Acute Injury and Diabetes Management

Carol is a 48-year-old spouse of a union worker. Based in the Southeast, she originally injured her shoulder while on a beach vacation. She was unable to work, raise her left arm, and experienced severe pain and numbness. To compound matters, Carol was also living with uncontrolled type 2 diabetes, obesity, and high blood glucose, affecting her creatinine and hemoglobin A1C levels.

Carol is not alone. According to a recent study1, 11–40% of adults in the United States are living with chronic pain; and another 11.3% of the U.S. population (37+ million people) have diabetes.2 In the past year, Carol had three Emergency Room (ER) visits for her shoulder injury and two visits for COVID-19. These utilization events prompted Conifer’s Personal Health Nurse (PHN) to reach out to Carol for engagement in Conifer’s PHM program.

How Conifer’s Personal Health Nurse (PHN) Helped

During her initial assessment, Carol discussed her recent ER visits, unsuccessful physical therapy (PT) attempts, and was unsure of her providers’ network status. The PHN also learned that Carol’s blood sugar was out of control; she was not following a diabetic diet; her latest A1C number was 7.8 (high range); and her kidney lab levels had increased due to poorly controlled diabetes.

Carol’s PHN took immediate, proactive and decisive action – establishing two foundational goals:

  1. Improve arm mobility
  2. Control her blood sugar

The PHN quickly confirmed Carol’s providers were in-network. She also coordinated with her orthopedic provider team and engaged them in proper treatment plans for shoulder pain, at-home exercises, and desk ergonomics for arm pain. In addition, she educated Carol regarding the injury complexities and the need for adherence to regularly scheduled PT and orthopedic appointments.

To address her diabetes-related goal, the PHN provided Carol with extensive education and coaching related to diabetic dieting, e.g., low glycemic fruits, good vs. bad fat, keto-friendly substitutes, proper hydration for kidney health, weight loss tips and provider-approved activities. Carol began taking control of her nutritional health, cleaned out her kitchen pantry, and got her family to commit to a healthier lifestyle. She began adhering to a diabetic diet, drinking water per recommendations, incorporating healthy alternatives, and avoiding high sugar foods and carbohydrates.

Member Results

With regular PT, she regained strength in her shoulder and significantly improved her range of motion. Carol’s PHN reinforced the importance of her prescribed exercise and walking routines and encouraged her to maintain proper posture during activities. Carol’s commitment paid off – her shoulder improved dramatically. She achieved her first goal and returned to the office.

Carol’s diet and lifestyle changes resulted in losing 35 pounds and lowering her blood glucose levels (A1C) to 6.3 (normal range). Her Evidence-Based Medicine (EBM) adherence increased to 93%. This means she completed all of her recommended diabetic screenings, which can lead to early detection of issues and improved health outcomes.


Like 70% of members engaged in Conifer’s PHM program, Carol is now self-managing her health conditions. Conifer PHNs holistically manage our members’ acute and chronic care needs to deliver better health outcomes – and to empower members to take an active role in their healthcare.

*Member’s name has been changed for privacy.

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