When Guidelines Meet Real Life: Diabetes Care in Patients with Acute Conditions - Burroughs
Jul 30, 2026, 09:00 AM
By Brian Burroughs, MSPAS, PA-C, AQH, BC-ADM, CDCES, CHC
One of the most interesting aspects of primary care is managing the intersection of chronic disease and acute conditions.
In my work, I explored this intersection through a survey-based study examining how clinicians approach Type 2 diabetes management in patients presenting with acute otitis externa, commonly known as swimmer’s ear.
At first glance, these conditions may seem unrelated. But in practice, they often overlap in ways that influence clinical decision-making.
People with diabetes are at increased risk for more severe infections, including complications such as necrotizing otitis externa. This raises important questions about how aggressively to manage both the infection and underlying glucose levels.
What I found in my study was variability.
Clinicians differed in how they approached glucose management in the setting of an acute infection. Some prioritized short-term glycemic management more aggressively, while others focused primarily on treating the infection itself.
There were also differences in awareness regarding potential complications and when to escalate care.
This variability highlights a broader challenge in medicine. Guidelines are often designed around single conditions, but patients rarely present that way.
As primary care clinicians, we are constantly integrating multiple factors. Acute illness, chronic disease, patient preferences, and resource availability all influence decision-making.
This is where interdisciplinary care becomes especially important.
Collaboration between primary care, endocrinology, and other specialists can help ensure that both the acute and chronic aspects of care are addressed appropriately. In the case of otitis externa in patients with diabetes, this may include careful monitoring, patient education, and a lower threshold for escalation when indicated.
It also reinforces the importance of clinical judgment.
Not every scenario fits neatly into a guideline. Being able to adapt recommendations to the context of the individual patient is a critical skill.
For me, this work also underscored the importance of education.
Helping patients understand why their diabetes may impact an acute condition, and what signs to watch for, can improve outcomes and reduce complications.
Ultimately, this study served as a reminder that effective diabetes care extends beyond routine visits.
It is present in urgent care visits, in acute illness, and in the countless moments where chronic conditions influence immediate decisions.
Recognizing and navigating these intersections is a key part of providing comprehensive care.