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Although a generic term for professionals who take care of patients might be expedient, many find the term “provider” to be quite offensive. History shows that calling a medical professional a provider is a professional insult. The term was first used by the German Third Reich to devalue and demean Jewish physicians as medical professionals (1). Jewish physicians were not allowed to refer to themselves as “arzt” (translated as “doctor”), …

One of the silver linings in the horror of the coronavirus disease 2019 (COVID-19) pandemic is the evolution and proliferation of telemedicine. According to the Centers for Medicare & Medicaid Services, “Telehealth, telemedicine, and related terms generally refer to the exchange of medical information from one site to another through electronic communication to improve a patient’s health” (1). Since the start of the pandemic, telemedicine services have proliferated. The American Academy of Family Physicians estimated that the rates of telemedicine among its membership …

The recent killing of George Floyd in Minneapolis, MN, among many other senseless deaths, has highlighted issues of endemic racism in America and prompted an examination and evaluation of practices across many different institutions. Systems of structural racism exist that includes the totality of ways in which societies further racial discrimination through mutually reinforcing systems of housing, education, employment, earnings, benefits, credit, media, health care, and criminal justice. Although the health care sector endeavors to be …

In Brief This article explores some of the reasons for the delay in insulin initiation in primary care and evaluates new approaches to insulin therapy that may address these barriers and, therefore, improve insulin use by primary care providers.

The term “evidence-based practice” is supposed to mean the use of the best available evidence when making patient care decisions. Typically, however, this “best evidence” is obtained from randomized controlled trials (RCTs), the patients are recruited from a homogenous group, and the data are closely controlled and monitored. Evidence gathered in such a research setting does not reflect real-world clinical practice. That is where more pragmatic real-world evidence (RWE) studies come in. If the …

The standards of care for diabetes are ever evolving. They evolve with new evidence, medications, and knowledge. To keep up with the changes, the American Diabetes Association (ADA) updates its Standards of Medical Care in Diabetes guidelines each year. After an extensive review by its Professional Practice Committee, the ADA publishes updated recommendations each January reflecting the current best approaches to the evaluation and management of patients with diabetes. The 2019 Standards were recently published in Diabetes …

The pandemic of diabetes is accelerating at an alarming rate; however, my concern is that the education of future clinicians is not keeping up. Although resident physicians are managing patients with diabetes in both inpatient and outpatient environments, their prior formal education has been limited. There is minimal or no exposure to the breadth of therapeutic options as outlined in guidelines from the American Diabetes Association and the American Association of Clinical Endocrinologists. There is minimal knowledge and experience with newer drug classes such as dipeptidyl peptidase …

It is estimated that ∼85% of people with diabetes are managed in primary care. Back in the day, primary care clinicians often referred patients to an endocrinologist once the decision was made to initiate insulin. Diabetes was considered too complex and too fraught with danger. So, once a primary care provider needed to proceed beyond metformin and sulfonylureas, the patient was referred to a specialist. Times have changed. Diabetes has become a larger pandemic, and the base of clinicians interested in and available to treat diabetes has increased. Family physicians, internists, physician’s assistants, and nurse practitioners now provide expanded options for the care of diabetes. Certified diabetes educators, pharmacists, and other clinicians provide additional and often crucial support. The armamentarium of insulins and other pharmacological agents to address the core physiological defects of the disease has …