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This editorial note highlights the persistent barriers to effective diabetes management in rural communities globally. It emphasizes the significant impact of social determinants of health (SDoH) such as food insecurity, transportation, and social isolation on diabetes outcomes, noting that emotional and social needs remain largely unaddressed by current healthcare systems. The Social Care Logic Model is presented as a comprehensive framework to bridge this gap, offering a multi-pathway approach encompassing social risk screening, emotional support, community service connections, and tailored clinical care. The editorial advocates for integrating Artificial Intelligence (AI) with Community Health Workers (CHWs) to deliver scalable, culturally tailored interventions that improve access to services, reduce social risk, enhance emotional well-being, and support chronic disease self-management in these vulnerable populations. It concludes by urging a continued focus on innovative, compassionate models that integrate clinical and social care to better serve those most impacted by healthcare disparities.
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