Improving Diabetes Prevention and Management

Grantee Name

Dr. Martin Luther King, Jr. Health Center, Inc.

Funding Area

Improving Diabetes Prevention and Management

Publication Date

September 2013

Grant Amount


Grant Date:

January 1, 2008 – March 31, 2010


Dr. Martin Luther King, Jr. Health Center (MLK) serves a predominantly vulnerable population of more than 668,300 people in the central and south Bronx.

Diabetes has reached epidemic proportions among these residents, with 11% to 17% of adults reporting having diabetes—a rate that is significantly higher than the overall New York City rate of 9% and the national goal of under 2.5%. Uncontrolled diabetes contributes to a number of health complications: increased risk for heart disease and stroke, end-stage renal disease, blindness, and amputations.

In January 2008, NYHealth awarded MLK a grant to standardize diabetes care across its ambulatory care clinics’ internal and family medicine departments; integrate community health workers (CHWs) into its treatment plan for patients with diabetes; and reduce diabetes-related complications. NYHealth funded this project through its 2007 Setting the Standard: Advancing Best Practices in Diabetes Management request for proposals.

Outcomes and Lessons Learned

  • Implemented a standard of diabetes care  at sites of the Bronx-Lebanon Hospital Center department of family medicine and at the Fulton Family Medical Center (FFMC);
  • Piloted a CHW program at one family medicine clinic to enhance diabetes education, peer support, and follow-up services;Hired five CHWs, who were fully integrated into the care teams and trained to teach diabetes self-management, conduct home visits and other follow-up services, and hold monthly group workshops; and
  • Created an Excel diabetes registry for patients registered at FFMC; the Excel registry ended up being used for study purposes only and not as a monitoring tool for patients.

Read the report associated with this grant, “Setting the Standard: A Foundation Initiative to Advance Best Practices in Diabetes Management.”