· Executive Brief
American Diabetes Month 2026
Move from recognition activity to a visible operating route with named owners and closed loops.
Leadership signal
Use American Diabetes Month to examine the system behind the message.
Leaders can use this window to test whether public information, service entry points, internal referrals, and follow-up responsibilities form one understandable route. The review should start with the experience of people using the system and the teams responsible for receiving them.
Start by distinguishing what is known from what the organization still needs to learn. A campaign plan, communication volume, or meeting count does not establish that a route is usable. Leaders need direct listening, clear ownership, locally defined measures, and a method for keeping exceptions visible.
Executive opening
Diabetes care is a chain of handoffs, not a single visit
American Diabetes Month arrives while many health systems still manage diabetes as a series of separate encounters. The research gathered here points to a different frame. Outcomes depend on whether testing, education, medication access, outreach and community support connect into one route that people can actually finish. When one link is weak, people drift out of care quietly, and the loss rarely appears on a single report.
Those losses are measurable. In a national survey of 2,528 U.S. adults with diagnosed diabetes, severe hyperglycemia rose from 5.6% before the COVID-19 pandemic to 8.5% during it.[5] Among adults aged 19 to 64 enrolled in Medicaid from 2016 to 2023, only 5.6% had ever received a diabetes self-management education and support encounter.[3] Population-average out-of-pocket costs for glucose-lowering drugs fell 46% from 2000 to 2022, yet newer agents and analog insulin still carried higher costs.[4]
The encouraging news is that operational redesign has evidence behind it. In a randomized trial at three Texas community clinics, community health workers worked with clinicians through a structured feedback loop.[10] Over 12 months, HbA1c fell by a net 1.0 percentage point compared with usual care.[10] A patient portal tool that let people initiate overdue diabetes services addressed 47 of 110 care gaps in a small pilot.[1] The same research shows where routes leak. A cardiology alert fired for 134 eligible patients, yet only 19.4% started a recommended medication.[8]
This brief adds that evidence to the executive guidance already on this page. It looks at burden, continuity, access, equity, the human workforce and public communication. Each section points leaders toward questions about ownership and completion rather than activity counts. The goal is a diabetes route that people can enter, navigate and complete with fewer losses at each handoff. The executive question is not whether diabetes matters, but whether the organization can show that each flagged need reached a completed step.
Current evidence
What the research says about control, cost and unfinished care
Glycemic control in the United States has stalled rather than improved. In nationally representative data, glycemic control among adults with diagnosed diabetes was 59.7% before the pandemic and 56.1% during it.[5] That difference was not statistically significant. Over the same comparison, severe hyperglycemia increased significantly.[5] It was more common among Hispanic or Mexican American adults (adjusted odds ratio 2.62) and non-Hispanic Black adults (adjusted odds ratio 2.80).[5] A stable average can hide deterioration at the high-risk end of a population. Governance reviews should therefore track the share of patients at very high HbA1c alongside the share at goal, stratified by race and ethnicity.
Cost remains a structural barrier even as average spending falls. National survey data linked to pharmacy-verified records showed population-average out-of-pocket costs for glucose-lowering medications declined 46% between 2000 and 2022.[4] Newer agents and analog insulin kept higher out-of-pocket costs while their uptake surged, and differences between subgroups persisted.[4] The authors conclude that high-cost newer therapies continue to impose financial burdens that may limit equitable access.[4] Coverage alone does not close the gap. A meta-analysis of 12 U.S. studies found insurance was associated with a higher likelihood of HbA1c testing, but associations with blood pressure control, eye examinations and LDL cholesterol control were not statistically significant.[7]
Many gaps are not clinical mysteries but unfinished tasks. In an integrated health system in New York, outreach campaigns from 2021 to 2023 addressed 50,145 preventive care gaps among 41,959 eligible people.[2] Phone outreach achieved higher compliance than chatbot or multichannel outreach across most groups and years.[2] The exception was diabetes care in 2023, when chatbot messages outperformed phone calls (odds ratio 1.81).[2] Channel choice, in other words, is a modifiable operating decision. The study also examined demographics, primary care relationships and social vulnerability alongside channel, a useful template for internal analysis.[2]
Detection without linkage produces little value. A systematic review included 17 studies of cardiometabolic screening programs in low- and middle-income countries.[14] Approximately 40% of those screened were classified as high risk for diabetes.[14] Yet preventive service uptake ranged from 15% to 58%, and confirmatory testing was as low as 22%.[14] Community health worker-led programs in that review showed greater than 90% sensitivity and specificity compared with clinician assessment.[14] The lesson applies to U.S. systems as well. A registry flag or screening result is only the first step of a route that someone must own through completion.
Figure 1
Diabetes routes lose people between flag, referral and completion
Percent of eligible patients or care gaps reaching a pathway step, as reported in each study. Values are copied from the cited studies [1], [3], [8], [9]; none is estimated.
Data note. These values come from different studies, populations, settings and definitions of completion, so this is an indirect comparison; the bars show where diabetes routes leak, not which intervention performs best.
Limitation. Each value reflects its own denominator; the Medicaid figure counts ever-use over several years, while the other three measure single steps in small single-program studies.
Figure data (4 rows)
| Measure | Value | Population, setting and year as reported | Source |
|---|---|---|---|
| Ever received a DSMES encounter | 5.6% | Adults aged 19 to 64 with diabetes in Medicaid, 2016 to 2023, N = 3,735,182 | [3] |
| Attended DSMES within three months of a pharmacy referral | 11% | 161 patients with three-month follow-up, 19 New York community pharmacies, 2021 | [9] |
| Started a recommended medication after a cardiology alert | 19.4% | 26 of 134 eligible patients with type 2 diabetes and atherosclerotic cardiovascular disease, one academic medical center | [8] |
| Care gaps addressed through patient-initiated portal orders | 43% | 47 of 110 care gaps among 50 adult primary care patients, single-arm pilot at an academic medical center | [1] |
Continuum of care
Where diabetes care breaks between visits, specialties and services
Handoffs between specialists and primary care are a common point of loss. At one academic medical center, an interruptive alert during interventional cardiology visits sent an automated message to the primary care clinician recommending a cardioprotective diabetes medication.[8] The alert fired for 134 eligible patients with type 2 diabetes and atherosclerotic cardiovascular disease.[8] Primary care clinicians addressed it for 61 patients (45.5%), and 26 patients (19.4%) started a recommended medication.[8] Medication cost was the most frequently documented reason for not starting therapy.[8]
That pattern describes a route in which the signal travels but responsibility does not fully transfer. The sending clinician acted and the message arrived, yet most cases did not reach a completed change. Leaders reviewing similar alerts should examine acknowledgment and completion, not only whether the prompt fired. The same question applies to referrals for education, eye care and pharmacy services that leave primary care.
Patients can carry part of the handoff when systems give them a usable tool. In a three-month pilot at an academic medical center, 78% of 50 primary care patients with diabetes initiated or reported care through a portal-based care gap tool.[1] Of 110 total care gaps, 47 (43%) were addressed through patient-initiated orders, and 79% of those ended in completed care.[1] Participants also described unease rooted in limited portal confidence, a reminder that digital routes still need human backup.[1] Users also showed improved diabetes self-efficacy and reduced distress during the pilot.[1]
Continuity also depends on how programs adapt when access is disrupted. A federally qualified health center serving a predominantly Hispanic community moved family-focused self-management education to hybrid virtual and in-person sessions led by community health workers.[13] Enrollment was lower after the switch than before (23% vs 30% of those recruited), but attendance rose slightly for patients in the family-focused arm and for their support persons.[13] Patients who chose virtual attendance were more often female, living with children and facing food insecurity.[13]
Operational leaders can treat each of these routes the same way. Every flag, alert or referral needs a receiving owner, a visible status and a defined completion signal. The gap between a sent message and a finished change can be wide, and it stays invisible unless someone measures it.
Figure 3
Why the pathway breaks
People
- Community health worker and pharmacist roles not linked to a receiving clinician
- Limited portal confidence among patients
- Language barriers for Spanish-speaking participants
Process
- Specialist recommendations sent to primary care without acknowledgment or completion tracking
- Referral to DSMES without scheduling support
- Outreach channel not matched to population or care gap
Technology
- No device or internet access for virtual education
- Alerts that fire without a closed loop
- Health information exchange data unavailable at the point of referral
Environment
- Counties without a DSMES supplier
- Transportation and scheduling barriers
- Food insecurity and competing family demands
Policy
- Higher out-of-pocket costs for newer agents and analog insulin
- Coverage that improves testing but not control
- Uneven DSMES access across state Medicaid programs
Measurement
- Reporting average control while severe hyperglycemia rises
- Program evaluations focused on clinical outcomes alone
- Utilization data affected by coding and completeness
Unranked qualitative cause-and-effect diagram for the outcome in the box: People with diabetes who are flagged for a care gap, education or a therapy change do not complete the next step Causes are assembled from the cited literature [1], [2], [3], [4], [5], [7], [8], [9], [11], [12], [13], [15]; categories are not weighted and their order carries no meaning.
Data note. Qualitative; no frequencies are implied.
Limitation. Causes drawn from published studies may not all apply locally; validate them with frontline teams.
Figure data (6 rows)
| Category | Causes drawn from the cited literature |
|---|---|
| People | Community health worker and pharmacist roles not linked to a receiving clinician; Limited portal confidence among patients; Language barriers for Spanish-speaking participants |
| Process | Specialist recommendations sent to primary care without acknowledgment or completion tracking; Referral to DSMES without scheduling support; Outreach channel not matched to population or care gap |
| Technology | No device or internet access for virtual education; Alerts that fire without a closed loop; Health information exchange data unavailable at the point of referral |
| Environment | Counties without a DSMES supplier; Transportation and scheduling barriers; Food insecurity and competing family demands |
| Policy | Higher out-of-pocket costs for newer agents and analog insulin; Coverage that improves testing but not control; Uneven DSMES access across state Medicaid programs |
| Measurement | Reporting average control while severe hyperglycemia rises; Program evaluations focused on clinical outcomes alone; Utilization data affected by coding and completeness |
Access
Making education, medication and support reachable
Diabetes self-management education and support (DSMES) is one of the most underused services on the diabetes route. In national Medicaid claims covering 3,735,182 adults with diabetes from 2016 to 2023, only 5.6% had ever received a DSMES encounter.[3] State-level utilization ranged from 0.1% to 32.0%, although some differences likely reflect variation in data completeness and coding across programs.[3] Many DSMES suppliers were concentrated in counties with big cities, and many counties still lacked a supplier.[3]
Community pharmacies can widen the front door, but referral alone is not enough. Across 19 New York community pharmacies, staff screened 390 adults with type 2 diabetes using prescription records, health information exchange data and point-of-care HbA1c testing.[9] Pharmacists made strong or moderate referrals for 70% of patients, and 70.9% of the analytic sample was publicly insured.[9] Among 161 patients with three-month follow-up, 11% attended DSMES.[9] Reported barriers included patient refusal (30%), scheduling (21%) and transportation (12%).[9]
Virtual delivery can extend reach, but only for people with the tools to use it. Among Medicare beneficiaries aged 65 and older with diabetes and no prior self-management training, 15.7% had neither a computer, laptop or tablet nor internet access in 2022.[15] The authors estimated that approximately one-third, or 3.4 million potentially eligible beneficiaries, lacked the digital resources needed for a full-service virtual program.[15] Another 68.5% had both a device and internet access, so most could use virtual options while a substantial minority could not.[15] A virtual option is an addition to the route, not a replacement for in-person access.
Affordability connects access to follow-through. Cost was the leading documented reason that patients flagged by the cardiology alert did not start a recommended medication, cited in seven cases.[8] Newer glucose-lowering agents and analog insulin also continue to carry higher out-of-pocket costs than older therapies.[4] Together, these findings suggest that benefit verification and financial counseling belong inside the clinical route rather than after it. Leaders can ask where in the current workflow a cost barrier is first detected, and by whom.
Access reviews should map where education, pharmacy and community programs are located against where patients live. They should also track how many referrals end in a scheduled visit, how many in attendance and how many in no contact at all. Those three outcomes show whether the front door leads anywhere.
Executive guidance · System route
Connect the month to an accountable system route.
Use this route as a discussion framework. Replace each stage with the organization’s approved process, qualified roles, current service capacity, and applicable requirements. Do not infer a clinical protocol from the observance title.
The route at a glance
- Listen
- Clarify entry
- Support longitudinal navigation
- Protect transitions
- Verify and learn
Reliability rule: Every stage needs a named owner, an observable status, an approved escalation path, and a defined signal that shows whether responsibility moved or remained unresolved.
Listen
Gather questions and friction points from people using the route, frontline teams, and community-facing staff. Separate observed barriers from assumptions.
Clarify entry
Publish a plain-language first step and identify who receives requests through each approved channel.
Support longitudinal navigation
Make entry points, education, service ownership, transitions, and follow-through visible across the locally defined route without prescribing care.
Protect transitions
Use acknowledgment and status visibility when responsibility moves between services, locations, or organizations.
Verify and learn
Review unresolved work, repeat contacts, and avoidable handoffs. Use the findings to improve the route rather than blame individuals.
Figure 2
The system route as one flow
The five stages of the system route described in this brief, drawn as one flow with a learning loop back to the start. The stages are the page’s original executive guidance, not a clinical protocol.
Data note. Shows sequence and handoffs only; it carries no counts or rates.
Limitation. Local processes may add, merge or reorder stages under organizational policy.
Figure data (5 rows)
| Stage | What the stage requires |
|---|---|
| Listen | Gather questions and friction points from people using the route, frontline teams, and community-facing staff. Separate observed barriers from assumptions. |
| Clarify entry | Publish a plain-language first step and identify who receives requests through each approved channel. |
| Support longitudinal navigation | Make entry points, education, service ownership, transitions, and follow-through visible across the locally defined route without prescribing care. |
| Protect transitions | Use acknowledgment and status visibility when responsibility moves between services, locations, or organizations. |
| Verify and learn | Review unresolved work, repeat contacts, and avoidable handoffs. Use the findings to improve the route rather than blame individuals. |
Equity and trust
Equity gaps follow race, insurance, geography and connectivity
Use of self-management education differs sharply across groups. Among Medicaid beneficiaries with diabetes, DSMES reached 8.9% of non-Hispanic multiracial beneficiaries but only 4.6% of American Indian and Alaska Native beneficiaries and 4.4% of Hispanic beneficiaries.[3] Utilization was 8.7% in counties in the lowest Social Vulnerability Index quartile.[3] Within West Virginia alone, county rates ranged from 1.5% to 18.2%.[3] Utilization was also higher among females (6.2%) and adults aged 19 to 34 (7.5%), and slightly higher in rural areas (6.2%) than urban areas (5.8%).[3] Place, not only personal choice, shapes whether education is within reach.
The digital route carries its own inequities. Non-Hispanic Black Medicare beneficiaries with diabetes were less likely than non-Hispanic White beneficiaries to have both a device and internet access (odds ratio 0.40).[15] Hispanic beneficiaries and those with a high school education or less were also less likely to have both.[15] At the federally qualified health center, by contrast, people preferring Spanish enrolled at higher rates during hybrid offerings.[13] Severe hyperglycemia was likewise more common among Hispanic or Mexican American and non-Hispanic Black adults in national data.[5]
Coverage expansion narrows only part of the gap. In the meta-analysis of insurance and diabetes care quality, racial and ethnic disparities in glycemic control persisted among insured individuals.[7] Hispanic or Latino and African American populations showed poorer outcomes, and gender disparities were also observed, particularly in lipid control.[7] The pooled studies compared private, Medicare, Medicaid and uninsured groups across work published between 2000 and 2025.[7] The authors conclude that addressing these inequities requires attention to socioeconomic and systemic barriers beyond insurance expansion.[7]
Targeted programs can move outcomes when they are designed with the people they serve. A meta-analysis of 46 randomized trials with 7,864 participants found non-pharmacological interventions reduced HbA1c among Black adults with type 2 diabetes, with a weighted mean difference of -0.38%.[6] Interventions spanning multiple domains achieved the largest reduction, at -0.43%.[6] Risk of bias was low, and the strength of evidence was rated high.[6] No included intervention addressed community or societal levels or the physical and built environment.[6] That leaves a clear opening for health systems working with community partners on structural barriers. The New York outreach analysis offers one practical method, adding social vulnerability scores so results can be read against community-level disadvantage.[2]
Human infrastructure
Community health workers and pharmacists carry the route
The strongest trial evidence in this brief concerns people, not software. A 12-month randomized clinical trial tested this at three community clinics in Texas.[10] Telementored community health workers delivered group diabetes education, individualized telehealth coaching and a structured feedback loop linking participants, workers and clinicians.[10] Among 257 low-income, uninsured White Hispanic adults with type 2 diabetes, the intervention reduced HbA1c by a net 1.0 percentage point compared with usual care.[10] It also lowered total cholesterol by a net 35.4 mg/dL and low-density lipoprotein cholesterol by a net 29.7 mg/dL.[10]
The design detail matters for operations. The feedback loop gave community health workers a defined path to raise participant concerns, improve care coordination and track whether issues were resolved.[10] The authors suggest the benefit may come from reducing fragmentation.[10] Secondary measures included recruitment, intervention fidelity and feedback loop issue resolution, the same operating signals leaders would need to scale the model.[10] That places role design and communication pathways alongside staffing levels as executive decisions.
Community health workers also adapt programs in ways that protect engagement. In the hybrid self-management program at a federally qualified health center, community health workers prioritized group discussion and shorter sessions focused on personal health goals and social-emotional concerns.[13] The authors credit the hybrid format with maintaining engagement by addressing language, social needs, life demands and technology barriers.[13]
Pharmacy teams are another underused part of the diabetes workforce. In the New York pharmacy referral program, 94% of community pharmacy professionals reported sufficient time for screening, and 91% found health information exchange access helpful.[9] Patients were identified mainly through prescription records (73%), and HbA1c values came from point-of-care testing (50%) or health information exchange (17%).[9] Identification capacity therefore exists in community settings, while attendance depends on scheduling, transportation and integration with the receiving program.[9]
For executives, these findings frame community health workers and pharmacists as infrastructure rather than add-ons. Their reach depends on defined referral targets, protected time, shared data and a clinician who reliably receives what they escalate. Without those conditions, a skilled workforce produces referrals that stall at the next handoff. Leaders can test readiness by asking frontline workers where their last unresolved escalation went and who closed it.
Executive guidance · Operating dashboard
Review reliability, not campaign activity alone.
Do not publish a number until the organization defines its numerator, denominator where relevant, owner, source system, exclusions, review cadence, and limits. The candidates below are management prompts, not benchmarks or reported results.
Four operating signals
Each signal pairs an executive question with one candidate local measure, set out below.
Executive guidance · Signal
Entry-point clarity
Can people and staff identify the approved first step without searching across conflicting instructions?
- Candidate local measure
- Locally defined contact, routing, and repeat-contact signals by channel and service.
Executive guidance · Signal
Ownership reliability
Does a specific team accept each request and make its status visible?
- Candidate local measure
- Requests without an owner, aged work, transfers, and escalations using locally approved definitions.
Executive guidance · Signal
Longitudinal ownership
Can people and teams see who owns the next step across a route that may involve repeated contacts?
- Candidate local measure
- Locally defined repeated contacts, aged work, transition acceptance, unresolved routes, and experience feedback.
Executive guidance · Signal
Improvement closure
Does the organization correct recurring friction and report what changed?
- Candidate local measure
- Selected barriers, assigned actions, completion status, and post-change review.
Figure 4
The operating system behind the dashboard
The four operating signals from this brief’s dashboard, each tied to the candidate owner named in the executive scorecard, around one accountable route. Drawn from the page’s original executive guidance.
Data note. Structural diagram; no measured values.
Limitation. Owners are candidates to be confirmed locally.
Figure data (4 rows)
| Operating signal | Candidate owner |
|---|---|
| Entry-point clarity | Executive sponsor and operational lead |
| Ownership reliability | Operational owner and participating teams |
| Longitudinal ownership | Sending and receiving owners |
| Improvement closure | Improvement owner and executive sponsor |
Executive guidance · Handoff workflow
Transfer responsibility with acknowledgment and visibility.
A handoff is reliable only when the sending party knows who is expected to receive the work, the receiving party acknowledges responsibility, and any unresolved exception remains visible. Local policy and qualified judgment control the actual process.
How responsibility moves
Lane A
From message to accepted ownership
- Confirm the approved message and intended audience.
- Publish the actual entry point and receiving role.
- Acknowledge receipt using the locally approved method.
- Escalate when ownership or response remains unclear.
Lane B
From accepted ownership to verified follow-through
- Record the next accountable owner and visible status.
- Record the next owner, status, and approved follow-through route so responsibility does not disappear between contacts.
- Keep unresolved work visible across boundaries.
- Confirm closure or document the continuing exception.
Executive guidance · Executive scorecard
Connect operating signals to accountable executive review.
The scorecard keeps review focused on decisions. Leaders should set definitions locally, examine variation without overclaiming cause, and pair quantitative signals with the experience of people who use and operate the route.
Who reviews what
- Executive sponsor and operational lead
- Operational owner and participating teams
- Sending and receiving owners
- Improvement owner and executive sponsor
Candidate owners named in the scorecard, confirmed locally.
| Operating signal | Executive question | Candidate owner | Suggested review point |
|---|---|---|---|
| Entry-point clarity | Can people and staff identify the approved first step without searching across conflicting instructions? | Executive sponsor and operational lead | At campaign launch and close |
| Ownership reliability | Does a specific team accept each request and make its status visible? | Operational owner and participating teams | At a locally defined cadence |
| Longitudinal ownership | Can people and teams see who owns the next step across a route that may involve repeated contacts? | Sending and receiving owners | At a locally defined cadence |
| Improvement closure | Does the organization correct recurring friction and report what changed? | Improvement owner and executive sponsor | Until action is verified |
Figure 5
Control points for a reliable diabetes care route
| Control point | Risk if missing | Owner | Evidence of control |
|---|---|---|---|
| Specialist recommendation acknowledged and acted on in primary care | Recommended therapy changes stall after the message is sent | Primary care medical director with specialty service leads | Share of recommendations acknowledged and completed within a locally defined window |
| DSMES referral linked to scheduling and attendance tracking | Referred patients never attend education | Diabetes education program manager | Share of referrals with a scheduled and attended session |
| Benefit verification and cost review before therapy changes | Cost blocks a recommended medication after the visit | Pharmacy and revenue cycle leaders | Documented cost barriers and resolutions per recommended change |
| Outreach channel matched to population and care gap | Low response to outreach and persistent open care gaps | Population health director | Care gap closure by outreach channel and population segment |
| Community health worker escalation path to a named clinician | Concerns raised in the community are not resolved in care | Community health program lead with clinic leadership | Escalations logged, accepted and resolved |
| Digital access and language screening before virtual enrollment | Virtual programs exclude people without devices, connectivity or language support | Patient access and digital health leaders | Enrollment and attendance by modality, language and access status |
| Equity stratification of completion measures | Gaps for specific groups and counties stay hidden in averages | Chief quality officer and health equity officer | Completion measures reviewed by race, ethnicity, payer, language and geography |
Control points derived from the cited evidence [1], [2], [3], [6], [8], [9], [10], [13], [15] and this brief’s executive guidance.
Data note. Each row is a control to verify, not a measured result.
Limitation. Owners and evidence of control must follow local policy and applicable requirements.
Public communication
Communicating about diabetes in ways that earn trust and action
Outreach is communication, and its channel shapes results. In the New York outreach study, phone calls remained the most effective approach overall, while chatbot messages had a targeted advantage for diabetes care gaps in 2023.[2] The authors call for segmented, equity-informed outreach that combines technology, patient preference and primary care continuity.[2] In that study, 81% of the analytic sample maintained an active relationship with a primary care provider.[2]
Trust is built through relationships that last long enough to matter. In a pilot at an academic eye institute, a community health worker worked with patients with diabetes and adverse social needs for an average of six months.[11] Of 45 enrolled participants, 23 completed the program, and 87% of completers had a positive experience with the community health worker.[11] Seventy-four percent felt respected and supported, while views of the broader program were mixed at 57% positive, 22% neutral and 17% negative.[11] Participants found the program helpful for resource education (65%) and self-confidence (57%), and they reported high trust in the community health worker.[11] Language barriers among Spanish-speaking participants were a reported challenge.[11]
Digital messages need plain language and confidence building. Portal users in the care gap pilot appreciated help keeping up with preventive care but expressed unease because of limited portal confidence.[1] The tool paired a notice that care was due with a direct way to initiate the order.[1] The tool’s median usability score of 78.8 still exceeded the study’s good usability threshold of 71.[1] Usability and confidence are therefore separate problems, and communication plans should address both.
Leaders should also be precise about what success means before they announce it. A review of 151 articles on 126 self-management education programs in seven European countries found health outcomes were used to assess impact in 84% of studies.[12] Quality of life and behavior or coping outcomes were assessed in 57% and 54% of studies respectively, instruments varied widely and economic evaluations were rare.[12] Public reporting on diabetes programs is more credible when it pairs clinical results with reach, experience and cost, using definitions set in advance. Each message should name a trusted messenger, a channel that fits the audience and a clear next step, and later reports should say whether people took it.
Executive guidance · 90-day plan
Use 90 days to correct one visible operating barrier.
The time boxes below are a management framework, not a clinical timeline. Adjust them to risk, scope, governance, resources, stakeholder participation, and applicable review requirements.
Ninety days, three moves
- Days 1–30See the current route
- Days 31–60Build the reliable path
- Days 61–90Make the change visible
Days 1–30 · Listen and map
See the current route
- Name an executive sponsor and an operational owner.
- Listen to people using the route and representative frontline teams.
- Map how American Diabetes Month communications connect to real entry points, owners, transitions, and escalation.
- Select one recurring barrier that the organization can responsibly address.
Days 31–60 · Design and test
Build the reliable path
- Define the trigger, receiving owner, required information, acknowledgment, escalation, and closure signal.
- Validate the design with every sending and receiving team involved.
- Review one repeated-contact or cross-service route and correct a verified ownership or information gap.
- Test the route in more than one representative setting or operating period where practical.
Days 61–90 · Implement and verify
Make the change visible
- Launch the redesigned route with a small set of locally defined measures.
- Review unresolved work and recurring friction using a learning approach.
- Correct implementation barriers and record who owns each remaining dependency.
- Report what changed, what evidence was reviewed, and what still requires live oversight.
Figure 6
The 90-day plan on one timeline
The 90-day plan from this brief drawn as a timeline: each action sits in the 30-day window the plan assigns it. The full wording of each action is in the figure data and in the plan above.
Data note. Time boxes are a management framework, not a clinical timeline.
Limitation. Durations are uniform 30-day windows; real tasks may span windows.
Figure data (12 rows)
| Window | Action |
|---|---|
| Days 1–30 · Listen and map | Name an executive sponsor and an operational owner. |
| Days 1–30 · Listen and map | Listen to people using the route and representative frontline teams. |
| Days 1–30 · Listen and map | Map how American Diabetes Month communications connect to real entry points, owners, transitions, and escalation. |
| Days 1–30 · Listen and map | Select one recurring barrier that the organization can responsibly address. |
| Days 31–60 · Design and test | Define the trigger, receiving owner, required information, acknowledgment, escalation, and closure signal. |
| Days 31–60 · Design and test | Validate the design with every sending and receiving team involved. |
| Days 31–60 · Design and test | Review one repeated-contact or cross-service route and correct a verified ownership or information gap. |
| Days 31–60 · Design and test | Test the route in more than one representative setting or operating period where practical. |
| Days 61–90 · Implement and verify | Launch the redesigned route with a small set of locally defined measures. |
| Days 61–90 · Implement and verify | Review unresolved work and recurring friction using a learning approach. |
| Days 61–90 · Implement and verify | Correct implementation barriers and record who owns each remaining dependency. |
| Days 61–90 · Implement and verify | Report what changed, what evidence was reviewed, and what still requires live oversight. |
Executive guidance · Leadership close
Pair recognition with a system people can trust.
Recognition matters. It becomes durable when leaders also listen, clarify the route, support the people operating it, close an identified gap, and report the result without claiming more than the evidence supports.
Leadership commitment
Connect the message to one usable, measured, and sustained operating change.
Executive action kit · Month observance
Turn American Diabetes Month into accountable action.
Move from recognition activity to a visible operating route with named owners and closed loops.
Leadership focus
Use this observance to examine navigation, longitudinal ownership, and specialty-care coordination. Select one verified barrier, assign an accountable owner, and carry the improvement beyond the campaign window.
Workforce lens
Ask whether staffing, role clarity, training, tools, workload, and escalation support the people operating the information, access, longitudinal ownership, and follow-through pathway.
Patient and community lens
Make the approved first step clear. Test whether a person can move from information to an acknowledged next action without navigating conflicting instructions.
Equity and access lens
Review language, transportation, affordability, food access, digital access, disability, and geographic availability.
Five-minute briefing
Inspect the operating sequence
Listen with people using the pathway, caregivers, primary care, specialty services, pharmacy, and community partners. Find one a confusing entry point, fragmented follow-through, or an unresolved navigation need, then test the locally approved route from entry through acknowledged follow-through.
- Listen
- Clarify entry
- Support longitudinal navigation
- Protect transitions
- Verify and learn
Leadership actions for this week
- Name an executive sponsor and frontline operating owner.
- Ask people using and operating the pathway where ownership becomes unclear.
- Test one representative route from first question to acknowledged next step.
- Select one barrier that can be corrected without overstating the evidence.
- Set a review date and define how completion will be verified.
Candidate measures
Define every numerator, denominator where relevant, owner, data source, exclusions, cadence, and limitation locally. These are management prompts, not external benchmarks.
- Locally defined contact, routing, and repeat-contact signals by channel and service.
- Requests without an owner, aged work, transfers, and escalations using locally approved definitions.
- Locally defined repeated contacts, aged work, transition acceptance, unresolved routes, and experience feedback.
Department readiness checklist
- The public and staff entry points match the actual approved process.
- A specific role accepts each request, referral, or escalation.
- Handoffs include acknowledgment and a visible unresolved state.
- Language, disability, digital, transportation, and trust barriers receive explicit review.
- Communications do not introduce unsupported themes, statistics, or clinical advice.
- A named leader will review what changed after the observance.
Intended audiences
- Executive and Operational Leaders
- Patient Experience and Access Leaders
Staff communication template
During American Diabetes Month, our organization will connect awareness with a practical review of the information, access, longitudinal ownership, and follow-through pathway. Use approved information, identify the correct entry point, confirm ownership when work moves, protect privacy, and escalate unresolved barriers through local channels.
Community communication template
American Diabetes Month is an opportunity to share trustworthy information and make the next step easier to find. Use our approved channels for information and support. If a request changes hands, our goal is to keep ownership and follow-through visible.
Measurement worksheet
- Signal
- What observable condition will show whether the route works?
- Definition
- What is included, excluded, and counted?
- Owner
- Who reviews the signal and acts on exceptions?
- Cadence
- When will leaders review it?
- Equity check
- Which differences require protected, locally appropriate review?
- Closure
- What evidence will confirm the improvement was completed?
- Editorial review
- Completed
- Source records
- 2 listed under Authoritative resources
- Review standard
- Sourced facts remain separated from original executive guidance
- Clinical boundary
- No new statistical or clinical claim was added by this action kit
Sources and content boundary
Authoritative resources
Use note: All operating models, measures, scorecard questions, and action steps are original executive guidance. This article supports leadership planning and education. It does not replace clinical judgment, emergency procedures, legal advice, professional standards, organizational policy, or applicable federal, state, and local requirements.
Peer-reviewed references
References
Fifteen peer-reviewed sources, newest first. Each was individually verified through authenticated academic research databases. Bracketed numbers in the text link here; the original executive guidance on this page carries no citations because it is guidance, not a sourced claim. Sources last checked in those databases on .
- 1.Nelson LA, Cobb J, Elasy T, Gangaputra SS, Hackstadt AJ, Harper K, et al. Pilot study of a patient portal intervention designed to empower patients to address diabetes care gaps. Digital Health. 2026;12:20552076261443175. https://doi.org/10.1177/20552076261443175
- 2.Chacko J, Jia Y, Stathakos K, Mazza K, Kim D, Diefenbach M, et al. Chatbot Outreach in Value-Based Preventive Care: Retrospective Analysis. JMIR Medical Informatics. 2026;14:e81370. https://doi.org/10.2196/81370
- 3.Ng BP, Booppasiri S, Ly M, Crowell A, Magee MF, Alva ML. Medicaid Claims-Based Diabetes Self-Management Education and Support Utilization in Adults With Diabetes: Sociodemographic and Geographic Assessments. The Science of Diabetes Self-Management and Care. 2026;52(5):406-417. https://doi.org/10.1177/26350106261475942
- 4.Wang Y, Tang S, Zhou X, Zhang P. National Trends in Out-of-Pocket Cost for Glucose-Lowering Drugs Among U.S. Adults With Diabetes, 2000–2022. Diabetes Care. 2026;49(8):1414-1419. https://doi.org/10.2337/dc25-2040
- 5.Wang L, Song L, Fan J. Trends and disparities in glycemic control and severe hyperglycemia in U.S. adults with diabetes mellitus before and during COVID-19 pandemic. Nutrition & Metabolism. 2026;23(1):95. https://doi.org/10.1186/s12986-026-01156-7
- 6.Osman F, Jiang C, Deckard AN, Staab EM, Thomas NC, Wan W, et al. Effects of Multilevel and Multidomain Interventions on Glycemic Control Among Black Persons with Type 2 Diabetes in the U.S.: A Systematic Review and Meta-Analysis. Journal of Racial and Ethnic Health Disparities. 2026:online ahead of print. https://doi.org/10.1007/s40615-026-03035-6
- 7.Gao P. Impact of Health Insurance Coverage on Diabetes Care Quality: A Systematic Review and Meta-analysis of Racial, Ethnic, and Gender Disparities in U.S. Adults with Type 2 Diabetes. Journal of General Internal Medicine. 2026;41(13):3850-3863. https://doi.org/10.1007/s11606-026-10589-y
- 8.Ernst K, Zimmerman C, Sukul D, Renner E, Wang L, Thompson AN, et al. Evaluation of clinical decision support to improve guideline directed medical therapy in patients with type 2 diabetes. Journal of the American Pharmacists Association. 2026;66(4):103081. https://doi.org/10.1016/j.japh.2026.103081
- 9.Daly CJ, Foster A, Chen EL, Jacobs DM. Expanding access to diabetes self-management and education programs through community pharmacy referrals: A statewide implementation evaluation. Journal of the American Pharmacists Association. 2026;66(5):103464. https://doi.org/10.1016/j.japh.2026.103464
- 10.Vaughan EM, Yu X, Amspoker AB, Naik AD, Balasubramanyam A, Johnston CA, et al. Structured Telehealth Community Health Worker–Clinician Feedback and Diabetes Outcomes. JAMA Internal Medicine. 2026;186(8):1012. https://doi.org/10.1001/jamainternmed.2026.1917
- 11.DeGracia BJ, Rustam Z, Amezcua Moreno J, Yu SE, Tran D, Ferguson K, et al. Pilot Community Health Worker-Based Intervention to Address Social Determinants of Health Among Patients with Diabetes in Ophthalmology. Clinical Ophthalmology. 2026;20:1-13. https://doi.org/10.2147/opth.s632778
- 12.Borsoi L, Falivena C, Callea G. Approaches to Diabetes Self-Management Education in Europe: An Extensive Literature Review. Clinical Therapeutics. 2026:online ahead of print. https://doi.org/10.1016/j.clinthera.2026.07.014
- 13.Deverts DJ, Zupa MF, Kieffer EC, Piatt GA, Heisler M, Valbuena F, et al. Transition to Virtual Diabetes Self-Management Education Delivery in the Setting of Health Care Disruption for Adults With Diabetes and Their Support Persons. The Science of Diabetes Self-Management and Care. 2026;52(3):229-242. https://doi.org/10.1177/26350106261432172
- 14.Jamileh E, Elmewafy AT, Almeer M, Alaguraja P, Al-Kindi S, Dakhil Z, et al. Cardiovascular Disease Screening Programs in Low- and Middle-Income Countries. JACC: Advances. 2026;5(8):103048. https://doi.org/10.1016/j.jacadv.2026.103048
- 15.Ng BP, LaManna JB, Hsieh MT, Hawkins GT, Park C. Digital Divide and Diabetes Self-Management Education and Support Among Medicare Beneficiaries. The Science of Diabetes Self-Management and Care. 2025;52(1):25-34. https://doi.org/10.1177/26350106251401498
Claim-to-source matrix
What each source supports
Every sourced claim in the new sections maps to the references that support it, the section where it is used, and the limitation a reader should keep in mind. Original executive guidance carries no sources because it is guidance, not a finding.
| Claim group | Sources | Years | Used in | Limitation |
|---|---|---|---|---|
| Glycemic control and severe hyperglycemia trends and disparities in U.S. adults | [5] | 2026 | Current evidence | National survey data comparing 2017–2020 with 2021–2023; cross-sectional periods, associations only. |
| Out-of-pocket costs for glucose-lowering drugs | [4] | 2026 | Current evidence | Self-reported diabetes with pharmacy-verified records through 2022; predates recent insulin and spending caps. |
| Insurance coverage and diabetes care quality and disparities | [7] | 2026 | Current evidence | Twelve observational studies of moderate quality with high heterogeneity for several outcomes. |
| Outreach channel and preventive care gap closure | [2] | 2026 | Current evidence | Retrospective single-system study in New York; outreach method assigned by engagement history, not randomized. |
| Screening detection and linkage to care | [14] | 2026 | Current evidence | Seventeen heterogeneous studies in low- and middle-income countries synthesized narratively. |
| Specialist-to-primary care alert and medication initiation | [8] | 2026 | Continuum of care | Single-center retrospective pilot with 134 patients; descriptive statistics only. |
| Patient portal tool for closing diabetes care gaps | [1] | 2026 | Continuum of care | Single-arm pilot with 50 compensated participants at one academic center. |
| Hybrid virtual self-management education during disruption | [13] | 2026 | Continuum of care | One federally qualified health center; before-and-during comparison within a trial. |
| DSMES utilization and supplier geography in Medicaid | [3] | 2026 | Access | Claims-based; state differences partly reflect data completeness and coding practices. |
| Community pharmacy referral to DSMES | [9] | 2026 | Access | Nineteen New York pharmacies over three months in 2021; attendance known for 161 patients. |
| Digital access among Medicare beneficiaries eligible for self-management training | [15] | 2025 | Access | Self-reported 2022 survey data; access to devices does not measure digital skill or confidence. |
| Interventions improving glycemic control among Black adults | [6] | 2026 | Equity and trust | Randomized trials from 1985 to 2019 with moderate heterogeneity. |
| Telehealth community health worker and clinician feedback loop | [10] | 2026 | Human infrastructure | Three Texas clinics serving uninsured Hispanic adults; generalizability to other populations untested. |
| Community health worker trust and experience in specialty care | [11] | 2026 | Public communication | Single-center pilot; 23 of 45 enrolled completed; no significant change in social needs scores. |
| How self-management education programs are evaluated | [12] | 2026 | Public communication | Narrative review limited to seven European countries. |
About the author
Greg Wahlstrom
MBAHCM
President and Chief Executive Officer, The Healthcare Executive
View Greg’s profile©2014 – 2026 The Healthcare Executive. All rights reserved.