Introduction: Empowering a low-income population of diabetic patients with onsite HbA1c testing results, coaching, and culturally appropriate diabetes self-management education materials improve outcomes and lower costs in a public health setting.

Objectives: This study examines the positive outcomes of a redesign in the Diabetes Education and Care Management (DECM) program at Denton County Public Health, (DCPH) a participant in Delivery System Reform Incentive Payment (DSRIP) plan.

Methods: Funding for ongoing management of diabetic patients across the U.S.A. remains an ongoing challenge. The DECM program elected to participate in the DSRIP program to secure funding to reach more diabetic patients with the goal of reducing their HbA1c and improve quality of life. Diabetic patients with an HbA1c of more than 9% met the DSRIP criteria for eligibility to DSRIP. Participants in the education program who followed the quarterly HbA1c appointment schedule were provided with diabetic medications and testing supplies to monitor glucose at no cost. Glycemic control was monitored by onsite testing of HbA1c during a quarterly visit at DCPH with the objective to lower the patients baseline HbA1c by 2.5%. Results presented reflect patient outcomes from Oct 2014 to Sept 2017.

Results: Approximately 251 of the 400 patients met the DSRIP criteria of HbA1c over 9% during the selected dates. The average baseline HbA1c was 10.7% in year 3, which was lowered to 8.2% by year end. Health economic models have shown that, for a population of 500 patients, the improvement of 1.0% in the HbA1c results can lead to multiple complications episodes avoidance (e.g.,: amputation, cataract extraction, etc.) which would result in over U$ 500,000.00 in savings for the healthcare system.

Conclusions: Our study suggests that empowering diabetic patients with education, state of art diabetes management, and onsite testing can lower overall HbA1c results leading to the reduction of complications and heath care costs.


J.P. Gallo: None. M. Richardson: None.

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