Diabetes INSIDE

Diabetes INSIDE® (Inspiring System Improvement with Data-Driven Excellence) is the American Diabetes Association’s (ADA’s) long-term strategy to translate more than 80 years of science and advocacy into action by supporting the nation’s health care systems to improve population outcomes for people with diabetes. 

Smiling group of physicians

The goal of Diabetes INSIDE is to catalyze, accelerate, and sustain health care improvement across health care systems, public health departments, and payers, as well as a range of stakeholders and organizations committed to improving diabetes outcomes. 

Quality Improvement (QI) Program Materials

The ADA provides Practice Facilitators with tools to facilitate the dissemination of QI principles, as well as the introduction of managed care processes that have been found to improve outcomes for those with diabetes.

For Clinical Health Workers (CHWs), the ADA has developed instructional modules to introduce the concepts of QI to CHWs. This information will provide CHW’s the skill set to become integral parts of a primary care office and in doing so improve the care that individuals with diabetes receive.

What is Quality Improvement? 

Change is often met with resistance, yet it is embraced in pursuit of potential enhancements. In primary care, changes hold promises for refining the support offered to individuals struggling with diabetes management—fostering better outcomes. However, the assurance of progress is not a formality. Rather, it hinges upon the strategies employed in its attempt. Quality improvement (QI) is the framework used to systematically make those changes.

The Role of Practice Facilitators

Practice Facilitators are individuals with specialized training in guiding practices to embrace QI initiatives. Their role necessitates fostering staff motivation, addressing impediments to change, shepherding through transitions, and ensuring accountability.   

The Role of Community Health Workers

Community health workers (CHWs) are frontline health workers with deep ties to their localities—spanning language, ethnicity, socioeconomic status, and life experience. These ties play a vital role in improving care and health outcomes for people living with type 2 diabetes.  

Scaling New Models for Quality Improvement

While the ADA continues to partner with individual primary care practices to implement guidelines and improve care, it is in the process of scaling QI activities that we will engage practice facilitators (PFs) and practice-based research networks.  

Interventions and Achievements 

Diabetes INSIDE interventions have included:

  • Quality improvement methodology training for health care personnel
  • Multidisciplinary health care team coaching and provider professional development
  • Recognition and dissemination strategies

Diabetes INSIDE has successfully collaborated with 16 different health care systems, positively impacting over 500,000 individuals with diabetes. While this targeted approach has yielded significant success, the ADA recognizes the potential to extend its reach even further.

Quality Improvement Programs 

Eye Health Initiative

ln 2023, the ADA partnered with Genentech to enhance access to eye health care in Birmingham, AL, a city marked by significant health disparities. The ADA’s eye health initiative was designed with targeted efforts, each intended to inform and build on the other, with the goal of understanding the barriers to diabetes eye care and engaging community partners to identify near-term and sustainable solutions to improve eye screenings and care for people with diabetes. A similar effort has now been made in Washington, DC.

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Quality Improvement Programs

Women’s Health Initiative

In 2024, the ADA partnered with CVS Health Foundation to enhance health outcomes for women living with gestational diabetes (GDM) and to establish sustainable models for improving women’s health. The Women’s Health Initiative was crafted with interconnected efforts aimed at uncovering the barriers to GDM care. Through community engagement, the initiative seeks to identify immediate and long-term solutions to enhance GDM screenings and care for women with GDM living Brooklyn, NY. 

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Publications Related to Diabetes INSIDE and Quality Improvement

Article

Diabetes INSIDE: Improving Population HbA1c Testing and Targets in Primary Care With a Quality Initiative

Roy E. Furman; Timothy S. Harlan; Lesley LeBlanc; Elise C. Furman; Greg Liptak; Vivian A. Fonseca 
Diabetes Care® 2020;43(2):329–336  

Article

Impact of Quality Improvement (QI) Program on 5-Year Risk of Diabetes-Related Complications: A Simulation Study   

Hui Shao; Vivian Fonseca; Roy Furman; Luigi Meneghini; Lizheng Shi 
Diabetes Care 2020;43(11):2847–2852  

Articles

Making Inroads in Addressing Population Health in Underserved Communities With Type 2 Diabetes 

Luigi F Meneghini, Addie L Fortmann, Taylor L Clark, Kellie Rodriguez
Diabetes Spectrum® 2019;32(4):303–311  

Article

Improving Diabetes Control Using Lean Six Sigma Quality Improvement in an Endocrine Clinic in a Large Accountable Care Organization  

Usha Kollipara, Mario Rivera-Bernuy, Joseph Putra, Jessica Burks, Amber Meyer, Shayla Ferguson, Carolyn Nelson, Jackie Mutz, Sasan Mirfakhraee, Puneet Bajaj, Asra Kermani, Jason S. Fish, Sadia Ali  

Clinical Diabetes® 2021;39(1):57–63