Rural primary care providers often miss cases of type 1 or other rare forms of diabetes, frequently defaulting to a diagnosis of type 2 diabetes. Even when managing type 2 diabetes, many feel underprepared—both in knowledge and time—to initiate treatment and provide patient education, leading them to refer patients to endocrinologists. These referrals can result in delays in care, loss to follow-up, and higher long-term costs. These adverse outcomes could be mitigated with stronger decision support for diagnosis and treatment pathways, enabling PCPs to manage less complex diabetes cases more effectively.
When rural providers encounter patients with elevated fasting blood glucose and/or elevated HbA1c levels, they often end the diagnostic workup there with a T2DM diagnosis. Some may initiate antiglycemic therapies with minimal patient education, follow-up, or connection to assistance programs, missing opportunities to engage patients in longitudinal, holistic diabetes management and decreasing the chance that patients will achieve diabetes control.
Others refer to endocrinologists immediately, which effectively derails diabetes care: patients struggle to access specialists due to limited availability and financial constraints and are quickly lost to follow-up. Within this paradigm, T1DM diagnoses are often missed entirely due to inadequate PCP knowledge and low access to diagnostic tools (C-peptide, islet autoantibody tests). These diagnostic steps represent both an overwhelming cognitive/implementation lift to rural primary care providers as well as a powerful linchpin to improved diabetes outcome if technologized.
NEEDS STATEMENT:
Develop integrated decision-support tools within electronic health records (EHRs) to help rural primary care providers accurately diagnose and manage diabetes.
REQUIREMENTS:
- Recommendations on when additional tests are necessary.
- Real-time guidance on treatment options including medication, lifestyle education, and patient assistance programs
- Risk stratification that accounts for social determinants of health
ADDITIONAL CONSIDERATIONS:
- Integrate on-demand education modules (such as from UpToDate) to connect providers with current guidelines.
- Incorporate best practices on communicating health information with patients.
