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有了指南和最佳实践建议，治疗/管理计划的重点是达到实验室目标和身体参数，以改善结果。尽管血红蛋白A1C和血压水平的靶向是发病率和死亡率风险的潜在决定因素，但优化这些参数仅解决与不同结果相关的某些因素。

In a previous issue,Ozieh等。查看健康决定因素（抑郁症，粮食不安全，贫困水平）对所有导致1376名患有糖尿病和慢性肾脏疾病的人死亡的个人和累积影响。即使对人口统计学，生活方式变量，血糖控制和合并症的调整，社会决定因素也与死亡率显着相关。抑郁与死亡率独立相关。拥有所有3个地区的个人的死亡风险高41％。卫生保健提供者已经认识到，社会经济因素在获得护理，健康素养和遵守治疗方面影响健康，但影响程度已被低估。

与拥挤的办公室/诊所schedul的挑战es and numerous competing health conditions needing evaluation, the ability to spend time to understand the economic situations or characteristics of a patient’s life is not often available. Physicians may be limiting the ability to treat patients without that information. This understanding would serve to strengthen the provider-patient relationship. Perhaps the approach for the initial assessment for diabetes care, chronic kidney disease or hypertension care would include questions to gauge food insecurity, ability to follow specific diet, or ability to get to appointments.This information would allow creation of feasible plans of care and eliminate the usually inaccurate assumptions that an individual not following a prescribed treatment is a result of lack of care by the patient.

在过去的几年中，已引入了新的药物，例如SGLT-2抑制剂，以治疗糖尿病，并有望改善心脏和肾脏结局。这些代理商通常很昂贵，并且通常具有挑战性地获得保险。随着研究和药物开发为我们带来了更新的治疗选择，我们需要记住，仅针对治疗剂的生化参数无法完全解决我们许多慢性疾病的健康影响。我们需要同时倡导对案例管理和社会干预措施进行投资。