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Exploring Barriers to Glycemic Control Among Individuals with Type 2 Diabetes
Dillon, Kaitlyn Dale, Rosemary
Dillon, Kaitlyn
Dale, Rosemary
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Abstract
Diabetes affects 17% of U.S. adults aged 18-64, and up to 76.9% of individuals with type 2 diabetes experience poor glycemic control. Hemoglobin A1c (HbA1c) levels above 9% are associated with increased risks of complications and significant lifestyle burdens. Although social determinants of health (SDOH) significantly contribute to patients' inability to achieve glycemic goals, these SDOH barriers often go underrecognized in clinical settings. This quality improvement project aimed to identify perceived barriers to glycemic control in patients with type 2 diabetes with an HbA1c >9% using a standardized verbal questionnaire administered via telephone. A secondary aim was to increase follow-up appointment scheduling within the target population through proactive outreach. Guided by the Minority Health and Health Disparities (NIMHD) Research Framework and the social-ecological model, a 12-week intervention was implemented in a suburban primary care practice. Eligible patients were identified through the electronic health record (EHR) and contacted by a care coordination nurse. A standardized SDOH questionnaire with supplemental open-ended prompts was administered by phone, and all patients were offered follow-up appointments. Outcome measures included contact rate, questionnaire completion, identification of reported barriers, and follow-up scheduling. Thirteen patients met the inclusion criteria, with a 69.2% successful contact rate. SDOH documentation increased from 33.3% to 77.7% after outreach. Although 44.4% of contacted patients completed the standardized questionnaire, all provided narrative descriptions of barriers. Follow-up appointment scheduling doubled from 22.2% to 44.4% among contacted patients. Findings suggest that a narrative-first approach may elicit more meaningful insights than structured SDOH tools alone and may strengthen future efforts to address barriers to diabetes management in primary care.
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2026-05-01
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Dillon_DNP Manuscript_2026.pdf
Adobe PDF, 1.47 MB
- Embargoed until 2027-05-01
Dillon_Poster Presentation_2026.pdf
Adobe PDF, 295.5 KB
- Embargoed until 2027-05-01