Staying Healthy Through the Holidays: Alabama Researchers Lead Community-Driven Diabetes Solutions

The holiday season is a time of celebration, filled with food, family, travel and traditions. But for many people, it can also mean disrupted routines, more time sitting, and eating habits that vary from usual.

Even for those who don’t have a chronic condition like diabetes, this time of year can make it harder to stay healthy. And for those who do, it becomes even more important to keep track of medications, maintain physical activity, and make intentional choices about meals.

“For communities already facing higher rates of diabetes and limited access to care, the holiday season can widen existing health gaps,” shares Joshua Lee, Ph.D., a Forge AHEAD scholar and researcher at the University of Alabama at Birmingham. “Rich foods, travel, and stress can make blood sugar control more difficult. Maintaining medication routines, thoughtful eating, and regular activity is key to avoiding complications. Supporting these habits during the holidays helps prevent setbacks and reduces the need for urgent care. It’s also a good time to stay connected with community resources, like local clinics or community health workers, who can help bridge gaps and keep patients engaged in their care.”

“For communities already facing higher rates of diabetes and limited access to care, the holiday season can widen existing health gaps,” shares Joshua Lee, Ph.D., a Forge AHEAD scholar and researcher at the University of Alabama at Birmingham. “Rich foods, travel, and stress can make blood sugar control more difficult. Maintaining medication routines, thoughtful eating, and regular activity is key to avoiding complications. Supporting these habits during the holidays helps to stay healthy and reduces the need for urgent care. It’s also a good time to stay connected with community resources, like local clinics or community health workers, who can help bridge gaps and keep patients engaged in their care.”

Across Alabama, Forge AHEAD scholars are exploring approaches that may help communities make small, realistic changes to support better health during the holidays. Their ongoing projects focus on early risk detection, peer-based education, and improved medication systems that could support healthier choices during this time of year.

Healthy routines often slip during the holidays

This time of year brings joy, but also challenges. Regular movement slows down. Meals tend to be heavier and more frequent. Travel or shifting schedules can make it easy to skip a dose of medication or forget to refill a prescription. For some, the season leads to avoidance: “I’ll just start again in January.”

But those small gaps, especially when it comes to blood sugar, blood pressure, or medication use, can grow into larger issues. Many people don’t realize they’re at risk. Others feel overwhelmed or disconnected from resources that could help.

“The holiday season can widen existing health gaps. Rich foods, travel, and stress make blood sugar control more difficult. Staying consistent with medications, food choices, and physical activity helps prevent complications and keeps people out of urgent care.”

— Joshua Lee, Ph.D.

That is where these Alabama-based projects come in. By developing tools that reflect people’s lived experiences and by focusing on support in familiar settings, these researchers aim to offer strategies that may help people maintain healthy habits during the busiest time of year.

Know your risk

Lucia Juarez, Ph.D., a Forge AHEAD scholar and researcher at the University of Alabama at Birmingham, is developing a diabetes risk score to help identify individuals, particularly Hispanic adults, who may be living with undiagnosed diabetes. Her work includes factors beyond the clinic, such as food access, language, and transportation.

This approach is intended to help people better understand their risk early, even before symptoms begin. During the holidays, that awareness can lead to small, meaningful behavior changes.

“The holidays are a joyful time, but they can also be a high-risk period for communities already facing a greater burden of diabetes,” said Juarez. “Supporting nutrition, physical activity, and medication use during this time is critical because even small shifts in behavior can have a long-term impact on health, and for Hispanic communities in Alabama, the holidays are an important moment to stay informed and engaged.”

Make a change

Know Your Numbers: Schedule a screening for blood sugar, blood pressure, and cholesterol before the holiday season.
Start Small: Begin healthy holiday swaps, for example, using whole grains instead of refined carbs or drinking water instead of sugary beverages.

“Culturally informed tools help people see themselves in the information we provide. When individuals feel understood and their culture and language are acknowledged, they’re more likely to recognize their risk and take action.”

— Lucia Juarez, Ph.D.

Build trust

Courtney E. Gamston, PharmD, a Forge AHEAD scholar and professor of experiential practice at Auburn University, is working with community health workers (CHWs), trusted individuals trained to help neighbors make informed health decisions. Her project examines how peer-led support from trusted community health workers may assist individuals facing challenges accessing primary care in managing diabetes.

CHWs offer practical strategies for maintaining healthy behaviors during the holidays, such as modifying traditional recipes, organizing family walks, or simply checking in with reminders and encouragement. They are a trusted resource, especially when the healthcare system can feel difficult to access or disconnected from day-to-day life.

“Community health workers empower people to enjoy the holidays while safeguarding their health. Their support helps families stay connected to healthy choices even when routines shift.”

— Courtney Gamston, PharmD

“During the holidays, people spend more time with friends, family, and community, making it harder to maintain healthy habits,” said Gamston. “Community health workers play a key role in providing education, advocating for healthy choices, and connecting individuals to local resources. Their consistent support for healthy choices empowers people to enjoy the holidays while safeguarding their health.”

She added, “The holiday season brings increased temptation to indulge in unhealthy foods, reduced opportunities for physical activity, and disruptions to daily routines which can impact medication-taking behaviors. By prioritizing healthy behaviors, individuals avoid short-term health setbacks and reinforce long-term management strategies. This is especially important in communities at high risk for diabetes because we know that diabetes onset and its outcomes are highly linked to our everyday health choices.”

Stay connected

Connect With a Community Health Worker: Ask your local clinic or community organization if CHW-led programs are available in your area.
Stay Active Together: Organize or join a community walking group or local dance event during the holidays.

Know your medications

Joshua Lee, Ph.D., a Forge AHEAD scholar, is leading a project at UAB that uses artificial intelligence to identify patients at risk of medication errors after hospital discharge. His system helps health teams intervene early, especially for individuals managing diabetes or taking multiple prescriptions.

During the holidays, when pharmacies may have reduced hours and travel can interrupt routines, managing medications becomes more complex. Lee’s work is exploring ways to support safer medication management during care transitions, and individuals can also take steps to stay prepared.

“The holidays can disrupt our daily routines, especially for people managing chronic conditions like diabetes. Missed doses, duplicate medications, or confusion caused by travel and schedule changes can all lead to medication errors. This risk is even higher when care transitions have occurred recently, for example, after a hospitalization, when treatment plans may have changed.

To reduce their risk, patients should carry an up-to-date medication list, clarify any recent changes with their care team, and use tools like pillboxes or phone reminders to stay on track. During the holidays, it’s especially important for caregivers and providers to stay in sync—whether it’s confirming medication lists before traveling or checking in after recent care changes—to help patients avoid gaps or duplications.”

Plan ahead

Keep a Medication List: Write down all medications and bring the list to holiday travel or family events.
Ask Questions: Talk with your pharmacist about refill options if you’ll be traveling or adjusting your schedule.

You don’t have to be perfect. You just have to start.

Whether you’re managing a condition like diabetes, supporting a loved one who is, or just looking to feel better through the holidays, small actions make a difference. The work of these Alabama researchers highlights how health is shaped by more than personal willpower. It is also supported by tools, information, and systems that can make better choices easier.

If you’re ready to take the first step, whether that’s getting screened, walking with a neighbor, or asking your pharmacist a question, you’re already moving in the right direction.

Want to learn more about these projects?

Small Steps for a Healthier Holiday Season

Know Your Health

Schedule a screening for blood sugar, blood pressure, and cholesterol before the holidays (Source: CDC Diabetes Management)
Keep an up-to-date medication list and bring it with you when traveling or attending family events (Source: FDA Medication Tips)

Make Simple Swaps

Choose whole grains instead of refined carbs
Drink water instead of sugary beverages (Source: USDA MyPlate – Diabetes)

Stay Active and Connected

Join or start a walking group or a community holiday dance event (Source: NIDDK – Diabetes and Exercise)
Connect with a community health worker through a local clinic or organization for support

Be Prepared

Talk with your pharmacist ahead of travel to ensure you have needed refills (Source: NIA – Questions About Medications)

Written by: Chris Campos

Closing the gap: managing high blood pressure after an ER visit

Leaving the emergency room with dangerously high blood pressure can feel overwhelming. For many patients, the support ends the moment they walk out the door. A new pilot program at the University of Alabama at Birmingham (UAB) is changing that by helping patients take charge of their health from home.

High blood pressure, or hypertension, happens when blood flows through your arteries with too much force, putting stress on your heart and blood vessels. Without timely care, patients discharged from the hospital with high blood pressure can face serious health risks, including strokes or repeated hospital visits.

World Hypertension Day, observed on May 17, highlighted the need for better blood pressure management worldwide. That urgency is at the heart of the “Post-Emergency Department Telehealth Follow-Up Program”, led by Lama Ghazi, M.D., Ph.D., assistant professor of epidemiology at UAB. The project offers personalized, tech-enabled support to help patients safely recover and stay out of the hospital.

Who Is participating?

The study successfully enrolled 40 adults aged 30–75 discharged from UAB’s emergency department (ED) with very high blood pressure (systolic readings of 160 mm Hg or higher). All participants live within 30 miles of the hospital, speak English or Spanish, and use a home blood-pressure monitor, with support available from caregivers as needed.

What does the program involve?

Participants receive home blood-pressure monitors along with comprehensive training. Nurses teach participants and caregivers how to measure and record their blood pressure accurately.

Lama Ghazi, M.D., Ph.D.

Assistant Professor, University of Alabama at Birmingham

Learn more about Ghazi.

Did You Know?

Hypertension, or high blood pressure, significantly increases the risk of heart disease and stroke. Regular monitoring can help control it.

Source: American Diabetes Association

Each week, participants connect virtually with a nurse-pharmacist team through phone or video calls. During these telehealth sessions, the team reviews blood-pressure readings, adjusts medications according to set guidelines, and addresses participants’ health questions.

Automated text reminders twice a week prompt participants to take their blood pressure and submit readings via text or phone calls. Pharmacists also help participants address medication-related challenges, such as affordability, by connecting them to discount programs and local healthcare services.

Early signs of progress

While full evaluation is ongoing, early trends from the pilot phase suggest the program is having a positive impact.

Blood Pressure Improvement (90-day follow-up):

Participants experienced an average systolic drop of 16 points (from 162 to 146 mm Hg).
Diastolic readings fell by an average of 9 points (from 94 to 85 mm Hg).

Reduced Return Visits:

Participants had 22% fewer ED visits within 30 days compared to similar patients who received standard care.

Strong Participation:

Nearly all scheduled telehealth check-ins were completed, with 95% of visits attended.

Positive Experience:

Most participants shared high levels of satisfaction with the support they received.
Many found the reminder texts easy to use and helpful in staying on track.

These preliminary results will help inform the next phase of the program, which continues to assess longer-term outcomes.

Recognizing the importance of digital literacy, the program introduced a 15-minute “tech check” call at the beginning to boost early engagement. Additionally, new Spanish-language tech guides introduced in March 2025 expanded access and helped ensure more participants could comfortably utilize and understand the materials.

What’s next?

The team will complete 180-day blood-pressure and quality-of-life assessments by mid-June 2025. A cost-effectiveness analysis is scheduled to begin in July, and expansion into two UAB community clinics is planned for late 2025. These next steps aim to evaluate long-term impacts on health outcomes and overall cost efficiency.

By combining user-friendly home monitoring, consistent virtual check-ins, and accessible medication support, Ghazi’s pilot demonstrates a practical approach to managing high blood pressure, potentially preventing severe health complications such as stroke.

Learn more about Ghazi’s Forge AHEAD pilot project.

Key Terms to Know

Hypertension: Persistently high blood pressure.
Telehealth: Remote healthcare provided through phone or video calls.
Systolic and Diastolic: Systolic (top number) measures pressure when your heart beats; diastolic (bottom number) measures pressure between beats.

Smarter follow-up and safer care: how AI could support men with diabetes

June is Men’s Health Month, an opportunity to focus on health challenges that often go unnoticed, especially among men living with chronic conditions like diabetes. At the University of Alabama at Birmingham (UAB), Forge AHEAD investigator Seung-Yup Lee, Ph.D., is leading a pilot study that combines artificial intelligence with clinical data to prevent medication mix-ups and help patients get the follow-up they need.

Why men with diabetes need a smarter safety net

Men are more likely to delay routine visits and less likely to follow up after hospital care. both of which can lead to missed medications, dangerous side effects and avoidable complications. For those living with diabetes, these risks are even higher. Managing medications correctly is critical to controlling blood sugar, avoiding hospital readmissions and staying healthy.

But for busy clinics, it’s not always clear who needs the most help. That’s where Lee’s project steps in.

Using AI to spot who needs help first

Lee’s team is developing an AI-powered risk score to help doctors and pharmacists spot patients who are most likely to have medication problems. The system analyzes a wide range of health data, including medical records, prescription refill patterns, and social factors like insurance status or housing instability, to assign a “reconciliation risk score” to each patient with diabetes.

Seung-Yup Lee, Ph.D.

Assistant Professor, University of Alabama at Birmingham

Learn more about Lee.

Did You Know?

Men are more likely than women to skip routine checkups, and more likely to face serious medication-related problems as a result.

Source: Healthline

The goal? Use this score to flag high-risk patients so care teams can follow up directly, either by phone or in person, to double-check medications, fix errors and offer support.

What the tool actually does, and how AI fits in

Artificial intelligence, or AI, refers to computer systems that are trained to notice patterns in large sets of information, kind of like how a person might learn from experience, but much faster. For example, just like a nurse might notice that certain symptoms usually come before a problem, AI can spot those same signs by studying thousands of patient records at once. In this project, AI is used to scan medical records, pharmacy data and provider notes to predict which patients might be most at risk for medication problems.

It’s important to know that AI doesn’t replace doctors, nurses or pharmacists. It doesn’t make decisions on its own or replace face-to-face care. Instead, it helps teams work smarter by pointing out which patients might need extra attention. That gives healthcare providers more time to focus on what people need most, support, questions answered and care that feels personal.

Data-driven prediction: The model looks at over 5,000 patient records and uses natural-language processing (a type of AI that reads doctors’ notes) to detect warning signs.
Real-time alerts: Risk scores are displayed inside a clinician dashboard so that care teams know who needs outreach before the next visit.
Focused follow-up: Patients with high scores receive extra attention, including calls from pharmacists to reconcile prescriptions and catch any problems early.

Measuring what matters: fewer errors, better follow-up

The pilot study includes around 200 patients and is testing whether the tool helps reduce medication discrepancies within 30 days. It’s also tracking whether fewer patients return to the hospital with drug-related issues, and how satisfied doctors and nurses are with using the system.

This type of focused support may be especially helpful for men, who often manage more complicated medication routines and may delay reaching out for help when issues arise.

Key Terms to Know

Medication reconciliation: The process of double-checking all a patient’s medications to make sure they match what was prescribed.
Risk stratification: Grouping patients by risk level to focus care where it’s needed most.
Health-related social factors: Things like income, housing or transportation that can affect someone’s ability to stay healthy.

What is AI?

Artificial intelligence (AI) refers to computer systems that can learn from large sets of data and help identify patterns.

In health care, AI is used to support, not replace, human decision-making by helping teams spot risks earlier and prioritize follow-up care.

Source: National Institutes of Health

What’s next for the project

If successful, Lee’s team plans to expand the tool across partner sites in Alabama, Mississippi and Louisiana. They’re also exploring ways to pull in data from state prescription-monitoring systems and bring the program into more community health clinics, including those that serve men with limited access to care.

How this could help you or someone you know

This project reflects a growing effort to use data to guide follow-up care and reduce preventable health problems. For men with diabetes, it could mean fewer hospital visits, safer medication use and better outcomes over time.

Learn more about Lee’s Forge AHEAD pilot project.