Digging Deep into Diabetes—Barriers to Achieving Glycemic Control in Diabetic Patients in a Resident-Run Clinic

Introduction: Diabetes mellitus (DM) affects over 29 million Americans with an estimated annual cost of $245 billion. Diabetes in patients with multiple comorbidities, financial, and/or social hardships pose challenges to achieve target hemoglobin A1c (HbA1c). We investigated the barriers to achieve the HbA1c goal in patients in a federally funded resident-run clinic.

Methods: Among diabetic patients in our clinic, 29% had a HbA1c >9.0 in 2016. We reviewed these patients’ medical records, and interviewed them to identify the barriers in achieving HbA1c ≤9.0. Interviews were used to assess their knowledge about diabetes, perceived self-efficacy of disease management, confidence level regarding treatment plan, and the patient’s declaration of barriers of diabetic management. Then, we conducted an intervention to include regular telephone follow-up and clinic visits to ensure adequate supplies, medication refills, and diet and medication compliance. We have also engaged social service workers to address issues with transportation, medication costs and insurance coverage.

Results: A total of 87 patients with HbA1C >9.0 qualified for the study, 94% were African American with female predominance (55%). Average age was 52.2 years and average BMI was 33.32 kg/m². Average HbA1c was 11.5%. We were able to reach 59 patients to interview. Of those reached, 98% knew they had DM, 83% knew about HbA1c, but only 32% knew their last HbA1c. Major obstacles to achieve HbA1C goal are noncompliance with diabetic diet (29%), inability to afford medications (22%), inadequate medication refills (25%) and forgetting to take medication (20%). After 3 months of intervention, average hemoglobin A1c dropped to 9.7% from 11.5%, and 34 (58%) patients had an absolute decrease in their HbA1c from pre-intervention period. HbA1C dropped below 9% in 12 patients (20%). The intervention is currently ongoing.