How does social connection influence diabetes outcomes? In this episode of Diabetes Care Conversations, host Patrick McMahon speaks with diabetes care and education specialist Megan Muñoz, RN, MSN, CDCES, about the impact of loneliness and social isolation on diabetes management. Together, they explore how social connection influences health outcomes and share practical strategies for helping people with diabetes build stronger support systems through person-centered care.
Patrick McMahon
Welcome to ADCES' podcast Diabetes Care Conversations, where we explore ideas, challenges, innovations shaping diabetes care and education. I am your host, Patrick McMahon.
So take a moment to think about the role connection plays in health and well-being. For people living with diabetes, support systems, relationships, and a sense of community have a meaningful impact on daily self-management and long-term outcomes. Yet loneliness and social isolation often go unseen in clinical care even as they continue to affect millions of people managing chronic conditions. Recent reports estimate that more than 50% of Americans experience feelings of loneliness, and approximately 25% of older adults are considering socially isolated. For people living with diabetes, these experiences can significantly impact emotional well-being, self-management behaviors, and long-term health outcomes. Today's conversation is inspired by ADCS's in practice article loneliness and social isolation, what is our role as CTCES? We'll explore how certified diabetes care and education specialists can better recognize the impact of social disconnection, incorporate social connectedness into person-centered diabetes care. Joining us today is Megan Munoz, registered nurse, certified diabetes care and education specialist, and author of this article. Megan, thank you so much for being here today. Could you share a little about your background and what inspired you to explore this topic?
Megan Muñoz
Yeah, thank you. What a nice introduction. My name is Megan Munoz. I have been a certified diabetes care and education specialist. I think it's been 10 plus years. So it's kind of hard to believe. And I really got interested because I kept running across people who were really struggling to manage their self-care. And I noticed kind of a common theme among those group of people, which is they didn't have a lot of connections or they considered themselves to be a little bit more disconnected socially. Even if they were surrounded by other people, they felt like people didn't understand them and didn't understand what they were going through. So that was, I think, the biggest piece is just seeing that.
Patrick McMahon
You're seeing this, you know, so I'm gonna dig a little bit into the what inspired you to write this article and why is loneliness and social isolation such an important topic in diabetes care right now.
Megan Muñoz
The one thing I remember is reading an article or hearing an interview about people that had open heart surgery and the connection between that and their post-op outcomes and the relationships they had around them. So people were more likely to have successful follow-up care and fewer complications and do much better post-op when they had someone that was involved in their care, whether it was a loved one or family member. So it got me thinking about.
When we talk about diabetes and complications and things like that, how does that connect for people with diabetes, especially since we've seen so much of that social isolation conversation come up with COVID? And I do remember a gentleman that I struggled helping in the diabetes world. And I remember talking about this gentleman with one of my coworkers and saying, I just don't know how to help him. He keeps coming back and I feel like we're not making any ground. And I feel like I've tried everything I could think of. And she said, Well, maybe he's just lonely. Maybe he's just coming back because he's lonely. And the more I looked at his life, I think that was very accurate. But I didn't know what to do with that. So I don't think I helped him very much, but it was kind of an eye-opening experience. And I guess the third and final thing I would say to that piece is when I hear people with diabetes talking about managing diabetes, it's in the context of really complicated social scenarios. So they've got financial stressors, they've got kids, maybe they're a single parent, they've got family dynamic stuff going on. There's so many stressors. There's work and long work hours and very little downtime. And I keep seeing that come up too. There's really no space a lot of times in our day and age to have that downtime, social connection time. And there's a lot that can get resolved with social connections. A lot of those things can be alleviated. Financial stressors, physical stressors, if we have other people around us a community that can help. Financial stuff maybe for babysitting care is not as critical when you have maybe a coworker that you can swap schedules with and share s babysitting schedules. So there's just a lot I think that can come from community.
Patrick McMahon
Great. So it sounds like you learned from different literature, you know, the hard work that you were kind of working on and you also seeing that kind of in your patients, especially with that kind of older gentleman there. You probably see his face, you're probably still kind of thinking about him, being like, How do I do this? And it's that loneliness or kind of reaching out to your peers and being like, I just can't kind of understand this this patient for that. So many people use the terms loneliness and social isolation interchangeably to find that difference between the two. I think we already started talking a little bit about those, but what is that difference?
Megan Muñoz
Yeah, that's a great question. So they're very different. Loneliness, like you alluded to in your introduction, is more a subjective experience. So it's how somebody feels. So they could be surrounded by family, they could be surrounded by community, but still feel very lonely. Whereas social isolation is more objective, something that we can quantify. So how many social connections do these people have? How many community events do they attend? Are they married? Do they have children?
Do they live in a rural area or do they live in the middle of the town? So those are more objective type things. And then I think the third thing to add to that piece is these are very different than someone choosing to be by themselves. Some people are just more introverted. They prefer to have downtime, quiet time. And that's different because that's an active choice versus feeling lonely and feeling isolated or actually being isolated. So I think there's that kind of distinction that's important too.
Patrick McMahon
So why is it important for healthcare professionals to understand that distinction between those three topics?
Megan Muñoz
I think it's because your interventions are different. So if somebody is socially isolated, we might need to think about how to set up structural things that we can do to help. So maybe it's helping them seek out volunteer opportunities. Maybe they have some great skill sets that they could be a part of the community free clinic or they could be a part of the animal shelter, even if it's from home. If they're a little bit more homebound, there's so much we can do technology-wise now, helping out with some of the paperwork and things like that. So that would be very different than if somebody is lonely. That might be more a therapy type of work where somebody's referred to as specialist that can help them unpack, even though you're surrounded by lots of people, what is it? What is the disconnect there? So I think the interventions are different based on that.
Patrick McMahon
Yeah, interventions might be different. The why might be a little bit different in that way. Again, if they're wanting to excuse themselves, kind of being like, I need my alone time to recharge and stuff like that is a little bit different in that way. So understanding your patient and the person you're kind of working with that. You mentioned the term social connectedness. What does that look like through this work through a social connected lens? And maybe can you explain what that means and how social connections influences maybe diabetes self management or your work in that area?
Megan Muñoz
Very true. Yes.
Megan Muñoz
That's an important point because I think the social connectedness piece is something I really picked up on when I was reading Dr. Vivek Murphy. He spent a lot of time in his career under the Biden administration looking at social disconnection, social isolation, and social connectedness. And that's a term that he used quite often. He's a really important driver in talking about this and the links between chronic health. And he even stated that social connection as as fundamental a need to human development and health as food, water, and shelter. And we often don't think about it to that degree. So there's that baseline level of all of us need this foundation of social connectedness. But then there's this added piece where people with diabetes tend to be more isolated or more lonely because maybe the access they have to other people or potentially because they have other types of things that they have to deal with day to day.
That many people that don't have diabetes don't even have to think about. Like you can sit down and eat a meal and you don't even have think twice about it. And someone's diabetes has to think about that constantly. So when we add that layer of a chronic disease on top of social isolation and that survival type need, there are a lot of ways that it can affect people with diabetes. So the acute everyday type of activities, you see more struggles with managing blood sugars, checking blood sugars, taking medication. It could also be more of those stressors like getting access to medication, getting to appointments, financial stressors, those types of things as well. We see decreased health behaviors for people who are more lonely and socially isolated. So they tend to be less active. They tend to have less variety in their food choices. They tend to be smokers versus non-smokers. So there's a lot of extra things like that. And that carries over into long-term complications. So when we look at social isolation, loneliness, and some of those key elements for people with diabetes, that actually increases their risk for things like renal disease, heart disease. And then so when we already have st happening for people who are socially isolated and we add that diabetes piece in, that just compounds the social isolation and diabetes complications piece when they come together.
Patrick McMahon
So definitely is really that foundational aspect of that. So, you know, it's not just something I I can add on. It is really for that kind of survival part. So again, as important as food, water, other parts in that way. Again, addressing these with your patient is a huge part for a healthcare provider or a certified diabetes care and education specialist. You know, a few parts of self care behaviors that could be affected by that from either your personal clinical experience or from your research for this.
Which self care behaviors do you see most impactful by loneliness or lack of support for that? Is it medication taking? Is it support in that way? What what did you find?
Megan Muñoz
I think it's both I would say monitoring blood sugars is probably the biggest. And I think the biggest reason why is because if people are struggling often it's hard to see the concrete results of that. So if you are struggling to take your medication or you know that your blood sugars are running higher than normal, maybe because you're under a lot of stress or there's other things going on that are impacting it, you're not gonna check your blood sugar.
You don't want to see that. I don't blame you. And so then there becomes this cycle of you can kind of put it off. I don't really see it. So it's not really happening. So I don't really have to deal with it. It's not in my face. So I would say that's the one I see the most is monitoring, followed very closely by taking the medication.
Patrick McMahon
Yeah, I could definitely see healthy eating. I always love to eat and have that kind of connection with family. And again, if you have those kind of structural parts, the default of hey, these are friendly for myself or friendly for my family, I could see that could definitely be a positive thing. But again, I could see the medication taking would be super affected by loneliness, by support in that way. You
Megan Muñoz
Great point Patrick because food is a very social thing. It's how we celebrate, it's how we connect with others, it's how we comfort ourselves sometimes. You have a great point there. I do think that food is greatly impacted. And it shows in the studies that I looked at too, food is definitely a big one.
Patrick McMahon
So you outlined several ways C D C S can address social isolation and loneliness. What are some practical or realistic ways providers can incorporate this into the routine?
Megan Muñoz
Great question, because there's not a lot out there to really screen for this. There's a diabetes distress scale, which I love because I love Dr. Polanski. That will sometimes capture these folks. Otherwise, you shouldn't assume if somebody's coming to appointments that they are not struggling with loneliness or isolation. Because actually in the research, what really surprised me is people who are more isolated or lonely tend to come to their appointments more regularly.
So it's not those folks that are canceling or missing. It's those folks that are still showing up. And so that's sometimes if people are really consistent about seeking out their health care, we may not see this person as at risk or somebody that we need to give that extra attention to as far as connection and community-based things. So I think screening for it. And then I think the other piece is how can we help people find that sense of purpose?
That is one thing that came out a lot during these different studies that I was looking at. People really need to have a sense of purpose. They need to feel like they matter to other people and they belong in the world. And so helping people develop that, if they don't have that, it could be something as simple as, like I said earlier, volunteering. It could be reading to kids at the school. It could be doing paperwork for a shelter. Most of us have a skill set of some kind that somebody could use and somebody needs. I know there are some really neat programs where they have daycare centers in nursing homes together so that there is that combination. Sometimes it's people going into schools and creating a game club for kids and teaching them some of the games like cribbage or chess or things that they wouldn't learn otherwise and help develop different strategy skills and math skills. So even if it seems very minor, like a game, knowing how to play a game, we all have a skill set and a value and it's helping that person find that. I will say it sounds mushy, right? It sounds like, okay, I'm here to talk about blood sugars and you're talking about going and volunteering at the free clinic in town or something like that. But the reality is once you build up that sense of purpose, you really start to think about taking care of yourself and your health very differently because now you're needed. Now the world needs you.
Megan Muñoz
Now you have things to contribute and you want to be around for those types of things and be able to do that.
Patrick McMahon
Yeah. So bringing the sense of purpose for you and also like kind of the trust with the provider or with the educator in that way. I can definitely see that. I'm from the Midwest and you know, you're saying games and I'm like, yeah, I could share playing Euchre, which is something where it's like getting that connection, even those small kind of things that'd be there, you know, like talking about that is a great way to build up the relationship, build that kind of resilience as well. You know, bringing back to the story of that older male, right? The patient that you had, you kind of mentioned that he was going to a lot of the sessions, but you know, you just couldn't quite figure things out in that way. What would you have done differently if he was coming to your clinic this week?
Megan Muñoz
Wish I had known some of the things I know now to be able to help. I think the biggest thing for him, he lived by himself and he lived out kind of in the country, and he had a lot of things in his home. So he really struggled with having a home and a space that was clean and organized. So I think because he was someone that really valued things and held on to a lot of things.
He might be somebody that would have some really interesting tools and some very interesting older toys or older tractors or just some different things that maybe other people would value being able to see. He wouldn't want anybody to take them, but he might value somebody coming and seeing some of the things that he held on to. So whether it's something like that, whether it's something we could talk a little bit more about seeking out a therapy and some help because I do think he had some extra mental health struggles that made it a little bit more difficult for him. But I definitely would have screened for it and I would have talked through some different options that he would have valued. And definitely since that was his comfort, his home and having a lot of those things around him, I would have tried to use that avenue to maybe be able to bring volunteers out to him or to have some other people that might come out and be interested in some of the things that he enjoyed.
Patrick McMahon
I think that's a great way to build up that connection. He could be talking about motors or tractors or anything. And I think that'd be a great approach for that. And loved how you reached out to one of your peers in that way and being like, you know, I think that's a really important part for us learning. And again, having that team approach. How can providers create conversations that reduce maybe shame or stigma around these kind of social isolation or loneliness? You know, sometimes is this my lane? Should I refer this? How can we create those kind of conversations again around maybe diabetes management or more focusing on that aspect?
Megan Muñoz
I think it's tough because providers are under such pressure to see people in such a short amount of time. So I don't know if some of it is more adding parts of that diabetes distress screening into that depression screening that happens in the medical office. So adding that extra piece about social connections in from that diabetes distress scale. I think sometimes adding awareness pieces to the clinic. So whether it's a poster on the wall. If they have a screen on the wall that adds different information for members or something in the waiting room, but something that creates some awareness of how many people do struggle with loneliness, how many people do struggle with social isolation, and if they are a talk to my provider today. And then I think it's also giving provider and people that are working as certified diabetes educators or diabetes care and education specialists, giving them the tools on what to do. Cause sometimes you can see there's a need and then you think, I don't know how to help. I don't know what to do. And so I think part of that could even be more training for us around, okay, if somebody's really lonely, we go this avenue and we have these resources, like a therapist that works with somebody versus somebody's more socially isolated. Do we have a list of community groups that we could tap into that we could connect those people and those community groups and connect those needs together. So that we are filling more than just that need for that person with diabetes, but we're also helping because community groups that might need volunteers or they need somebody to work part time for them or something like that.
Patrick McMahon
Leveraging the strengths of the community, getting people connecting. I think that's a a really great one. It's not just those thirty minutes or fifteen minutes or forty five minutes that you have with that patient or that individual, but again, thinking about how they can contribute. Maybe one more suggestion for them to do that. Like, all right, that's great. Coach Megan told me to do this and I, you know, I did that. Yeah. What gives you hope about the future of more connectedness or person centered approaches to diabetes care?
Megan Muñoz
Love that there's a diabetes online community. I used to be online quite a bit. I'm not anymore. I like to be anonymous. But I love that people could go out there and they could connect with each other, they could advocate with each other. And that's something that people can do, whether they are homebound or not, or whether they're a busy mom with three little kids and they're also trying to manage diabetes and work. That's a great avenue. So that gives me hope. I think the second thing is it's becoming more common to talk about where you talked a little bit earlier about stigmas and shame. The more we have conversations about these things, the less likely somebody will shut down when we try to bring this up and have discussions about it. So I think highlighting those things. The third thing that gives me hope is that piece by Dr. Vivik Murphy, the former surgeon general, the fact that he so succinctly put that this is as critical as food, water and shelter really puts it on the map in a different way. Because if I tell somebody, you really need to go out and find some social connections, they're gonna say, okay, Megan, whatever, you know, go pound dirt. I got so many other things to do. And that's fair, but when you put it into the context of, okay, this is as critical as making sure you eat today. This is as critical as you making sure you drink water today. It really does create a heaviness and an importance on it.
And so I'm hoping that that will continue to drive research and support and ways that we can further connect people, whether they have diabetes or not, in their communities.
Patrick McMahon
Yeah, definitely impactful. Just the imagery of that. You know, you can definitely think of yourself on a desert island and you're like, I need food, I need water. I also need people here to kind of help me connect in that way. So
Megan Muñoz
Yeah. You don't want to be Forrest Gump and be talking to your volleyball Wilson. You need people. You need people.
Patrick McMahon
So what message or takeaways would you want listeners, especially CDCES and healthcare professionals, to remember about today's conversation?
Megan Muñoz
Number one, I would say you don't have to be perfect. I'm definitely not perfect. And I don't always catch what's going on with people, but be curious. That was one thing I one of my most favorite define diabetes care and educational specialists ever taught me. Be curious and be willing to connect with people in different ways. So I think that's the biggest thing to take away, which is be willing to explore it. You may not have the answers. You may not get it right. You may run across people who are like, I don't want to do this and it does not have anything to do with my diabetes. And that's okay. Don't give up. Keep trying to expand into different avenues, including this. And if you do come up with some great things at work, go to the national conference and tell us all about it. So that way we can learn more from what you've figured out that works and doesn't work. Because that's really like you said, connecting with peers can make a huge difference in helping other people with diabetes.
Patrick McMahon
Thank you. Peer sharing is a huge aspect of that. And I think that's a good reminder to be curious, explore, make sure you read Megan's article, The ADCS in practice, loneliness and social isolation. What is your role as a CDCES? So, Megan, thank you so much for joining us and sharing valuable insights on loneliness, social isolation, and diabetes care and what we can do to kind of, you know, reach those individuals. Today's conversation reminds us that diabetes management is much more than numbers and clinical outcomes. It's about relationships, support systems, purpose, and feeling connected. As healthcare professionals and educators, we have an opportunity to build more compassionate, person-centered approaches to truly support the whole person.
Thank you for listening to this episode of Diabetes Care Conversations and for engaging with ADCS. You'll find resources related to this episode in the show notes. And remember, being an ADCS member provides access to education, resources, networking opportunities and support in advancing diabetes care and education. To learn more about the benefits of ADCES membership, visit adces.org/join, so that's visit adces.org/join.
Thanks again for listening, and you'll see us next time on Diabetes Care Conversations.