By Tijani Mohammed

In crowded outpatient clinics where nurses race the clock and patients juggle long commutes, a quiet change is taking root: alongside blood pressure and HbA1c, clinicians are beginning to log a short score that captures the emotional burden of living with Type 2 diabetes.

That “fifth vital sign” —diabetes distress—is the organizing idea behind a mobile clinical pathway modified by Precious Esong Sone, a Cameroonian scholar at East Carolina University (ECU) with a track record of turning evidence into practice.

He holds a double BSc (Public Health; Environmental Sustainability & Agricultural Science) from the Pan African Institute for Development in Buea, Cameroon, and MBA with a specialization in Healthcare Management from East Carolina University with expectations to graduate May of 2025. Additionally, Sone is a PMP®️-certified project management professional. 

Rather than invent new tools, Sone’s framework operationalizes two validated ones: the DDS-17 distress scale and Diabetes Self-Management Education (DSME). What’s new is the way they are combined and delivered: intake screening on a phone, brief education modules reinforced by weekly follow-up calls or SMS/WhatsApp, and simple electronic fields that let a clinician see HbA1c and distress trends side-by-side. The result is a repeatable workflow that clinics can run without buying equipment or hiring specialists.

“Screen, respond, and keep people engaged between visits, that’s the whole point,” Sone says. “If you don’t treat the emotional load, adherence falls apart.”

What the early rollouts show

Project summaries and letters from participating sites report that adults with baseline HbA1c ≥ 8% showed clinically meaningful drops in distress scores, stronger self-efficacy, fewer missed appointments, and improving glycemic trends after eight weeks. Several hospitals now run standing distress check-ins as part of routine care. The pathway was piloted across multiple hospitals, nonprofits and health centers, and it remains in use at several Cameroonian facilities; program materials indicate adaptation within a teaching hospital in Nigeria, underscoring cross-border transferability across Anglophone West Africa.

Why this matters

In many high-volume clinics, the psychosocial burden of diabetes—fear, frustration, burnout—goes unseen even as it drives non-adherence and complications. By turning distress into a measurable score and linking it to short, phone-based coaching, Sone’s pathway gives overstretched teams a low-cost lever with immediate relevance to teaching hospitals and public facilities across West Africa including Nigeria. It fits how patients already communicate and how clinics already document care.

Built on peer-reviewed research and recognized by stakeholders

Sone’s publication record anchors the work. A first-author paper lays out a digital framework for screening and managing diabetes distress; a companion comparative study examines how AI can responsibly support mental-health care in resource-limited settings, drawing lessons from multiple regions and informing the pathway’s ethics and localization.

The researcher’s portfolio has been recognized by multiple honors including the Best Research Paper Award by the International Organization for Academic and Scientific Development (IOASD) in 2019 for the peer-reviewed paper in Diabetic Foot Management following a competitive, international expert review process. Additional recent recognition includes the Creative & Innovative Member Award from Omicron Delta Kappa (ODK), a prestigious national honor society in the United States recognizing top student leaders across scholarship, service, integrity, and character.

How the model works (at a glance)

• Screen: Capture DDS-17 at intake; chart it beside vitals and HbA1c.

• Act: Deliver brief DSME “micro-sessions” plus weekly phone or WhatsApp follow-ups tailored to literacy and language.

• Track: Trend distress and HbA1c together; send reminders for missed visits; use simple templates for continuity.

• Scale: No new infrastructure; runs on existing phones and basic record fields—fit for district networks and tertiary centers alike.

What’s next

After analyzing pre/post DDS-17 scores, HbA1c trends, and interview themes, the team will release clinic-ready recommendations for making distress screening routine. The package scripts, supervisor checklists, and EMR field templates are designed so teaching hospitals and high-volume public facilities across the sub-region can plug it in with minimal training and immediate patient benefit. The same playbook is relevant to rural U.S. clinics, where distance and shift work make group classes hard to attend.

By making diabetes distress a routine, trackable “fifth vital sign,” Sone has shifted a stubborn challenge from invisible to actionable. His mobile-first pathway grounded in validated tools, adapted for real clinics, and reinforced through simple phone touchpoints has already shown measurable benefits in early use.

Equally important, it requires no new infrastructure, enabling district networks and teaching hospitals to adopt it quickly from Cameroon to major West African health centers that share similar operational realities. For health leaders pursuing equitable, outcomes-driven care, the framework offers a portable blueprint to scale compassionate, evidence-based diabetes management across the region and in underserved communities in the United States.