Assessment of Glycemic Control at St. Luke’s Free Medical Clinic: Retrospective Chart Review

BACKGROUND: A free clinic is a health care delivery model that provides primary care and pharmaceutical services exclusively to uninsured patients. With a multidisciplinary volunteer clinical staff, which includes physicians, social workers, dieticians, and osteopathic medical students, St. Luke’s Free Medical Clinic (SLFMC) cares for over 1700 patients annually in Spartanburg, South Carolina. OBJECTIVE: This study aims to measure the change, over time, in patient hemoglobin A(1c) measurements at the SLFMC to quantify the success of the clinic’s diabetes treatment program. METHODS: A prospective-retrospective chart review of patients (n=140) enrolled at the SLFMC between January 1, 2018, and January 1, 2021, was performed. Patients were stratified as having controlled (hemoglobin A(1c)<7.0, n=53) or uncontrolled (hemoglobin A(1c)≥7.0, n=87) diabetes relative to a therapeutic hemoglobin A(1c) target of 7.0, which is recommended by the American Diabetes Association. For both controlled and uncontrolled groups, baseline hemoglobin A(1c) values were compared to subsequent readings using a Wilcoxon matched-pairs signed rank test. Results from the SLFMC population were compared to the published literature on hemoglobin A(1c) from other free clinics. RESULTS: Patients with uncontrolled diabetes experienced significant reductions in median hemoglobin A(1c) at both 6 months (P=.006) and 1 year (P=.002) from baseline. Patients with controlled diabetes showed no significant changes. Black and Hispanic patients with uncontrolled diabetes experienced a 1.0% mean improvement in hemoglobin A(1c) over the study window. The SLFMC’s wholly uninsured patient population showed a population rate of controlled diabetes (42%), which was similar to recent nationwide averages for adults with diabetes (51% to 56%), as reported by the National Health and Nutrition Examination Survey. The clinic’s Hispanic population (n=47) showed the greatest average improvement in hemoglobin A(1c) of any ethnic group from baseline. Additionally, 61% of the SLFMC’s Black population (n=33) achieved a hemoglobin A(1c) of <7.0 by the end of the study window, which surpassed the nationwide averages for glycemic control. CONCLUSIONS: We present free clinic hemoglobin A(1c) outcomes obtained through a retrospective chart review. Uninsured patients treated for diabetes at the SLFMC show a reduction in hemoglobin A(1c), which is comparable to nationwide standards, although average hemoglobin A(1c) levels in this study were higher than nationwide averages. Black and Hispanic patients with uncontrolled diabetes showed a mean 1% improvement in hemoglobin A(1c) levels. These results represent some of the first in the literature emerging from a free clinic that is not affiliated with a major medical school.