Exploring Barriers and Facilitators to Glycemic Control and Shared Medical Appointment Engagement in Underserved Patients with Diabetes.

OBJECTIVE: The purpose of this study was to evaluate barriers and facilitators to glycemic control and diabetes shared medical appointment (SMA) engagement in underserved patients with type 2 diabetes. METHODS: Semi-structured focus groups were conducted in 50 patients using an interview script guided by a social determinants of health (SDOH) conceptual framework. RESULTS: Patients positively perceived the social support and access to care benefits of the SMA. While barriers related to self-care behaviors (particularly diet), financial issues, and unreliable transportation were common, notable differences among the four groups existed. Controlled patients were motivated by fear of diabetic complications. Poorly-controlled patients discussed comorbidities and negative influence of family as barriers to glycemic control. Diabetes distress and fatalism were endorsed by poorlycontrolled, non-engaged patients. CONCLUSIONS: Overcoming SDOH including transportation barriers, food insecurity, and diabetes distress and fatalism are promising areas of intervention for SMA models to improve care for underserved populations.

Irritable Bowel Syndrome: Clinical Manifestations, Dietary Influences, and Management.

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder that is characterized by symptoms of chronic abdominal pain and altered bowel habits in the absence of an overtly identifiable cause. It is the most commonly diagnosed functional gastrointestinal disorder, accounting for about one third of gastroenterology visits. It generally presents as a complex of symptoms, including psychological dysfunction. Hypersensitivity to certain foods, especially foods that contain high amounts of fructose, plays a role in the pathophysiology of IBS. Elevated consumption of high-fructose corn syrup (HFCS) has been discussed in this aspect. The treatment options for IBS are challenging and varied. In addition to dietary restrictions for HFCS-induced IBS, such as low-FODMAP (Fermentable Oligosaccharides, Disaccharide, Monosaccharides, and Polyols) diets, existing drug therapies are administered based on the predominant symptoms and IBS-subtype. Patients with IBS are likely to suffer from issues, such as anxiety, depression, and post-traumatic-stress disorder. Biopsychosocial factors particularly socioeconomic status, sex, and race should, thus, be considered for diagnostic evaluation of patients with IBS.