PI: Lowering A1c Levels in Diabetic Clients 

Goal: 73% of diabetic clients’ most recent HgbA1c will be 9.0% or less by December 2018 (2017 rate = 65%)

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 are we going to make this happen? Targeted efforts to help reduce the percentage of clients with HgbA1c levels above 9% began in late January 2017. Since then, our clinical staff has taken an “all-hands-on-deck” approach to achieving this goal.

  • We have created a standing order for clients with HgbA1c levels over 9% are referred to a nurse for diabetes management education
  • Placing more point-of-care machines in our clinics so our clinical staff can complete the necessary testing in a timely fashion
  • Calling diabetic clients within 24 hours of any missed appointment to reschedule
  • Calling diabetic clients who are past due for a HgbA1c test
  • Implementing 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.
  • The team is meeting with local shelters to discuss their food sources and offerings to attempt to create diabetic-friendly meal options.

Current progress: