Assessing Diabetes Care at the Cornell Scott-Hill Health Center Diana Tucci August 2, 2010

Diabetes as a Chronic Illness Poor control of sugar → Insulin intolerance Long term exposure:

Diabetes in CT At a prevalence rate of 6.4% in Connecticut, we are below the US average of 7% but still over twice the Healthy People 2010 goal of 2.5%

Who has the most Diabetes? Older people African Americans Low-income Adults As we can see here, Diabetes in Connecticut (and the rest of the country) is a disease of poverty. In the lowest income range, <$15k, we can see very clearly that Diabetes prevalence is almost twice the national and state average as well as over 5 time greater than the Healthy People 2010 goal. This crucially important to understand in a CHC setting because these are the people most likely to use the CHC’s services. Therefore, it is vital to continuously evaluate diabetes care in CHCs if we are to reach our goals and alleviate this horrible burden.

Fortunately, there is a standard set of guidelines developed by the American Association of Clinical Endocrinologists for the treatment of diabetes at various points in time based on a patient’s severity. It is broken down by the level of Hemoglobin A1c, which is the percentage of hemoglobin that has sugar bound to it, and reflects the patient’s control over his or her sugars for the past 3 months. At every point, lifestyle modification is represented first and foremost, but after that pharmacological treatment aggressiveness is recommended based on a patient’s A1c levels. Because no medication is without risk, the goal is to have patients on as few drugs as possible, using insulin as a last resort. This is because insulin comes with the dangerous risk of hypoglycemia and is difficult for many patients to comply with due to use of needles.

Care at the CS-HHC Resources on-site Diabetes Education Specialist Nutrition Podiatry Ophthalmology MDs, APRNs, PAs

Question Are physicians at the CS-HHC prescribing diabetes medications appropriately for a patient’s A1c level?

Methods All patients with A1c > 8% in 2010 Chart review of hybrid EMR Descriptive statistics collected from data N=322 patients NHbA1c<9% = 104 NHbA1c>9% = 218

Barriers to Care Lack of communication High demand for care Computer illiteracy Lack of time for quality improvement

What next? Identification of under-treated patients Uncovered a pattern of treatment Other research possibilities Referrals to specialists Health Promotion A1c tracking after one-on-one diabetes education

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