Carolinas Research Day 2021

Clinical Studies

05 Evaluation of Glycemic Control at St. Luke's Free Medical Clinic

Wade Hopper, OMS-II, Justin Fox, OMS-II, JuliSu Dimucci-Ward, PhD, MPH, RDN, CDE, LD

Edward Via College of Osteopathic Medicine-Carolinas

Purpose: The free clinic is a health care delivery model that provides primary care and pharmaceutical services exclusively to uninsured populations. St. Luke’s Free Medical Clinic (SLFMC) operates in Spartanburg County, South Carolina, where 16% of the population is uninsured. Using a multidisciplinary—and mostly volunteer—clinical staff, SLFMC provides primary care and pharmaceutical services to over 1,700 uninsured patients. This study aims to measure the change over time in average patient A1c at SLFMC in order to quantify the success of the clinic’s diabetes treatment program. Methods: A prospective-retrospective chart review of patients enrolled at St. Luke’s between January 1, 2018, and January 1, 2021 was performed. Patients were stratified as having controlled or uncontrolled diabetes relative to a therapeutic A1c target of 7%

recommended by the American Diabetic Association. For both controlled and uncontrolled groups, baseline A1c values were compared to subsequent readings using a Wilcoxon matched-pairs signed rank test. Results from the SLFMC population were compared to published A1c literature from other free clinics. Findings: The study demographic was balanced in gender (43% M, 57% F), diverse in ethnicity (24% Black, 33% Hispanic, 41% White), and prone to comorbidity (hypertension 71%, obesity 60%). Among patients with diabetes (n=138), 65% saw improvement in their A1c and those that improved showed a mean decrease of 1.73% while enrolled at SLFMC. Patients with uncontrolled diabetes (n=85; baseline mean A1c 9.51%) experienced a 0.68% reduction in mean A1c and saw significant reductions in A1c at both 6 months (p<0.01) and 1 year (p<0.01) from baseline.

Of patients with controlled diabetes (n = 53; baseline mean A1c 6.13%), 75% remained under 7.0% A1c for the entirety of their time at SLFMC. Using the most recent follow-up data available for each patient, 42% of the study population had an A1c under 7.0%. Conclusions: Diabetes treatment at SLFMC is directly correlated with reduction in hemoglobin A1c. The 42% glycemic control rate achieved by the purely uninsured study group is within 10% of the 2007- 2014 national averages for adults with diabetes as published by the National Health and Nutrition Survey (NHANES). Future studies at SLFMC should focus on barriers impeding A1c improvement and therapeutic adherence amongst the clinic population, especially since the current study took place under COVID-19 restrictions.

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