U.S. Department of Health and Human Services
Indian Health Service: The Federal Health Program for American Indians and Alaska Natives
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  Quality of IHS Health Care

Performance Measures

Health Topic: Diabetes
Diabetes affects many American Indians and Alaska Natives (AI/AN). In fact, between 1997 and 2003, the number of AI/AN patients who have diabetes and get their health care from IHS increased by 41%. The high costs of health care along with more patients getting diabetes represent a challenge for IHS.

Between the years of 2002 and 2004, the number of deaths from diabetes in the AI/AN population was almost 3 times higher than all other races.

Patients who have diabetes also are more likely to have heart disease (Cardiovascular Disease), which affects the heart and blood vessels. Heart disease is the number one cause of death for AI/AN patients. It is very important for patients who have diabetes to take care of themselves. You can do this by getting the tests you need. The tests will show how well diabetes is being controlled. Hemoglobin A1c (blood sugar) is one of the tests.

What is a Hemoglobin A1c test?
Hemoglobin A1c measures your blood sugar control over a 3 month period.

Who should get this test?
It is important for people with diabetes to have this test done once a year or more.

Why are blood sugar levels important?
Blood sugar levels show if your diabetes is controlled. Controlling your blood sugar makes you feel better. This can reduce your chances of going blind, losing feeling in your legs and getting amputations. It also reduces your chances of getting kidney disease, going on dialysis, and having a heart attack or stroke.

What is a good Hemoglobin A1c number?
A lower number is a better score.

  • A number lower than 7% shows you have ideal (best) blood sugar control.
  • A number higher than 9.5% shows you have poor blood sugar control.

What is the GPRA Measure?
The GPRA measure is the percentage of IHS AI/AN diabetes patients whose most recent hemoglobin A1c (blood sugar) test result was higher than 9.5 (poor control) during the year.

How is IHS doing?
IHS has not established a long-term goal for this measure. The IHS 2012 goal was to achieve the rate of 16.6% for the proportion of patients diagnosed with diabetes who have poor glycemic control (defined as A1c > 9.5). IHS did not meet this goal by reaching 19.8%. The bars on the graph below show that IHS has increased the rate from 18% in 2003 to 19.8% in 2012. During this time IHS was providing care to more patients with diabetes. In fact, between the years of 1997 and 2003, the number of AI/AN diabetes patients who received their health care from IHS increased by 41%. Beginning in 2013 IHS will no longer report on this measure to focus on the "Good Glycemic Control" measure.

Percentage of IHS AI/AN Patients with Diabetes  with Poor Blood Sugar Control (A1c > 9.5)  Note: A lower score is better

View a table of this chart's data.

Year Percent
2003 18
2004 17
2005 15
2006 16
2007 16
2008 17
2009 18
2010 18
2011 19.1
2012 19.8
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To see how IHS is doing on this measure at the Area (regional) levels, click here.