PI: Lowering A1c Levels in Diabetic Clients 

Outcome: While we did not reach our goal of 73%, we improved by 5% from the previous year and 10% since 2016! 

What's a HgbA1c level? Good question. It's an individual's average blood glucose level, and serves as an indicator of diabetes control. We check these levels with a test every three months for clients with levels greater than 7% and every six months for clients with levels below 7%.

Why does it need to come down? Any diabetic client with an HgbA1c level above 9% is considered too high. When not properly managed, diabetes can cause serious complications—heart disease, nerve damage, vision loss and more.

How did we make this happen? Targeted efforts to help reduce the percentage of clients with HgbA1c levels above 9% began in late January 2017. Our clinical staff took an “all-hands-on-deck” approach to achieve this goal.

• We created a standing order for clients with HgbA1c levels over 9% are referred to a nurse for diabetes management education
• Placed more point-of-care machines in our clinics so our clinical staff can complete the necessary testing in a timely fashion
• Called diabetic clients within 24 hours of any missed appointment to reschedule
• Called diabetic clients who are past due for a HgbA1c test
• Implemented standing orders for nurses to more quickly titrate basal insulin and metformin with the goal of lowering A1c level faster.

The latest: 

• Through the assistance of a volunteer endocrinologist, the team has created a medication titration flowsheet to assist providers in making decisions about medications to be given. To measure success, we are conducting chart review to see if medication regimen changes are occurring, and what impact they have.
• Re-think your drink campaign: We have visuals of well-known beverages with their respective amounts of sugar + label providing education across all sites in medical areas.
• We have a health education resources page which includes diabetes handouts that staff can access and print out for clients to increase their knowledge and self-management of diabetes.

Resources:

• What's My A1C
• High Blood Sugar
• Low Blood Sugar
• Healthy Eating Plate 
• Can I Get Diabetes? 
• Type 2 Diabetes
• Living With Diabetes 

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