· Executive Brief
National Diabetes Education Week 2026
Use the observance to review how people find information, enter the right route, and remain connected through follow-through.
Leadership signal
Recognition becomes useful when leaders inspect the real route.
The strongest use of the observance is operational. Map where questions enter, how requests move, when ownership changes, and how unresolved work becomes visible. The goal is not to make a clinical claim. It is to make the organization’s response easier to understand and manage.
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 education works when the system delivers people to it
National Diabetes Education Week arrives at a moment when the evidence for diabetes self-management education and support is stronger than the systems that deliver it. In one academic medical center, only 10% of people with diabetes were referred to self-management education classes, and 37% of those referred completed them.[14] Among U.S. Medicare beneficiaries with diabetes from 2017 to 2019, 37.94% had received this education after study criteria were applied.[11]
The outcome evidence makes those gaps costly. A health record study followed 134,411 adults newly diagnosed with type 2 diabetes.[6] Attending education classes within 3 months of diagnosis was associated with lower long-term risk of myocardial infarction (hazard ratio 0.77).[6] A Slovak cohort of 14,106 matched patients associated structured education with a 57% lower mortality risk during the first 2 years of follow-up.[4] Both studies are observational, so they show association rather than proof of benefit.[4][6]
For executives, the central problem is operational rather than clinical. Referral prompts, scheduling, reimbursement and educator capacity decide who actually reaches a class or a virtual session.[14] Culturally adapted programs are also showing that attendance and retention can be high when the design fits the people being served.[1][5]
Those numbers describe a pathway that loses most people before the first session. Each loss happens at a step that someone in the organization could own: the referral prompt, the scheduling call, the session format or the reminder. This observance is a chance to treat diabetes education as a pathway with owners, capacity and completion measures, not as a pamphlet or a single class schedule. The sections below summarize peer-reviewed evidence on participation, outcomes, telehealth delivery, cultural tailoring, the educator workforce and measurement. They sit beside the executive guidance already on this page and give boards and operating leaders a shared factual base for deciding where to act first.
Current evidence
What the research shows about participation and outcomes
Low participation is not mainly a patient choice. At the academic medical center that reported a 10% referral rate, authors found barriers at patient, provider and health system levels.[14] Technology platforms and training did not prioritize education referrals, and both clinicians and patients were often unfamiliar with program content and benefits.[14] Scheduling mechanisms often delayed or lost patients who were interested in attending.[14]
National data point to the same gap and to its unequal shape. Using a nationally representative survey linked to claims, researchers applied five machine learning approaches to 95 variables describing Medicare beneficiaries with diabetes.[11] A random forest model reached 85% accuracy, 74 of the 95 variables were identified as key predictors, and the predictors of participation differed by race and ethnicity.[11] Participation therefore depends on biological, behavioral, sociocultural and environmental conditions that a health system can measure.[11]
The outcome studies are large and consistent in direction. In the newly diagnosed cohort, early class attendance was also associated with lower risk of heart failure (hazard ratio 0.84) and stroke (hazard ratio 0.84) over a 12-year follow-up.[6] In the Slovak insurer program, the lower mortality risk persisted after 2 years at 32% (hazard ratio 0.68).[4] Patients treated by participating diabetologists who did not receive the education showed no survival benefit, which suggests the association lies with the education itself rather than program enrollment.[4] For leaders, that distinction matters: enrolling patients in a disease program is not the same as delivering the education that the program promises.[4]
Tailoring the content to culture appears to help. A systematic review included 17 studies, 15 of them randomized trials, and 9 were conducted in the United States among ethnic minority groups.[3] Of 14 studies measuring self-management behaviors, 9 showed substantial improvements, and a meta-analysis of 7 studies found a significant hemoglobin A1c reduction of -0.57.[3]
Knowledge alone does not explain who manages well. Among 123 randomly selected outpatients in the Marshall Islands, 76% showed inadequate self-management.[10] Attending diabetes education classes was positively associated with self-management, while diabetes knowledge level was not a significant predictor.[10] The practical reading for leaders is that structured, attended education matters more than distributing information. A system that counts brochures handed out or portal messages sent is measuring activity, not the attendance that the evidence links to better results.
Figure 1
Diabetes education reaches too few people, but tailored programs keep those they reach
Percent of people reaching or remaining in diabetes self-management education, as reported in each study. Values are copied from the cited studies [1], [5], [11], [14]; none is estimated.
Data note. These values come from different studies, populations, settings and definitions, so this is an indirect comparison; the bars show where the education pathway leaks and where tailored designs held people, not a head-to-head result.
Limitation. Referral and completion figures come from a single academic center, the Medicare figure is national survey-linked data from 2017 to 2019, and the attendance and retention figures come from small pilot programs.
Figure data (5 rows)
| Measure | Value | Population, setting and year as reported | Source |
|---|---|---|---|
| Referred to self-management education classes | 10% | People with diabetes at one U.S. academic medical center | [14] |
| Completed classes among those referred | 37% | Referred patients at the same U.S. academic medical center | [14] |
| Received self-management education | 37.94% | U.S. Medicare beneficiaries with diabetes, 2017 to 2019, after inclusion and exclusion criteria | [11] |
| Attendance in a culturally adapted group program | 86% | 32 Black adults with diabetes or prediabetes in a 6-week community program | [1] |
| Patient retention in a Vietnamese-language program | 90.9% | 88 Vietnamese American adults with type 2 diabetes from 10 primary care clinics | [5] |
Continuum of care
Where education fits from diagnosis to long-term support
The first referral window is the diagnosis itself. The cardiovascular findings came from patients who attended classes within 3 months of their initial diagnosis.[6] The authors concluded that the results support timely referral to structured education in primary care.[6] A referral that waits for the next problem visit, or that depends on a patient calling back, can miss that window.
Prevention belongs on the same continuum. Among 150 Chinese Americans at risk for diabetes enrolled in a mobile prevention trial in New York City, 81.9% of respondents reported at least 1 social determinant of health barrier.[2] The authors recommended routine screening for these barriers and structured resource navigation or referral pathways within prevention efforts.[2] Education programs that ignore housing, language or discrimination may lose people before the first session.
Ongoing support is where many programs thin out. Persistently poorly controlled type 2 diabetes affects 10–15% of patients with diabetes and contributes disproportionately to morbidity, mortality and expenditure.[8] Staff and patients in a comprehensive virtual care program said it complemented primary care goals but required new and complex patterns of communication with the existing care team.[8] The intensity of the program also made ongoing patient engagement harder to maintain.[8]
Primary care integration can work, but workflow decides the result. A culturally tailored Vietnamese-language program combined automated messages with nurse calls for 3 months and then monitored 88 adults from 10 primary care clinics for 12 months.[5] It did not significantly change hemoglobin A1c but was followed by a significant reduction in low-density lipoprotein and improved exercise performance.[5] Clinic staff workload and clinic workflow were key determinants of feasibility and acceptability.[5]
Youth transitions show what a structured bridge can do. In a Medicaid quality improvement project, 18 youth received weekly phone or video contact with a certified diabetes care and education specialist and monthly video visits with a nurse practitioner.[12] Pump use rose from 4 participants at baseline to 16 by the end.[12] The authors noted that ongoing monitoring is needed to judge whether the gains last.[12] For pediatric programs, the same question applies when young people move into adult services and the specialist relationship that carried them may end. Leaders can ask who owns education and support at that handoff, and how the receiving team learns what the young person already knows.
Figure 3
Why the pathway breaks
People
- Clinicians and patients unfamiliar with program content and benefits
- Educator and nurse capacity too limited for referral volume
- Educators unsure of onward referral routes
Process
- Referral not made at diagnosis
- Scheduling steps delay or lose interested patients
- Intensive programs hard to sustain engagement in
Technology
- Record platforms do not prioritize education referrals
- Virtual options not offered or not supported
- Remote follow-up not built into clinical pathways
Environment
- Housing, food access and other social barriers
- Language barriers and limited English proficiency
- Experiences of racial discrimination
Policy
- Medicare reimbursement limits program expansion
- Wait times from constrained educator capacity
- Payer decisions without cost-effectiveness evidence
Measurement
- Referral and completion not tracked as separate steps
- Participation not stratified by race, ethnicity and language
- Feasibility measures such as retention not reviewed
Unranked qualitative cause-and-effect diagram for the outcome in the box: People with diabetes are not referred to, do not start, or do not complete self-management education and support Causes are assembled from the cited literature [1], [2], [5], [7], [8], [9], [11], [14], [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 | Clinicians and patients unfamiliar with program content and benefits; Educator and nurse capacity too limited for referral volume; Educators unsure of onward referral routes |
| Process | Referral not made at diagnosis; Scheduling steps delay or lose interested patients; Intensive programs hard to sustain engagement in |
| Technology | Record platforms do not prioritize education referrals; Virtual options not offered or not supported; Remote follow-up not built into clinical pathways |
| Environment | Housing, food access and other social barriers; Language barriers and limited English proficiency; Experiences of racial discrimination |
| Policy | Medicare reimbursement limits program expansion; Wait times from constrained educator capacity; Payer decisions without cost-effectiveness evidence |
| Measurement | Referral and completion not tracked as separate steps; Participation not stratified by race, ethnicity and language; Feasibility measures such as retention not reviewed |
Access
Making education reachable in person, by video and by phone
Access to diabetes education is shaped by capacity and payment as much as by interest. Existing Medicare reimbursement strategies limit expansion of these programs, generating significant wait times and constraining what diabetes care and education specialists can offer.[14] The authors recommended changes to referral and scheduling systems and to reimbursement policy.[14] A referral that enters a long queue is an access failure even when the order is placed correctly.
Telehealth is now supported by trial evidence. A meta-analysis of randomized trials found that nurse-led telehealth reduced hemoglobin A1c compared with usual care (mean difference -0.62%), drawing on 11 trials with 10 in the pooled analysis.[7] Fasting plasma glucose did not differ significantly between groups (mean difference -0.62 mmol/L, p = 0.41).[7] The authors called for trials that clarify intervention intensity and fidelity, which are operating choices as much as clinical ones.[7]
Virtual delivery can reach groups that in-person classes often miss. In a federally qualified health center trial, 120 Latino adults with uncontrolled type 2 diabetes received 12 one-hour culturally tailored education sessions, and 98% preferred Spanish.[13] Virtually delivered education improved hemoglobin A1c, with real-time continuous glucose monitoring adding greater improvement.[13] The authors added that continued cyclic glucose monitoring may be needed for a sustained effect.[13]
Remote models also extend specialist reach to young people with high risk. The Medicaid youth project enrolled participants with an A1C of 9% or higher, and 78% were non-White.[12] Mean A1C moved from 11.4% at baseline to 9.8% at 6 months under intensive telehealth contact.[12] Small single-site projects like this one show feasibility, not scale, but they identify the staffing pattern a scaled service would need.[12]
Intensity cuts both ways. Participants in the comprehensive virtual program found it effective, yet its intensity made sustained engagement difficult.[8] Leaders weighing telehealth investment should plan for engagement, scheduling flexibility and the care team time needed to keep patients connected, not only for the technology.[7][8] They should also ask whether virtual sessions are offered at times that working adults and caregivers can attend. Finally, access includes the devices, connectivity and plain-language instructions that let a patient join a video session without help. When those supports are missing, the virtual option quietly becomes available only to people who already had the easiest access to care.
Executive guidance · System route
Map the path from first contact to verified follow-through.
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
Culturally adapted education reaches people standard programs miss
Participation gaps follow racial and ethnic lines, and so do the factors that predict them.[11] Black adults in the United States experience a disproportionate share of type 2 diabetes and its complications, yet their participation in self-management education is low.[1] A co-designed, culturally adapted 6-week group program delivered in community settings enrolled 32 Black adults with diabetes or prediabetes.[1] Retention was 100% and attendance was 86%.[1]
Participants in that program credited culturally affirming facilitation, trust and group support for their participation.[1] The study was single-arm, so its findings are exploratory, but they show that design choices about who teaches, where and in what format change who stays.[1]
Language and social conditions are part of the equity picture. In the Chinese American prevention trial, 99.3% of participants were born outside the United States and 88.0% reported speaking English less than very well.[2] The most frequent barriers were the need to improve English proficiency, reading skills or education (51.7%), racial discrimination (32.9%) and adverse housing conditions (25.5%).[2] Female participants were more likely to fall into higher barrier categories (odds ratio 3.83).[2]
Culturally tailored programs can also be acceptable to older adults and clinics. Among 45 Vietnamese American patients interviewed, 80% described the program as convenient and helpful.[5] Clinic participation was 83% and patient retention was 90.9%.[5] These are feasibility signals that executives can track in their own programs alongside clinical outcomes. Stratified participation data are the starting point, because without them a system cannot see which communities a standard program is failing to reach. The national prediction work found racial and ethnic differences in what predicted participation, which means a single outreach strategy is unlikely to fit every group.[11]
The economics of tailoring look favorable in at least one population. A 20-year model of a culturally adapted family-model program for Marshallese adults estimated $3083 per quality-adjusted life year gained.[9] The adapted program was preferred in 87.1% and 93.7% of simulations at willingness-to-pay thresholds of $50,000 and $100,000 per quality-adjusted life year.[9] The authors cautioned that differences in costs and outcomes between strategies were modest.[9] Even with that caution, the model gives finance and equity leaders a common language for discussing adapted programs as investments rather than optional extras.[9]
Human infrastructure
Educators, nurses and care teams carry the education pathway
Diabetes education depends on a specialized workforce that is often treated as background capacity. Reimbursement limits have restricted the capabilities of diabetes care and education specialists and contributed to significant wait times.[14] When educator hours are fixed and referrals rise, the result is a longer queue rather than more education. That makes workforce planning a direct determinant of the referral and completion rates that boards see. Recruitment, certification support, protected teaching time and the mix of group and individual sessions all shape how many people one educator can serve.
Educators are also referral nodes for other services, and that role needs support. A national survey of 1,495 certified diabetes care and education specialists found that 44.5% chose hearing impairment as a condition associated with diabetes, compared with 96.7% for kidney dysfunction.[15] Over 60% were not familiar with how to refer patients to an audiologist, and most had referred fewer than 20% of patients.[15] Onward referral routes need the same clarity as the referral into education.
New delivery models change job design. In the comprehensive virtual care program, staffing may require new clinical roles or substituting existing responsibilities to deliver the approach with fidelity.[8] Adaptations that standardize provider training and connect patients to locally available resources and complementary programs may increase the benefit.[8] Using existing infrastructure and care team organization facilitated implementation.[8]
Nurses already carry much of the remote work. The nurse-led telehealth evidence supports integrating structured nurse-delivered remote follow-up into clinical pathways between clinic visits.[7] In the Vietnamese American program, limited staffing and supply infrastructure were key barriers to sustainability.[5] Even so, 18 clinic staff took part in focus groups and endorsed the program as acceptable and feasible.[5] Pilot success can fade if the nurse calls and supplies that made it work are not budgeted.
Intensive models make the staffing cost visible. The youth telehealth project relied on weekly contact with a certified specialist and monthly nurse practitioner visits for each participant.[12] Leaders planning for scale can ask how many patients each educator or nurse can support at that intensity, and what work would be dropped if referrals doubled.[12][14] Community health workers, pharmacists and peer leaders may extend that capacity, but each added role needs a defined scope, training and a clear route back to the education team.
Executive guidance · Operating dashboard
Measure whether the operating route works as intended.
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
Keep work owned when it crosses a boundary.
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
Ask questions that connect intent, ownership, and results.
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 education pathway
| Control point | Risk if missing | Owner | Evidence of control |
|---|---|---|---|
| Education referral prompted at new diagnosis | Patients miss the early window associated with lower long-term risk | Primary care medical director | Share of newly diagnosed patients referred within 3 months |
| Referral-to-first-session scheduling owned | Interested patients are delayed or lost in scheduling | Access operations lead and education program manager | Median days from referral to first session and share never scheduled |
| Completion tracked separately from referral | Low completion stays hidden behind referral counts | Quality and analytics lead | Referral and completion rates reported as separate steps |
| Virtual and phone options offered | Patients who cannot attend in person are excluded | Telehealth program lead with nursing leadership | Share of sessions delivered virtually and engagement over time |
| Language and culturally adapted programs available | Participation stays low among groups standard programs miss | Health equity officer and education program manager | Attendance and retention stratified by race, ethnicity and language |
| Educator capacity matched to demand | Referrals create wait times instead of education | Chief nursing officer and finance lead | Referrals per educator and wait time trend |
| Participation, outcome and cost reviewed together | Programs lose funding without a visible case | Chief medical officer and board quality committee | Annual review linking participation to outcome and cost evidence |
Control points derived from the cited evidence [1], [5], [6], [7], [9], [11], [14] 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 education as a service people can trust and reach
The first communication gap is inside the organization. Clinicians and people with diabetes were often unfamiliar with what self-management education includes and how it helps.[14] Internal messages during this observance can explain what the program offers, who qualifies and how to refer, so that the conversation at the point of care is concrete.[14] Primary care teams are more likely to refer when they know what happens after the order, how long the wait is and how results come back to them. Patients are more likely to attend when the person recommending education can describe it in a sentence and name the first appointment.
Message tone matters as much as content. In the Marshall Islands study, 90% of participants recognized diet as a cause of diabetes, yet dietary control scored lowest among self-management domains.[10] A higher perceived threat of illness was associated with poorer self-management, suggesting that fear may discourage coping rather than encourage it.[10] Diabetes fatalism emerged as a barrier, which argues against alarm-based campaigns.[10] Messages that describe a practical next step, a supportive group or a convenient format may serve better than messages built on complications and risk.
Trust is built through who delivers the message and how. Black adults in the adapted program pointed to culturally affirming facilitation, trust and group support as reasons they took part.[1] The tailored-intervention review recommended participatory approaches that include people living with type 2 diabetes and their families and reflect their perspectives, needs and priorities.[3]
Language access is a communication requirement, not an add-on. In the Latino trial, 98% of participants preferred Spanish, and in the Chinese American trial 88.0% reported speaking English less than very well.[13][2] Materials, reminders and scheduling calls that arrive only in English will not reach these groups, however well they are designed.[2]
Executives also communicate with payers and boards. The Marshallese cost-effectiveness study was framed explicitly to inform reimbursement decisions by public and private insurers.[9] Pairing participation data with outcome and cost evidence gives leaders a credible case for sustaining education capacity after the observance ends.[4][9] Public messages should also promise only what the organization can deliver. Inviting people to education during this week creates demand, and that demand needs open sessions, staffed phone lines and a referral route that works. Trust grows when the invitation, the appointment and the follow-up all match.
Executive guidance · 90-day plan
Move from listening to a verified improvement in 90 days.
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 National Diabetes Education Week 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 National Diabetes Education Week 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
Carry one accountable improvement beyond the campaign window.
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
Listen to the people closest to the route, assign one barrier, and verify the change.
Executive action kit · Week observance
Turn National Diabetes Education Week into accountable action.
Use the observance to review how people find information, enter the right route, and remain connected through follow-through.
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 National Diabetes Education Week, 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
National Diabetes Education Week 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.Tikare O, Omuya H, Wen MJ, Kansariwala T, Pickard A, Pouncy J, et al. Culturally adapting an evidence-based diabetes self-management education program for black adults: a pilot mixed methods implementation study. Frontiers in Public Health. 2026;14:1806362. https://doi.org/10.3389/fpubh.2026.1806362
- 2.Jiang N, Liu J, Song H, Zhao Y, Li H, Yi SS, et al. Social Determinants of Health Among Chinese Americans at Risk for Diabetes in a Mobile Diabetes Prevention Trial: Cross-Sectional Baseline Analysis. JMIR Diabetes. 2026;11:e95295. https://doi.org/10.2196/95295
- 3.Afaya RA, Seib C, McGuire A, Petsky H. Effectiveness of Culturally Tailored Interventions on Self-Management in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. Worldviews on Evidence-Based Nursing. 2026;23(4):e70141. https://doi.org/10.1111/wvn.70141
- 4.Selvek M, Saal B, Mužik R, Tkáč I. Impact of Education in Disease Management Program for Patients with Diabetes Mellitus on All-Cause Mortality: A Propensity Score-Matched Cohort Study. Diabetes Therapy. 2026. https://doi.org/10.1007/s13300-026-01922-z
- 5.Nguyen A, Eschiti V, Bui TC, O’Neal K, Nguyen T, Nguyen AP, et al. Promoting Diabetes Self-Management Among Vietnamese Americans: Mixed Methods Pilot Study. JMIR Diabetes. 2026;11:e80177. https://doi.org/10.2196/80177
- 6.Cohen DA, Nau C, Han S, Habib M, Sturm R, Martin J, et al. Early diabetes education and long-term cardiovascular outcomes among adults with newly diagnosed Type 2 diabetes. Primary Care Diabetes. 2026. https://doi.org/10.1016/j.pcd.2026.10.001
- 7.Hu R, Luo X, He C, Cui X, Yuan P, He Q, et al. Effectiveness of Nurse-Led Telehealth Compared With Usual Care on Glycemic Control and Body Mass Index in Adults With Type 2 Diabetes: A Systematic Review and Meta-Analysis. Journal of Clinical Nursing. 2026:jocn.70457. https://doi.org/10.1111/jocn.70457
- 8.Drake CD, Lanford-Davey T, Eldridge MR, Waddell ZE, German J, Shapiro A, et al. Implementation barriers and facilitators of a virtual telehealth program for patients with persistently poorly controlled type 2 diabetes mellitus: a rapid qualitative analysis approach. BMC Health Services Research. 2026;26(1):1265. https://doi.org/10.1186/s12913-026-14680-2
- 9.Lamprecht-Carson D, Wang H, Chang S, McElfish PA, Andersen JA, Michaud TL. Cost-Effectiveness of a Culturally Adapted Diabetes Self-Management Education Program for Marshallese Adults With Type 2 Diabetes-a State-Transition Markov Analysis. Diabetes, Obesity and Metabolism. 2026:dom.71351. https://doi.org/10.1111/dom.71351
- 10.Yoshino J, Wase-Jacklick F, Enos HK, Ken I, Aiga H, Masuda K. Understanding type 2 diabetes self-management in the Marshall Islands: A mixed-methods exploration of sociocultural and structural barriers. PLOS Global Public Health. 2026;6(9):e0007152. https://doi.org/10.1371/journal.pgph.0007152
- 11.Jiang X, Lv G, Li M, Yuan J, Lu ZK. Predicting diabetes self-management education engagement: machine learning algorithms and models. BMJ Open Diabetes Research & Care. 2025;13(1):e004632. https://doi.org/10.1136/bmjdrc-2024-004632
- 12.Rasbach L, Purrington G, Adkins D, Benjamin R. Telehealth to Promote Adoption of Automated Insulin Delivery Systems in Youth With Risk Factors for Adverse Diabetes Outcomes. The Science of Diabetes Self-Management and Care. 2025;51(5):497-504. https://doi.org/10.1177/26350106251361370
- 13.Ehrhardt N, Montour L, Berberian P, Vasconcelos AG, Comstock B, Wright LAC. A Randomized Clinical Trial of a Culturally Tailored Diabetes Education Curriculum With and Without Real-Time Continuous Glucose Monitoring in a Latino Population With Type 2 Diabetes: The CUT-DM With Continuous Glucose Monitoring Study. Journal of Diabetes Science and Technology. 2025;20(5):1650-1660. https://doi.org/10.1177/19322968251331526
- 14.Tharakan A, McPeek Hinz E, Zhu E, Denmeade B, German J, Huang WA, et al. Accessibility of diabetes education in the United States: barriers, policy implications, and the road ahead. Health Affairs Scholar. 2024;2(8):qxae097. https://doi.org/10.1093/haschl/qxae097
- 15.Zelnicek TD, Sewell HE, Planas LG, Skaggs JC, Lim J, Johnson CE, et al. Assessing Current Knowledge of Hearing Impairment With Diabetes by Surveying Providers With CBDCE Certification. The Science of Diabetes Self-Management and Care. 2024;51(1):110-119. https://doi.org/10.1177/26350106241296484
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 |
|---|---|---|---|---|
| Referral, completion and system barriers to diabetes education | [14] | 2024 | Current evidence | Single academic medical center; descriptive rates with policy analysis. |
| National participation and predictors of engagement | [11] | 2025 | Current evidence | Medicare beneficiaries from 2017 to 2019; predictive models, not causal estimates. |
| Early education and long-term cardiovascular outcomes | [6] | 2026 | Current evidence | Observational health record cohort; residual confounding possible. |
| Structured education and all-cause mortality | [4] | 2026 | Current evidence | Retrospective insurer data from Slovakia; propensity matching cannot remove all confounding. |
| Culturally tailored self-management interventions | [3] | 2026 | Current evidence | Seventeen studies with only 7 in the meta-analysis; heterogeneous interventions. |
| Self-management, education attendance and fatalism in a high-prevalence setting | [10] | 2026 | Current evidence | Cross-sectional survey of 123 outpatients in one atoll with small qualitative sample. |
| Social determinant barriers in diabetes prevention | [2] | 2026 | Continuum of care | Baseline cross-sectional data from one city trial of 150 participants. |
| Implementation of comprehensive diabetes telehealth | [8] | 2026 | Continuum of care | Secondary qualitative analysis of 19 patients and 8 staff within one trial. |
| Culturally tailored Vietnamese-language education in primary care | [5] | 2026 | Continuum of care | Single-arm pilot; no significant change in hemoglobin A1c. |
| Telehealth with certified specialists for Medicaid youth | [12] | 2025 | Continuum of care | Quality improvement project with 18 participants; durability unknown. |
| Nurse-led telehealth and glycemic control | [7] | 2026 | Access | Eleven trials of varying intensity and fidelity; short-term outcomes. |
| Virtually delivered culturally tailored education in a federally qualified health center | [13] | 2025 | Access | Open-label trial in one federally qualified health center; authors note continued monitoring may be needed for a sustained effect. |
| Culturally adapted education for Black adults | [1] | 2026 | Equity and trust | Pilot single-arm study of 32 participants; exploratory findings. |
| Cost-effectiveness of culturally adapted education | [9] | 2026 | Equity and trust | Model-based 20-year estimate; modest differences between strategies. |
| Educator knowledge of onward referral | [15] | 2024 | Human infrastructure | Self-selected national survey of certified specialists. |
About the author
Greg Wahlstrom
MBAHCM
President and Chief Executive Officer, The Healthcare Executive
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