A 51-year-old man comes to your clinic for follow-up regarding his type 1 diabetes.

This patient is experiencing social instability (homelessness, job loss) likely contributing to poorly controlled diabetes. Before investigating or prescribing further, it is essential to address his ability to afford and manage self-monitoring and insulin.

Toronto Notes 2023 – Endocrinology, Diabetes:

“Social determinants such as housing insecurity and financial barriers significantly affect diabetes self-management. Addressing access to glucose monitoring and insulin is critical.”

MCCQE1 Objectives – Internal Medicine > Chronic Disease Management:

“Candidates must assess barriers to effective disease control, including financial and psychosocial limitations.”

Antidepressants (B) may be helpful later if depression is suspected. Thyroid testing (C) is not the priority. A dietitian (D) may help long-term, but immediate access and adherence are more urgent.

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