Diabetes Core Update: Special Edition – Diabetes and Primary Care (March 2026)

Date: March 5, 2026
Length: ~31 minutes
Host: Neal Skolnik, M.D.
Guests: Dr. Asan Ebakanosian (Chief Quality Officer, ADA), Dr. Christopher Jones (Medical Director, Intermountain Health; Chair, ADA Primary Care Interest Group)

Episode Overview

This special edition of Diabetes Core Update examines the evolving landscape of diabetes and cardiometabolic disease management in primary care. Host Dr. Neal Skolnik is joined by Dr. Asan Ebakanosian and Dr. Christopher Jones to discuss bridging the gap between ever-expanding clinical recommendations and real-world practice, driving quality improvement, the importance of team-based care, and supporting primary care clinicians amid growing complexity and workforce challenges.

Key Discussion Points & Insights

1. The Role of the ADA’s Chief Quality Officer (CQO)

(03:00 – 06:00)

• Dr. Asan Ebakanosian explains the ADA’s creation of the CQO role to focus on practical implementation of recommendations, aiming to close persistent care gaps despite advances in research, advocacy, and provider education.
  • Quote:
    “Despite ... great efforts and a lot of the great leadership ... there are still gaps in care ... how our recommendations get to patients, get to providers, how the providers implement and use those recommendations." – Dr. Ebakanosian (03:23)
• The CQO’s mission: Facilitate on-the-ground transformation so evidence-based recommendations translate into practice.

2. Bridging the Gap: Education, Knowledge, and Implementation

(06:07 – 11:10)

• Quality assurance goes beyond education—it’s about creating systems that make it easier to do the right thing by streamlining workflows and reducing cognitive burden on clinicians.
  • Quote:
    “Every system is designed to get the results it produces ... how do we change the system? How do we make the system make the default the easier piece to do?” – Dr. Ebakanosian (06:16)
• Example: The routine underuse of UACR (urine albumin-creatinine ratio) due to system/process barriers, not lack of knowledge.
  • Quote:
    "Even with all the great knowledge ... if the process ... missed that opportunity ... my knowledge doesn't matter anymore." – Dr. Ebakanosian (07:00)
• ADA is working to support providers with EHR prompts, better workflows, and clear priorities from among 600+ recommendations.

3. Major Challenges and Opportunities in Primary Care

(11:45 – 17:20)

Dr. Ebakanosian:

• Three Levels of Challenges:
  1. Individual: Overwhelming administrative and clinical demands for providers; a shrinking workforce faced with growing disease burden.
  2. Institutional: Insurance and EHR-related barriers, inflexible processes, and restrictive policies that constrain delivery of optimal care.
  3. Systemic: Broader issues like reimbursement for primary care and the ever-growing complexity of guidelines (from 4 pages in 1989 to over 350 in 2026).
• Opportunity: Advocacy and multisector change across all levels.

Dr. Jones (Perspective of Individual Providers):

• Recognizes information overload; the need for efficient use of technology and resources.
• Stresses building team-based care, where clinicians do not work in isolation but as part of multidisciplinary teams.
  • Quote:
    “We are never an individual, and we should never be sitting there thinking, I am in charge of my patients today ... we must create that team.” – Dr. Jones (16:16)
• The core challenge: Coordinating care and resources for best outcomes amid overwhelming information and workload.

4. Building Effective Systems and Teams

(17:21 – 20:03)

• Dr. Jones introduces "practice inertia," encouraging clinics to continually assess and take "the next step" towards improvement, however small.
  • Quote:
    “We talk about clinical inertia ... I like to think of practice inertia. Is our practice just ... the same as it was yesterday ... we need to start ... identify where you are and then take the next step.” – Dr. Jones (18:07)
• Importance of identifying and leveraging all roles in the care team—sometimes up to 20 different contributors per ADA’s Table 1.1.

5. The Changing Relationship: Primary Care & Specialists

(20:03 – 23:00)

• Dr. Jones advocates for stronger collaboration, NOT simply transferring care to specialists. Using referrals strategically for specific skills (e.g., CGM training) and then returning care to primary providers.
  • Quote:
    “Rather, I would love to see the primary care doctor identify the next step ... maybe I don’t feel comfortable with CGMs ... send the patient to endocrinology ... [they] train them ... send them back to me and I’ll continue.” – Dr. Jones (21:34)
• This model preserves continuity, grows PCPs’ skills, and leverages scarce specialty slots for the most complex cases.

6. Tackling Burnout and Expanding the Workforce

(23:00 – 30:00)

• The reality of limited PCPs and exploding cardiometabolic disease: Burnout risk is high due to complexity and competing demands.

• ADA is addressing this by:

  • Convening a Primary Care Council: 10 national associations (nurses, PAs, pharmacists, educators, etc.), representing 800,000+ professionals. Focus: identifying needs, sharing best practices, and ensuring everyone works at the top of their license.
  • Building the Primary Care Alliance: Testing and disseminating new workflows, AI-supported solutions, and sharing practical tools. Call to action for listeners to get involved (Email: qualityadiabetes.org).

• Emphasis on sharing what works and supporting teams so each member practices at their full scope.

  • Quote (on teamwork):
    “How do we ensure that everyone is working at the top of their license ... that they feel energized and activated to contribute in that care team?” – Dr. Ebakanosian (25:57)

7. Looking Forward: Ongoing Change and Invitation to Engage

(30:09 – end)

• Final Thoughts (Dr. Jones):
  • Watch for new ADA recommendations, especially on technology and team roles.
  • Stay engaged—there is “so much to learn and so much to do and it’s all enjoyable and fun.” (30:44)
• Final Thoughts (Dr. Ebakanosian):
  • Acknowledges progress and the need for intentional action and collaboration.
• Host’s Reflection:
  • Importance of “intentional” approaches and focusing on “what to do next” as care grows more complicated.

Notable Quotes

• Dr. Skolnik:
  “... the goal of education is actually behavioral change and that once ... there's a gap between when I teach and what someone learns ... I taught my dog how to whistle. I didn't say he learned, right?” (05:06)

• Dr. Ebakanosian:
  “Every system is designed to get the results it produces ... how do we help modify a system so you have everything you need to do the right thing?” (06:16)

• Dr. Jones:
  “We must create that team because we're the leader of that team. But there are plenty of people listening ... who are part of that team ... and they're absolutely critical.” (16:16)

• Dr. Skolnik:
  “... when the standards of care started ... in 1989 ... just four pages ... now over 350 pages ... How are we matching up to the evolution of care?” (13:46)

• Dr. Jones:
  “Do we have practice inertia? We need to start and we need to move in a way to change our practice with the growing environment that we have.” (18:09)

• Dr. Ebakanosian:
  “How do we expand the role of the team? ... Help us think through what's the best way to engage, what's the best way to empower, and what's the best way to ensure that they feel energized and activated to contribute in that care team?” (25:22)

Timestamps for Important Segments

• [03:00] – Why the ADA created the Chief Quality Officer role
• [06:07] – Translating recommendations into practice; quality assurance
• [08:44] – Addressing missed opportunities like UACR
• [11:45] – Key challenges (individual, institutional, systemic)
• [15:29] – Dr. Jones on team-based care
• [18:03] – Overcoming 'practice inertia'
• [20:31] – Evolving relationships: primary and specialty care
• [23:00] – Burnout, complexity, and ADA’s system-wide initiatives
• [25:00] – The Primary Care Council and Alliance
• [30:22] – Closing thoughts, invitations, and looking forward

Summary Tone

The episode is collaborative, thoughtful, and practical. Speakers blend optimism and realism, recognizing the pressure on providers while emphasizing actionable steps, teamwork, and system redesigns. They're committed to moving beyond awareness to sustainable behavioral change and quality improvement, with an open invitation for listeners to participate in ongoing advancements.

This summary captures major insights, quotes, moments, and timestamps for listeners seeking a concise yet detailed recap of the March 2026 Diabetes Core Update special on primary care and diabetes.