Special Edition: Primary Health Care Digest – World Diabetes Day

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November 13, 2017                                                                                                              


From the Desk of the CMO

Welcome to the first special edition of the Primary Health Care Digest! In recognition of November as National Diabetes Month and tomorrow’s World Diabetes Day, this edition focuses entirely on the topic of diabetes.

At least one out of every seven patients who walks through your health center door has a diagnosis of diabetes. Given the prevalence of diabetes and the impact that poor control has on quality of life, health outcomes, mortality, and costs, BPHC is launching a diabetes quality improvement strategy to support your advancement of diabetes prevention and management at your health center. 

As a former health center medical director and staff physician, I, along with my primary care team, struggled with managing patients with diabetes, especially those with co-occurring conditions, such as serious mental illness, substance use, and adverse social determinants of health. We couldn’t begin to move the needle on diabetes control without addressing these other issues. However, health centers are well poised to move the needle: by caring for the entire family, working in multidisciplinary teams, providing evidence-based care, and addressing the social determinants of health. And, you are developing the EHR tools to facilitate these efforts. 

Today’s special edition includes curated resources and information on diabetes specifically for health center clinicians. Throughout this month, we are including additional diabetes resources in the weekly Digest e-newsletter. Please forward the Digest to your clinical staff members and encourage them to sign up to receive the weekly editions.

We also want to hear from you! Please share your promising diabetes practices and let us know what other topics you would like us to focus on in future special editions. You can email me directly at BPHCCMO@hrsa.gov.


Health centers are an essential part of our nation’s health care safety net. On behalf of the entire staff of the Bureau of Primary Health Care, thank you for everything you do!

Judith Steinberg, MD, MPH
Chief Medical Officer
Bureau of Primary Health Care

BPHC’s Diabetes Quality Improvement Strategy


As part of our commitment to support you in improving diabetes management at HRSA-funded health centers, BPHC has developed a diabetes quality improvement (QI) strategy that:

  • Aligns quality improvement priorities across BPHC and our Health Center Controlled Networks, National Cooperative Agreements, and Primary Care Association technical assistance and training partners.
  • Drives improvement through data and evidence-based research.
  • Develops and implements technical assistance resources.
  • Establishes and leverages partnerships and collaborations with federal agencies, national organizations, and professional societies.

The goals of this strategy are to increase diabetes prevention efforts and improve diabetes treatment and management.

The strategy aims to drive quality improvement in the following clinical quality measures: 

  1. Weight assessment and counseling for children and adolescents.
  2. BMI screening and follow up for adult patients.
  3. Poor control of diabetes.

BPHC also aims to increase the proportion of health centers that meet the Healthy People 2020 goal for uncontrolled diabetes for each racial/ethnic group. 

BPHC is launching a series of interactive webinars aimed at diabetes care QI at HRSA-supported health centers. We invite health centers and Health Center Program strategic partners to join us for the inaugural session, “Diabetes Quality Improvement Talks: Foundation of Change,” to learn more about BPHC’s diabetes QI strategy and hear from our health center colleagues about their promising diabetes practices. Please see the Technical Assistance and Training section for details.

Clinical Resources


2017 ADA Standards of Medical Care in Diabetes
The American Diabetes Association (ADA) publishes the Standards of Medical Care in Diabetes annually, based on the latest medical research for clinical practice. The evidence-based recommendations for diagnosing and treating adults and children with all forms of diabetes include comprehensive clinical information, treatment goals, and tools to evaluate quality care. The Standards are updated every year in January. Download the 2017 Standards of Medical Care in Diabetes.

Screening for diabetes

Screening for obesity

National Diabetes Prevention Program
Help your at-risk patients prevent or delay type 2 diabetes by screening and referring them to a CDC-recognized diabetes prevention lifestyle change program.

Agency for Healthcare Research and Quality (AHRQ) Effective Health Care Program Resources



Visit the training calendar to learn details about or register for events, and view recordings of past events.

Technical Assistance & Training

All times listed are EST.

Diabetes Quality Improvement Talks: Foundation of Change
Join BPHC for an interactive webinar to learn more about BPHC’s diabetes QI strategy and hear promising practices from health centers.

CME/CE will be available.

Tuesday, Dec. 5, 2-3:30 p.m.
Join the webinar the day of the session
Call-In: 888-603-9609
Passcode: 818 4117


National Diabetes Education Program’s Clinical Practice Tools and Patient Education Materials
The National Diabetes Education Program (NDEP), a joint program of CDC and NIH’s National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), provides clinical practice tools and patient education materials that can help health professionals effectively meet the needs of people with or at risk for diabetes.

Here are some resources: 

  • CDC’s NDEP Archived Webinars
    CDC’s NDEP archived webinars trains clinicians in new approaches for engaging communities, increasing cultural competence, and promoting diabetes prevention and management.

  • NIDDK’s NDEP Website for Health Professionals
    This website features resources such as guiding principles for diabetes care, a diabetes prevention toolkit, diabetes care practice transformation resources, and an archived webinar series.

  • NIDDK’s Diabetes Discoveries & Practice Blog
    Engage in dialogue with thought leaders on emerging trends in diabetes care though NIDDK’s blog, Diabetes Discoveries and Practice