A Diabetes Management Initiative in the Central and South Bronx

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.

Grantee Name

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

Funding Area

Improving Diabetes Prevention and Management

Publication Date

September 2013

Grant Amount

$214,210

Grant Date:

January 1, 2008 – March 31, 2010

Improving Diabetes Prevention and Management

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.”