re-distribute care; when discussing with peers, young people opened up more than they would with clinicians, which resulted in better recognition of their needs and changed the focus of subsequent one-to-one consultations:

‘…they kind of open up. And they may for the first time accept that they’ve not been taking insulin as recommended, or as advised’ (Interview 25 Diabetes consultant)

Experienced diabetes specialist nurses and other members of the implementation team worked closely with a youth worker, whose contribution was instrumental to developing age- and life-stage appropriate, relationship-based group consultations. The youth worker participated actively in sessions, for example delivering ‘icebreakers’ as a group formation activity and contributing to discussions in a way that would level power dynamics, signifying that group consultations focused on young people’s priorities, rather than purely meeting service or cost-efficiency targets. Clinicians valued youth worker support which allowed them to focus on clinical management without juggling multiple roles for which (in many cases) they had never been trained for (such as facilitating groups of young people).

A typical clinic would start with introductions and an ice-breaker, followed by setting ground rules (see Table 2). Depending on the focus of the session, one or more specialists would join, such as diabetes consultants, dietitians, or psychologists. Topics included healthy eating, blood glucose sensors and measurements, exercise, psychology, sex and healthy relationships, hypos and blood tests, diabetic eye screening and annual review information sessions, sex and healthy relationships, and women’s health, among others.

Although clinicians originally intended for young people to be allocated to specific groups meeting repeatedly and developing long-term relationships throughout the programme, in practice, this proved difficult to sustain and group composition became more fluid. Regular attendees particularly welcomed new participants joining the clinics so they could keep learning from different experiences, but groups also benefited from a certain level of consistency to increase connections between members. The youth worker helped in building affinity quickly between young people who had never met each other so they would open up in discussions and feel supported. At the end of each clinic, participants provided feedback and suggestions for improvement in sessions facilitated by the researcher or the youth worker after clinicians had left the room; this was important for ongoing service co-production (alongside dedicated co-design sessions described elsewhere [30]) to continue meeting patient needs and providing young people with a sense of ownership over this new model of care.

Key challenges in the implementation and delivery of group consultations: staff experiences

Delivering group clinics involved working with uncertainty and managing multiple interdependencies across diabetes care pathways. It was not simply a matter of providing individual care to multiple people at the same time. Group consultations required a different degree, mode and depth of preparation, and engagement by clinicians and young people alike. The transition was gradual and required changes in established practices but also surfaced and challenged deeply embedded ways of thinking about patient-centred care provision.

Table 4 provides examples of how complexity underpinned the work required to deliver group consultations, including the challenges staff encountered. There was little scope for standardising the processes followed, especially at the beginning, when diabetes specialist nurses were learning through trial and error. Yet, the need to manage uncertainty continued throughout the programme; each session had to be treated as unique and required comprehensive preparation to meet changing patient needs and address all eventualities (unpredictable participation, parents attending, etc.).

Table 4 Complexity principles underpinning group clinic delivery, including examples from the study and supporting quotes

Self-organisation underpinned efforts to informally co-ordinate between different clinicians providing one-to-one and group care to young people, in terms of selecting participants for group clinics, understanding their needs, inviting the right experts to contribute, and managing interdependencies with other care processes (e.g. diabetes education, individual appointments) (Q3). In-depth clinical and relational knowledge about young people mattered when deciding how to bring them together and facilitate the sessions so they would benefit most; this knowledge needed to be collectively accumulated and negotiated between different clinicians involved and drawn out of medical records. Informal, improvised, and spontaneous interactions between clinicians enabled ongoing co-ordination, largely driven by the efforts of the diabetes specialist nurses, but also other staff involved (e.g. diabetes consultants, research officer). Other practical and logistical challenges ensued, such as securing seminar rooms, adjusting booking processes, and maintaining continuity with the rest of the diabetes service (Q5).

Formal and informal opportunities were needed for reflection and sense-making, and to support learning within and across implementation sites (e.g. implementation and project meetings, co-design, training sessions). Development of adaptive capability became important for clinicians who were delivering a new model of care highly dependent on human relationships. Group clinics involved the dual challenge of delivering good clinical care and education, while facilitating a group of young people. In some cases, it was important for clinicians to engage in emotional work to support groups where conflict and competition emerged and to ensure outcomes remained positive (Q12). Health professionals drew on their skills consulting with young people, but also attended group facilitation training, held regular debriefs between implementation and clinical teams for ongoing adjustment of the model, and derived significant learning from on-the-job trial and error.

Attendance and young people’s motivations

Despite significant effort, mean attendance was relatively low at 32% for site A and 33% for site B—a challenge already familiar to those delivering young adult services. Local teams had to work creatively to make sessions worthwhile regardless of how many young people ended up attending. Despite suggestions that a ‘good’ session should include 6–8 patients, in practice, the ‘right’ number largely depended on the focus and facilitation mode of each session (e.g. more young people could meaningfully participate in a session about exercise compared to psychology). Larger groups did not always guarantee high levels of contribution; there were successful groups with as many as 4 young people who identified with each other and shared openly.

[…] it seemed to be around sort of three, four, five we were getting [to attend], even though you know, we invited more than twenty patients, within a good amount of time. So I think just trying to make sure a lot of people, or as many people as possible would attend, was the biggest challenge. (Interview 29, Diabetes Specialist Nurse)

An average of 4–5 young people attended each group consultation at both sites. Higher attendance rates were recorded when a small group of selected young people were invited for a specific care-focused intervention, such as flash glucose monitoring follow-up (range of 83–100% in three sessions). Variable attendance rates were observed at broader educational and self-management sessions (e.g. psychological health, healthy eating), especially when there was an open invite to all young people recruited at each site (range of 0–60% in 25 sessions). As group clinics continued, attendance was mostly from those who had attended previous sessions, suggesting group consultations appealed to and continued to attract a specific set of young people (5–6 young people attended 5–10 sessions in site A and 3–4 in site B), but the majority only attended a small number of sessions.

Some young people expressed feeling motivated to participate in group consultations, mainly to meet others with diabetes in their age group. However, others were unable to fit group consultations alongside standard, individual diabetes care and other responsibilities (such as family, education, employment, social life). They also expressed feeling ambivalent or in ‘two minds’ about this new service model as they did not know what to expect or did not feel ready to engage with their condition; some overcame initial fears although others chose not to participate at all.

But yeah, it’s like having a group clinic is so much nicer, in order to meet people. But then on the other hand, I think because you don’t really know them, you don’t have that personal connection with them, you don’t really want to voice out everything that you’re going through. Do you get that? I’m a quiet person, like I wouldn’t tell people what I’m going through if I don’t really know them. So I was in like two minds. (Interview 12, Patient 7—never attended)

If I’m being honest, at the beginning, I didn’t want to come. I did, but I didn’t. I just like – oh, when is it going to be, is it going to be really long, I might not like it. But I still came. And I liked it. I was like ‘okay, this isn’t what I was expecting’. I was not expecting it to be so laid back. I don’t know. It was really comfortable, the setting. (Interview 10, Patient 5—regular attendee).

Not all young people had disclosed their diabetes in their communities and they were unsure how to share deeply personal experiences. There was also an underlying resistance to supporting a new consultation mode if this would mean reducing individual appointments for cost efficiency.

Differences between attenders and non-attenders in implementation sites

In Tables 5 and 6, we present baseline characteristics of the 73 young people recruited in the two implementation settings, comparing those who attended one or more group clinics to those who did not attend any group clinics at each site (further comparisons with participants recruited in control sites are available in the detailed project report [30]).

Table 5 Participant baseline characteristics by attendance group and site
Table 6 Baseline clinical characteristics and questionnaire scores by attendance group and site

At site A, comparing participants who did (N = 23) and did not (N = 27) attend any group clinics, there were no significant differences in sex, ethnicity, deprivation, speaking English as a first language, type of diabetes, or use of technology within the last year (Table 5). Those who attended were on average diagnosed at a younger age (11 vs. 16 years) and more likely to have attended group education sessions in the past (39% vs 7%), with borderline statistical significance (p = 0.033 and 0.053 respectively). There were no statistically significant differences in these variables when comparing attenders (n = 14) and non-attenders (n = 9) at site B.

Comparison of attenders and non-attenders at site A showed no statistically significant differences between these groups when comparing baseline clinical characteristics and questionnaire scores (Table 6). In contrast, attenders at site B had better glycaemic control (mean HbA1C 68 vs. 98 mmol/mol, p = 0.023) and had attended 80 vs. 50% of planned appointments within the previous year (p = 0.009).

Young people’s experiences in group clinics

Young people who attended group clinics (especially repeat attenders) discussed their experiences as predominantly positive: they felt better understood and supported, learnt new things from peers and clinicians, and were better able to normalise diabetes self-care. Only in a few instances did young patients express (initial) reluctance to share clinical details or found peer comparison challenging; in these cases, internal dynamics required careful management by clinicians.

Group clinics provided the opportunity to discuss emotions and frustrations with others going through similar challenges. Young people found peers could understand and identify with their experiences, which made them feel less isolated. They felt better able to engage in open discussion as they gained encouragement from each other when they started to realise how all were struggling to follow clinical recommendations:

F1: How, I just want to ask generally, how are you guys, like those on type 1, how are you guys finding carb counting? How do you get round it, how do you start all up? F2: I’m not going to lie I haven’t been really carb counting. F1: OK I’m glad to [have asked], I mean it’s a bad thing but it’s like I’ve been struggling so much I’m just like I’ve given up with it totally. Are you the same like? F2: (indicates agreement) (Site A, exchange between female patients in Clinic 2)

Being able to explore emotional challenges of living with diabetes was repeatedly mentioned as a key aspect of positive experiences in group clinics, compared to individual appointments, where young people expressed reluctance to voice their difficulties:

The one-to-one is more personalised, scientific. […] Where [the group clinic] is more lifestyle based. It’s more about how to live with your diabetes, rather than just manage it […] With the doctor, I kind of want to just get it over and done with really quickly, and then just go. So I wouldn’t, I don’t try to ask as many questions or I just forget. (Interview 27, Patient 16)

One of the young people with type 2 diabetes did express feeling alienated initially, in a clinic where everyone else had type 1 diabetes, but then explained: ‘it was [a] very welcome [environment] so, feelings of being left out didn’t last too long to be honest’ (Interview 24, Patient 15)

Another participant suggested that they felt less comfortable with individual appointments because they perceived them as ‘professional’—which at their life stage seemed alienating, as they were unsure how to navigate the rules of engagement and match them with their own priorities.

Social and situated learning emerged through a combination of patient input and clinical advice (e.g. on alternating injection sites, ketone testing or avoiding hypos), carefully facilitated by the diabetes specialist nurses who ensured young people gained insight without feeling judged or criticised. Learning emerged both for those newly diagnosed and for those diagnosed at a younger age, who had been looked after by their families and were only just beginning to learn how to care for themselves independently. Clinicians were surprised that young people had not already acquired this learning through individual appointments on similar topics.

Patient participants talked about how group discussions with peers helped them think about their diabetes differently and normalise their experiences through getting to know how others approached their self-care. This even resulted in some feeling more confident and comfortable with their condition to the extent they started disclosing to their workplace and friends:

[…] within the workplace I would never tell people that I’ve got diabetes, and stuff like that. Now, the other day I was speaking to my friend about where I should be injecting, where I shouldn’t be injecting. Feel like now I’m a bit more confident and comfortable with it. (Interview 13, Patient 8)

There was, however, some reluctance to share clinical details considered private (e.g. glucose levels) or have test results displayed on the computer screen for discussion. Others were not always prepared to discuss self-care aspects they were struggling with or to manage a group discussion that might have led to sharing beyond what they were comfortable with, so chose to control their contributions. For those newly diagnosed, comparison with peers was not always motivating, especially when they were comparing themselves with others doing worse:

And so what I was thinking is that would it get to a stage where it’s going to be hard for me to manage my diabetes. Yeah, it definitely did freak me out a bit, yeah. (Interview 14, Patient 9)

Costs of group consultations and health care

The average staff costs for setting-up and delivering group consultations were similar across the two implementation sites (£572 for site A and £545 for site B) (Additional file 1: Tables 1a and 1b). The average cost of clinic per participant was marginally higher in site A (£158) compared to site B (£127), due to poorer attendance in the former (average number of participants was 3.7 for site A versus 4.5 for site B) (Additional file 1: Table 2). The study participants attended on average 3.6 out of 5.9 scheduled appointments per year, including consultations with a diabetes doctor, diabetes specialist nurse, dietician, and psychologist. The average annual cost of scheduled care was £723 per patient per year. The study participants had on average 3.9 unscheduled contacts per year including A&E visits, hospital admissions, and contacts with general practitioners and diabetes specialist nurses. The average annual cost of unscheduled care was £2566 per patient (Additional file 1: Table 3).

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Steven Adams, Anika Moa urge support for teen’s diabetes campaign

Diabetes News

Basketball star Steven Adams and singer Anika Moa are backing a Tauranga teenager’s campaign after he petitioned the government to fund lifesaving equipment for New Zealanders with type 1 diabetes.

Posting a photo of his nephew Kepaleli, the NBA player urged people to sign the petition to fund lifesaving monitoring equipment.

The petition, set up by 16-year-old Toby Good, aims to secure Continuous Glucose Monitoring (CGM) technology for the 26,000 children and adults living with type 1 diabetes in Aotearoa.

* Pharmac ‘procrastinating’ over funding glucose monitors, Diabetes NZ says
* Wellington teen with type 1 diabetes raises thousands for unfunded glucose monitor for children
* Difference between Type One diabetes and Type 2 diabetes explained

Adam’s nephew Kepaleli, the son of his Olympian sister Dame Valerie Adams, was diagnosed with type 1 diabetes in 2020. Adams has spoken about how the CGM device helped their family.

“When we came home, it felt like we had a newborn baby – that same sense of nervousness and paranoia,” he said. “We were up every hour pricking his finger, it was awful.

“A couple of months down the line, we discovered a device we could attach to Kepaleli, letting us get his blood glucose readings on our phones just so we’re not constantly causing him pain. We’re now close to two years in, and we’ve become more relaxed about Kepaleli’s condition.”

Singer Anika Moa also urged people to sign the petition after explaining how it had helped her battle the condition.

Steven Adam’s nephew Kepaleli was diagnosed with type 1 diabetes in 2020.


Steven Adam’s nephew Kepaleli was diagnosed with type 1 diabetes in 2020.

“My life completely changed on the day I was diagnosed with type 1 diabetes,” said Moa. “My symptoms were so obvious but not to me, who didn’t even understand what kind of f****d up autoimmune disease I had.

“With the help of my CGM monitor/Dexcom 6 and the diabetes specialists, it has helped me wake up (most) days happy, healthy and feeling loads better than a year ago.

“So please, please, please – if you have time today, sign this petition to get CGM’s funded. It literally saves lives. I want all our kids in Aotearoa to be able to get these free.”

Toby Good, who has type 1 diabetes himself, said CGM devices saved lives by warning users when blood glucose levels were dangerously high or low.

“They reduce the burden on individuals, families, and the health system and improve overall health outcomes,” said Good.

Despite being funded in many countries, including Australia, Canada and the UK, Pharmac does not currently fund the monitor.

“Costs of the device make it unaffordable for many families,” said Good. “People care about this. I never asked for type 1 diabetes. The condition has no known cause or cure. What I do know is that the CGM has saved my life, several times.”

Anika Moa.

Nicky Claridge

Anika Moa.

Good said thousands of New Zealanders had already signed the petition.

”It’s great that Steven Adams, Val Adams and Anika Moa have backed our cause,” he said. “We can’t wait any longer. Lives are at risk. It’s not fair.”

Good’s mother, Lavina Good, said that while she was able to pay for the device for her son, many people were missing out.

”Pharmac just needs to read the comments on Toby’s petition,” she said. “They say it all. One mother said its insane she has to find $389.50 a month to give her son a chance.

“Many families just can’t do that. This is an incurable, life-threatening disease with reasonable outcomes only for those with resources. It is morally wrong.”

Diabetes New Zealand have previously said Pharmac needed to “stop procrastinating” over funding of the monitors.

Pharmac’s director of operations, Lisa Williams, said there were two CGMs on their options for investment list that it was considering funding.

“We are also reviewing our approach to the assessment of diabetes technologies, ensuring we are considering emerging evidence and applying this consistently across all currently open funding applications,” said Williams.

Pharmac director of operations Lisa Williams.


Pharmac director of operations Lisa Williams.

“Unlike other countries, Pharmac works within a fixed budget, which means that we need to make difficult choices about which items to fund within the available budget.

“To achieve the best health outcomes, we have to prioritise our decisions. This prioritisation is dynamic, and we must take the time to consider various ways in which funding (or not funding) a medicine would impact New Zealanders.

“Because of this, we cannot provide a definitive timeframe for if or when medicines will be funded – something we know can be difficult to hear.”

In May 2022 the government announced a $191 million budget increase for Pharmac over 2022/23 and 2023/24 to spend on pharmaceuticals.

“We are currently working our way through our options for investment list, negotiating agreements with suppliers,” said Williams.

“So far this year (July 1, 2022 – June 30, 2023), Pharmac has funded 12 new treatments and widened access to 17 medicines, and we hope to fund many more treatments over the coming 12-to-24 months.”

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Health officials host diabetes screenings, vaccination clinic at Acrisure Stadium

Diabetes News

PITTSBURGH (KDKA) – Healthy players on the field and healthy fans in the stands.

The Steelers teamed up with area health officials to make sure the black-and-gold nation is protected against all illnesses, including diabetes.

As quickly as you can say “Go Steelers,” fans at today’s game can be screened for diabetes.

“It’s simple. It’s a finger stick,” said Nick Vizzoca, president of the Center for Healthcare Solutions. “We check their A1C levels, right on the spot. We give them the information and they’re good to go.”

So, before focusing on T.J. Watt’s return to the turf or Kenny Pickett’s ongoing quest for his first NFL win, the Healthcare Council of Western Pennsylvania is hoping people take a second to focus on their health.

“They feel good, and a lot of people with diabetes do feel good. And don’t realize that they have it,” Vizzoca added.

In Pennsylvania alone, experts estimate about 300,000 people have the disease and don’t even know it.

To show you just how easy screening is, KDKA’s very own Chris DeRose got a quick check-up.

First, the paperwork.

“I feel like I’m about to get my nails done,” said DeRose.

Then the prick.

“That wasn’t too bad.”

Minutes later, the results.

“82 is a really good number! So, you have a low risk for diabetes!”

“That’s awesome!”

“Hopefully, we don’t find anybody with diabetes, but if somebody does, we’ll take the action to make sure they get the care they need,” said Vizzoca.

Giant Eagle pharmacists were also on-hand before the game to administer flu and covid-19 shots.

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Diabetes indicators improve with use of health incentives, CDC study finds –

Diabetes News

Incentivizing patients to follow a lifestyle modification program helps them improve across a range of diabetes-related health measures, a new meta-analysis has found.

Investigators performed what they said is the first systematic review and meta-analysis to examine the effect of incentives on diabetes-related health indicators when patients participate in lifestyle modification programs. 

The researchers analyzed data from 19 randomized controlled trials. Relative to a control group, the incentive group had significant reductions in weight, and both systolic and diastolic blood pressure. One study found a significant reduction in hemoglobin A1c. A reduction in cholesterol level was also noted but was not significant. 

Six incentive-related domains were also studied. These included type of incentive, monetary value, recipient of the incentive (such as individuals, groups or a combination of both), frequency of incentives, certainty of incentive attainment and schedule (how the amount of the incentive was provided to recipients during the study period). 

Incentive effects

When incentives were provided, the meta-analysis showed patients experienced a nearly 2 kg greater weight loss and a significant reduction in BMI compared to no incentive, reported the authors, including researchers from the Centers for Disease Control and Prevention. 

“This finding has important health implications considering that a large study reported a 16% reduction in diabetes risk for every kilogram of weight lost, and others have shown that weight loss in conjunction with a lifestyle modification program can lower the risk for cardiovascular disease,” they wrote.

Incentives were also shown to be effective for reducing systolic and diastolic blood pressure. Those findings suggest a benefit for programs that seek to help participants achieve ideal blood pressure goals, such as less than 140/90 mm Hg, the authors said. This would be especially helpful for programs associated with chronic disease prevention and management, they added. 

Incentive type

Type of incentive did not appear to have an outsized effect on the positive results. “Therefore, it seems reasonable for lifestyle modification programs to use a variety of incentive domain subgroups,” the authors concluded.

Adults aged 65 years and older make up approximately 40% of the adult diabetic population, according to federal data from 2018. In nursing homes, the prevalence of diabetes is estimated to range from 25% to 34%. 

The current study was published in the CDC’s journal Preventing Chronic Diseases.

Related articles:

NIH: Two drugs most effective in treating type 2 diabetes

Overtreated diabetes raises hypoglycemia risk in nursing homes, investigators say

Contested insulin therapy remains common in nursing homes: study

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Diabetes testing clinic seeks to help at-risk Winnipeggers

Diabetes News

Maples residents were checking up on their health Saturday afternoon at a diabetes testing clinic targeting Winnipeggers of South Asian descent.

The pop-up clinic, operating out of the Maples Community Centre, offered free A1C testing from Dynacare. The test helps determine if you are at risk of type 2 diabetes.

“There’s currently 412,000 Manitobans that are living with or at risk for diabetes … and so we’re here to create awareness in the south Asian and Sikh communities today,” said Kelly Lambkin, Senior Manager of Community Fundraising and Events for Diabetes Canada.

November is diabetes awareness month. Lambkin said some people are more at-risk than others when it comes to developing the disease.

“High-risk populations include our Indigenous populations, our south Asian populations, our African/Caribbean as well,” she said.

Participants at the clinic underwent several tests, including blood pressure and BMI. The process finished with the A1C blood test, which averages your blood glucose over a three month span.

Test results will be mailed out to participants and their primary health care provider. Lambkin said the campaign is already a success.

“This is our fifth year for hosting this campaign. Our goal is to test 50,000 Manitobans, each year we’ve exceeded our goal we plan to do that again this year,” said Lambkin.

“It is so critical to assess your risk for diabetes,” she said. “Diabetes is a progressive disease, so as soon as you identify those risks, it could delay complications in the future.”

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Health Foundation gives 10 grants under Diabetes Initiative

Diabetes News

EL PASO, Texas (KTSM) – The Paso del Norte Health Foundation recently awarded 10 grants totaling more than $1 million under the Disease Prevention & Management priority area and Diabetes initiative.

The Health Foundation works in partnership with organizations to implement initiatives and programs for diabetes prevention, early detection, and management in the region.

The following are those awarded:

  • Centro Familiar para la Integracion y Crecimiento, A.C. – $41,472.00 Aprende a cuidar de ti – To provide a diabetes education pilot program to 80 people in Ciudad Juárez, MX.
  • El Paso Diabetes Association, Inc. – $209,774.40 Diabetes Education – To offer Diabetes Self-Management Education and Support plus two kids camps in El Paso, TX.
  • New Mexico State University Foundation, Inc. – $25,811.13 On the Road to Living Well with Diabetes – Otero – To offer the On the Road to Living Well with Diabetes program to 100 residents of Alamogordo, Chaparral, Tularosa, Dona Ana County, and other Southern New Mexico communities.
  • New Mexico State University Foundation, Inc. – $8,800.00 One-hour diabetes literacy presentations – To plan instructional media to support diabetes awareness across the Paso del Norte region.
  • Paso del Norte Health Information Exchange – PHIX – $225,750.00 Diabetes Prevention and Management: Data and Referrals – To increase utilization of a closed-loop referral system for diabetes related services and lead the diabetes data workgroups in El Paso, TX.
  • Project Vida Health Center – $49,720.00 Diabetes Prevention Program – To provide a Diabetes Prevention Program to 60 people in El Paso, TX.
  • Texas A&M University – $218,784.50 Project VyBE – To train 30 Community Health Workers as diabetes education coaches and have a minimum of 200 individuals complete diabetes education in El Paso County, TX.
  • Texas Tech Foundation, Inc. – $114,944.00 Diabetes and the Dentist: Early Diabetes Detection, Education and Referral – To develop and pilot test a diabetes screening and referral program at the Texas Tech Dental Clinic in El Paso, TX.
  • The University of Texas at El Paso – $125,147.00 UTEP BBRC Community Health Workers led diabetes intervention capacity building – To train 30 Community Health Workers to deliver the five-week intervention, “On the Road with Diabetes” to 300 participants in El Paso County, TX.
  • The University of Texas at El Paso – $33,790.00 Diabetes Prevention Education Program for Community Outreach – To develop a one-hour diabetes awareness program, prepare at least 20 public health students to deliver, the program, and offer the program at least 60 times to groups in El Paso, TX.

November is National Diabetes Month. Diabetes is a disease that occurs in adults and youth when the blood glucose, also called blood sugar, is too high. This disease can damage the eyes, kidneys, nerves and heart, and is linked to some types of cancers.

According to the El Paso Center for Diabetes, an estimated 9.4 percent of the U.S. population has diabetes, making it the seventh leading cause of death. In El Paso, the prevalence of diabetes outpaces the national numbers, with 13.9 percent of adults, or about 94,000 El Pasoans, living with diabetes.

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Food Insecurity, Diabetes, and Cardiorenal Syndrome

Diabetes News

​​​​​​In this podcast, Sri Banerjee, MD, PhD, MPH, MAS, speaks about his research on the association between food insecurity, cardiorenal syndrome, and all-cause mortality among low-income adults in the United States, including why there is limited data on food insecurity and chronic disease, and ways clinicians can screen for food insecurity. 

Additional Resource:

Sri Banerjee, MD, PhD, MPH, MAS, is a faculty member at Walden University in the School of Health Sciences. He is a clinical biostatistician and an epidemiologist in Leola, Pennsylvania. 

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Omaha, NE Diabetes Doctor For Type 2 Expert Consultations Service Update

Diabetes News
Omaha, NE Diabetes Doctor For Type 2 Expert Consultations Service Update

Omaha, NE Diabetes Doctor For Type 2 Expert Consultations Service Update

Diabetes specialist Dr. Chris Driscoll and the team at Omaha Integrated Health (+1-402-816-2738) have announced an updated range of services for patients in Omaha and the surrounding areas.

October 24, 2022 – At Omaha Integrated Health, patients are now able to make an appointment with a functional medicine Omaha diabetic doctor that specializes in reversing Type 2 Diabetes.

Interested parties can learn more at

The announcement comes as diabetes is quickly becoming one of the most widespread diseases, affecting over 400 million people globally. One in four people are predicted to experience the illness at some point in their lifetime. Despite this high number, a lot of people go undiagnosed or get the wrong diagnosis. When they do receive a correct diagnosis, they immediately learn that controlling their diabetes can be an impossible task. This may lead to serious health consequences like blindness, neuropathy, renal failure, heart failure, amputation of limbs, and death.

When the body does not properly control or utilize sugar (glucose) for energy, type 2 diabetes develops. Immune, neurological, and circulatory system disorders might occur when blood sugar levels are too high, explains Dr. Chris Driscoll, D.C., chief clinic director at Omaha Integrated Health.

The two main issues that contribute to blood sugar levels rising are insulin resistance in the body’s cells increasing with time (the hormone responsible for moving sugar into the cells). The pancreas may have trouble producing the necessary quantity of insulin as the condition worsens. In either scenario, the inability of carbohydrates to enter cells leads to elevated blood sugar levels. Blood sugar levels that are too high cause havoc in the body, harming important organs and eventually leading to organ failure, he adds.

Although advice like modifying one’s diet, getting in shape, and exercising can be helpful, it depends on each individual’s situation because different factors contribute to diabetes in different people. Each patient has a unique set of underlying issues that contribute to the progression of their diabetes.

An expert in functional medicine and diabetic care, Dr. Chris Driscoll has extensive experience working with patients as part of Omaha Integrated Health. Dr. Driscoll assists diabetic patients in lowering their blood sugar levels. He accomplishes this by treating the disease’s underlying causes, enabling his patients to reverse Type 2 diabetes and avoid the related health problems that frequently accompany diabetes.

A spokesperson for the company said: “Each patient has diverse underlying reasons that contribute to the progression of their diabetes and that the medical community appears to neglect. These issues are not being addressed well, if at all. To find out what is wrong with a patient’s body and why they are no longer healthy, we will schedule a follow-up full evaluation and lab work if it is decided that they are a good candidate. A personalized healthcare strategy tailored to their body’s requirements will subsequently be developed. We provide natural remedies as well as other options and information to assist patients to find the best-personalized approach to lower their blood sugar levels and restore health to their body without using risky, side-effect-filled medications.”

For more information and to schedule a consultation, visit:

Media Contact
Company Name: Omaha Integrated Health
Contact Person: Dr. Chris Driscoll
Email: Send Email
Phone: 402-816-2738
Address:13906 Gold Cir Suite #200
City: Omaha
State: NE
Country: United States

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Diabetes patient persists on hospice care without medication |

Diabetes News


CUSTOMER SERVICE: (800) 708-7311 EXT. 236

TO YOUR GOOD HEALTH #12345_20221109


BYLINE: By Keith Roach, M.D.

TITLE: Diabetes patient persists on hospice care without medication

DEAR DR. ROACH: My dad has been on hospice care for several months now. He had an untreated wound infection that was not responding to meds, so he went on hospice. Also, his wife died, and he lost the will to live after that.

His sugars are well into the 400s. He is on pain meds and nothing else. His doctor says he should not have lasted this long, medically speaking. He gave me no other explanation except a shrug. His spirits are OK, but I fear something else will get him in the end, like bed sores, pneumonia, a fall or COVID. Is it normal for a diabetes patient who no longer takes their medication to linger like this? He is not suffering per se, but quality of life is not good either. — H.D.

ANSWER: The goal of hospice care is to provide comfort to a person in the last phase of their life. If your father was thought by his physician to have a condition that was likely to end his life (normally, an expectation of end of life coming within six months is a necessary condition for hospice care), and he made up his mind to choose this option (and understood the consequences of that action), then hospice is a reasonable choice.

Elevated blood sugars in people in hospice care are common. They are often not treated, as they usually do not cause symptoms. Elevated blood sugars over months (or years) predispose people with diabetes to complications, including infection, heart disease and stroke, but in a person in hospice care, these considerations are less important than the overall goal of reducing suffering. Medications are given orally whenever possible and, again, only to relieve symptoms.

Something will indeed “get him in the end,” as it will for all of us. People in hospice care have accepted that. It can be hard for family members, especially when there is not an immediately terminal disease like cancer associated with the hospice care.

DEAR DR. ROACH: My wife was just diagnosed with Paget’s disease of the breast. Is it true that surgery is the only option for treatment? We’ve never heard of this condition. The biopsy shows no cancer beyond the nipple area. — B.W.

ANSWER: Paget’s disease of the breast is an uncommon type of breast cancer almost only ever found in women (the more common type of breast cancer is found in men about 1% of the time, but PDB is extremely rare in men). The disease looks like a scaly or raw lesion on the nipple, which usually spreads to the areola around the nipple. Most women have itchiness, pain or burning, which often starts before — often months before — any skin changes. A careful exam and mammogram should be performed by an expert in women with symptoms of PDB, or with something abnormal she can see or feel on the nipple. The prognosis is much better in women who do not have a mass that can be felt on exam.

Surgery is almost always part of the treatment plan. Depending on the stage of the disease, some women will need a mastectomy, but in some cases, women can be treated with breast-conserving surgery (also called “lumpectomy”) followed by radiation treatment. There is no standard recommendation on medications, such as tamoxifen, in the treatment of PDB.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to or send mail to 628 Virginia Dr., Orlando, FL 32803.

(c) 2022 North America Syndicate Inc.

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Can people with diabetes enjoy dessert from time to time? Experts weigh in

Diabetes News

BATON ROUGE, La. (BRPROUD) – According to one estimate, approximately 505,468 people in Louisiana, or 14.2% of the adult population, have been diagnosed with diabetes.

It’s common knowledge that most people with diabetes are cautious about how much sugar they consume. This is because the disease impacts the body’s ability to produce or respond to a hormone called insulin, which is key in regulating the metabolism of sugars and carbohydrates.

That said, experts say there are safe ways for people with diabetes to satiate sugar cravings.

Articles from sources such as Everyday Health suggest:

  • Allow yourself an occasional treat, but plan for it– According to registered dietitian Karen Lau, “Make sure the meal is balanced with other foods. Cut out carbs from the main dish, and save it for dessert instead.” This can mean skipping bread, pasta, or potatoes so you can eat a small serving of dessert.
  • Say ‘yes’ to fruit, in moderation– Instead of satisfying sugar cravings with processed foods, opt on fruit. That said, fruits do have carbohydrates, meaning you’ll still need to adapt your meal plan. But a small serving of fruit is typically feasible. One source suggests considering fruits with 15 grams of carbohydrates such as: one small apple, one small orange, one very small banana, 1/2 grapefruit, 3/4 cup of blueberries/blackberries/pineapple, one cup of raspberries or melon, 1 and 1/4 cup of whole strawberries.
  • Take a few bites and make them lastSome healthcare experts recommend splitting a piece of cake with a friend or having half of a large cookie instead of the whole thing. This works best when a person eats with mindfulness, meaning they eat more slowly and take the time to savor the tastes they’re enjoying.

Living with diabetes does not necessarily require assigning all desserts to a death sentence. Instead, by planning meals with care, swapping out processed sweets for fruits, keeping dessert portions small, and slowing down to savor each bite of the treat, individuals with diabetes may still be able to enjoy some of their favorite sweets.

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