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 lower than 7 (ideal control) during the year.

How is IHS doing?
The United States long-term goal is for 58.9% of adults aged 18 years and older diagnosed with diabetes had an A1c value less than 7 percent by the year 2020 (Healthy People 2020). The IHS 2012 goal was to achieve the rate of 32.7%. IHS exceeded the goal by reaching 33.2%. The bars on the graph below show that IHS has raised the rate of ideal blood sugar control from 25% in 2002 to 33.2% in 2012.

Percentage of IHS AI/AN Patients with Diabetes  with Ideal Blood Sugar Control (A1c < 7)  (IHS 2013 goal is establish a baseline for ideal blood sugar control A1c < 8)  Note: A higher score is better

View a table of this chart's data.

Year Percent
2002 25
2003 28
2004 27
2005 30
2006 31
2007 31
2008 32
2009 31
2010 32
2011 31.9
2012 33.2
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To see how IHS is doing on this measure at the Area (regional) levels, click here.