Optimizing adult diabetes care in community health

Diabetes mellitus is an epidemic. Many organizations and states have established reportable quality care measures. Our organization explored novel ways of chronic disease management. The purpose of this article is to decrease the percentage of patients with a hemoglobin A1c (HbA1c) more than 8%.

Prospective, pre- and postintervention, quality improvement project was implemented in the Employee and Community Health Clinic using an endocrinology nurse practitioner (NP) to coordinate and provide care to adult patients with diabetes. A convenience sample of 103 patients with diabetes was selected for this project. Patients were excluded from the project if they did not complete preintervention satisfaction surveys or did not sign research release forms.

One hundred three patients were referred, and two met exclusion criteria. Of those patients, 51% were female with an average HbA1c of 9.1%. Eighty-one of the referred patients attended their appointment. The patients who sought care had a reduction in HbA1c from 9.0% ± 1.8% to 8.3% ± 1.7% (p value < .001). Patients who did not appear had no significant change in their HbA1c from 9.8% ± 3.1% to 9.4% ± 2.7% (p value = .61).

Incorporating specialty trained NPs can lead to improvements in HbA1c, patient-reported control of diabetes, and a reduction in the frequency of hypoglycemia.