• Neighbourhood Medical Centre (NMC) is a federally qualified Health Centre that provides services including primary care, chronic disease management, mental health, dental care, specialty care, case management, etc.
• About 18% of the NMC patient patients have been diagnosed with diabetes with 22% of the hypertension patient population, however, after diabetic education, most of the patients have switched to SGLT2 inhibitor docks.
• Social Determinants of Health (SDOH) has identified economic stability, education, social and community context, health and healthcare, neighbourhood, and built environment as the barriers to healthy outcomes.
• NMC Diabetes Education and Management Service (DEMS) is a pharmacist-led multidisciplinary composed of certified diabetes and education specialist, medical assistants, nurses, physician, practitioners, mental health counselors, and case management counselors.
• The overall goal of the DEMS management plan is to decrease the progression of and improve the quality of life and include patients with HbA1c levels of more than 9%, patients with a history of noncompliance and patients with multiple comorbidities.

“People don’t care about how much you know until they know how much you care.”-Theodore Roosevelt