New clinical workflow to decrease disparities in Diabetes

Beacon, June 9th, 2026

A1c measures are not always easy to get. Patients need to get lab work done, which can be time consuming for patients, requiring transportation and time to get to a testing site.  A1c is a average over time; it reflects average blood sugar over the past 2–3 months, which doesn’t support real-time clinical decision making. However the advent of new technologies such as Continuous Glucose Monitors (CGM) have revolutionized the way that patients with Diabetes can monitor their blood sugar. Yet the problem still exists of how best to leverage this data in a clinical setting.

In 2024, as part of the Bree’s Health Equity Action Collaborative, Confluence Health began thinking about how to address higher rates of uncontrolled HbA1c among Hispanic, American Indian/Alaska Native, and African American patients. Their project focused first on the feasibility of using new ways of addressing HbA1c control, including attempting to optimize the prescribing of CGMs for patients of color and improving care processes for those with uncontrolled A1c.

They began by creating an intervention to use CGM data and other information effectively in clinical care, including identifying eligible patients through chart review and providing prescribing support to clinicians. As part of their intervention Dr. Kathryn Eren, at Confluence’s East Wenatchee Family Medicine, created a workflow for downloading and using CGM data in a clinical setting. The workflow consisted of a minor investment in two desktop computers for the clinic to enable downloading of continuous glucose sensor readers and a time investment in training staff and providers to use the new download capabilities.

East Wenatchee clinic conducted a successful implementation of the new workflow with 70% of providers at the East Wenatchee Clinic implementing the new workflow. Wenatchee Clinic also
saw reductions in uncontrolled diabetes among the intervention target populations of -2.3% in spite of overall increases in uncontrolled diabetes for all patients at Confluence as a whole.  This test provided evidence for the feasibility of using CGM data in the clinic and demonstrated promising results from the use of new technologies.

CALL TO ACTION: The use of new technologies to address high rates of uncontrolled A1c and disparities in control is more important than ever. The resources provided by Confluence here are open-source and can be used to replicate their model of care. You can read the full case study HERE. If you would like to contact the researchers at the Bree or at Confluence Health for more information, email Karie Nicholas at knicholas@qualityhealth.org.