Purpose of Review

An expanding body of research documents associations between socioeconomic circumstances and health outcomes, which has led health care institutions to invest in new activities to identify and address patients’ social circumstances in the context of care delivery. Despite growing national investment in these “social care” initiatives, the extent to which social care activities are routinely incorporated into care for patients with type II diabetes mellitus (T2D), specifically, is unknown. We conducted a scoping review of existing T2D treatment and management guidelines to explore whether and how these guidelines incorporate recommendations that reflect social care practice categories.

Recent Findings

We applied search terms to locate all T2D treatment and management guidelines for adults published in the US from 1977 to 2021. The search captured 158 national guidelines. We subsequently applied the National Academies of Science, Engineering, and Medicine framework to search each guideline for recommendations related to five social care activities: Awareness, Adjustment, Assistance, Advocacy, and Alignment. The majority of guidelines (122; 77%) did not recommend any social care activities. The remainder (36; 23%) referred to one or more social care activities. In the guidelines that referred to at least one type of social care activity, adjustments to medical treatment based on social risk were most common [34/36 (94%)].

Summary

Recommended adjustments included decreasing medication costs to accommodate financial strain, changing literacy level or language of handouts, and providing virtual visits to accommodate transportation insecurity. Ensuring that practice guidelines more consistently reflect social care best practices may improve outcomes for patients living with T2D.

中文翻译：

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国家糖尿病治疗指南中的社会关怀建议

审查目的

越来越多的研究记录了社会经济环境与健康结果之间的关联，这促使医疗保健机构投资于新的活动，以在提供医疗服务的背景下识别和解决患者的社会环境。尽管国家对这些“社会关怀”倡议的投资不断增加，但社会关怀活动在多大程度上被常规纳入对 II 型糖尿病 (T2D) 患者的关怀中，具体而言，尚不清楚。我们对现有的 T2D 治疗和管理指南进行了范围界定审查，以探讨这些指南是否以及如何纳入反映社会护理实践类别的建议。

最近的发现

我们应用搜索词来查找 1977 年至 2021 年在美国发布的所有成人 T2D 治疗和管理指南。该搜索捕获了 158 个国家指南。随后，我们应用国家科学院、工程院和医学院的框架来搜索每项指南，以寻找与五项社会关怀活动相关的建议：意识、调整、援助、宣传和协调。大多数指南（122；77%）不推荐任何社会关怀活动。其余 (36；23%) 涉及一项或多项社会关怀活动。在提到至少一种社会关怀活动的指南中，最常见的是根据社会风险调整药物治疗 [34/36 (94%)]。

概括

建议的调整包括降低药物成本以适应财务压力、改变识字水平或讲义语言，以及提供虚拟访问以适应交通不安全。确保实践指南更一致地反映社会关怀最佳实践可能会改善 T2D 患者的预后。