HPC Provides Comprehensive Diabetes Care Through High-Risk Clinic

Whitney VenegoniPost written by Whitney Venegoni, APRN, FNP-C, Family Nurse Practitioner, Diabetes Clinic

November is Diabetes Awareness month and the perfect time to talk about the comprehensive diabetes care provided at Health Partnership Clinic (HPC).

Unfortunately, diabetes is prevalent among patients seeking care at our clinic. At HPC, 18 percent of our adult patients have diabetes. The risks associated with uncontrolled diabetes are widespread. To help address the need for more comprehensive care, we have a High-Risk Diabetes Clinic (HRDC) that focuses on diabetes and other chronic conditions that contribute to diabetes. One of the goals of the HRDC is to get AICs and blood sugar levels under control.

To learn more about the HRDC at HPC watch our video.

News Flash: Life is Hard!

Gwen WagnerBy: Gwenyth Wagner, DNP, APRN, Adult Nurse Practitioner, Diabetes Clinic at Health Partnership Clinic

Have you seen the Facebook post which is called “Choose your Hard”?

It goes something like this:

Marriage is hard. Divorce is hard.
Choose your hard.
Dieting is hard. Being obese is hard.
Choose your hard.
Following a budget is hard. Being in debt is hard.
Choose your hard.

You get the picture. Life can be a joy, but many things worthwhile are also hard.

I was thinking of this as I was counseling one of my diabetic patients who was struggling with adhering to her medication regime. After all, sometimes in the moment, we can feel great even when our sugars are running high, and that warm, luscious cinnamon roll seems so worth it!

November Diabetes Awareness Month. Vector illustrationFor a while we can try to forget that uncontrolled blood sugars over time will damage our eyes; block out that our provider told us we are starting to show signs of kidney damage; and pretend that the heart disease that happened to our parent (who also had diabetes) won’t happen to us!

So, I have adapted the above quote for the individual with diabetes though it could be adapted to address a variety of health issues! Perhaps it will be helpful in those times we are tempted to take the easier path.

Checking your blood sugars is hard. Being hospitalized due to high blood sugars is hard.
Choose your hard.
Giving yourself insulin injections is hard.  Going on dialysis is hard.
Choose your hard.
Giving up food with sugar is hard. Needing laser surgery for eye disease is hard.
Choose your hard.
Making time for your diabetes appointments is hard. Walking with missing toes is hard.
Choose your hard.

So, the next time you are faced with one of these health decisions, Choose Your Hard!

Health Partnership Clinic’s High Risk Diabetes Clinic Provides Focused Diabetes Care


Post written by Gwenyth Wagner, DNP, APRN, Adult Nurse Practitioner, Diabetes Clinic

The diabetes clinic is a specialized clinic at Health Partnership Clinic. Patients are referred to the clinic from their primary care provider if the provider feels like the patient would benefit from more concentrated care for the diabetes. Typically, this is a patient who is having difficulty reaching their goal A1C which is a measure of blood glucose. The goal set out by the American Diabetes Association is less than 7.0. If a patient has an A1C of nine or greater then they may be referred to the diabetes clinic.

How is an appointment with the diabetes clinic different than a regular appointment?

The diabetes clinic focuses on providing comprehensive care for the diabetic patient to help them improve the A1C. The diabetes clinic is made up of a medical assistant, a diabetes coordinator, a behavior health clinician and the nurse practitioner. We all have our roles. As the nurse practitioner, I am responsible for ordering medications which include oral agents and injections that will work best for the patient and to work with the patient to find a routine that works for them. I also do routine labs and conduct a physical exam to watch for any complications of the disorder. Education is very important to controlling diabetes well, and the patient will receive education and tips from both the nurse practitioner and the diabetes coordinator. The diabetes coordinator helps things run smoothly. She makes appointments, monitors the diabetes schedule, and will make follow up calls to the patient, especially when there have been changes to their insulin or medication regimes.

A behavioral health clinician meets with patients as well at the time of their visit. They help identify barriers which affect the patient’s ability to follow through on their treatment plan. These might be mental health issues such as depression, or practical challenges such as finances and access to medications.

How do patient’s receive help to get them the medications they need?

In the diabetes clinic we try to help patients get their medications in several ways. There is a pharmacy discount program that helps those who are uninsured or who have inadequate insurance get access to some of the new diabetes medications. Some patients are eligible for prescription assistance plans and we will help patients apply for their needed medications. Finally, we also have a limited supply of some insulin products for patients who qualify.

Have you seen patients make improvements?

We have had several “success stories” of patients who have met their A1C goal or at least made an improvement. The patients who have made progress list the following things as key to their success:

  1. Increased knowledge of a healthy diabetic diet and learning how to count carbohydrates. We have seen incredible improvements in those patients who are heavy soda drinkers when they stop drinking sugar sweetened beverages.
  2. Access to medication: Patients often just need help getting the right medications and finding options that are affordable – this can make a big difference in their care.
  3. More consistent appointments that focus just on diabetes. That increased accountability has been helpful to some patients in obtaining improved control over their diabetes.

Our goal is to help patients help themselves. We want to provide our patients with the tools, resources and education to enable them to be successful and improve their health. It will benefit them in so many ways in the future if they can improve the control of their diabetes today!


The Holidays are Coming! Ten Tips for Controlling Blood Sugars.

Gwen WagnerPost written by Gwenyth Wagner, DNP, APRN, Adult Nurse Practitioner, Diabetes Clinic

November is Diabetes Awareness Month. The following are tips to navigate the holiday season. They can be helpful whether or not you have diabetes!

  1. Concentrate on the things you love and enjoy about the holiday season that don’t have to do with food!
  2. Plan ahead for parties and special occasions. Bring an appetizer of veggies and dip, or a side dish that is mainly protein such as a meat or cheese platter. Remember it is high carbohydrate foods that raise your blood sugars.
  3. Keep the carbohydrate count in mind. Some foods may appear healthy – but are they? If they are heavily breaded or have a sweet dressing or sauce…you may find your blood sugars climbing.
  4. If you like to cook, challenge yourself to find new recipes that are lower in carbs but still delicious that you can bring to a special event. Those recipes are out there!
  5. Don’t skip meals so you can indulge later. Having consistent meals helps you have consistent blood sugars. Skipping meals can cause dangerously low blood sugars if you are on medication. Also – skipping meals can make you “hangry” and then it is often harder to make good choices when presented with food options later on!
  6. Check your blood sugars often. This will help you learn how certain foods affect your blood sugar. If possible, invest in a continuous glucose monitor as it will give you instant and continuous blood glucose results without having to prick your finger.
  7. Focus on “harm reduction”. This is another term for “moderation”. If you must taste Aunt Sarah’s fresh-baked Christmas cookie, settle for half of the cookie or even just a quarter. Eat it slowly and enjoy it.
  8. Be aware of what you are putting in your mouth. When we are celebrating it is often easy to eat mindlessly without realizing how much we are taking in!
  9. Limit alcohol. As you know alcohol has carbohydrates, and too much alcohol may make us forget to follow the above suggestions! Again, find substitute beverages you enjoy and drink alcohol in very limited amounts.
  10. Count your blessings! When you are feeling deprived – think of the things you are enjoying that you can be thankful for.

Diabetes and COVID-19:  Tips to staying healthy during a pandemic.

Gwen Wagner

Gwen Wagner

Post by: Gwenyth Wagner, DNP, APRN, Adult Nurse Practitioner, Diabetes Clinic

The COVID-19 pandemic has brought new health concerns for all of us but even more for the individual with diabetes.

According to the American Association of Diabetes, approximately just over 10 percent of the American population has diabetes. Nearly 1.6 million people have type I diabetes, a condition in which your pancreas does not make insulin. Approximately 32.6 million Americans have type II diabetes, which is characterized by insulin resistance and/or your body’s inability to make all the insulin that it needs. Insulin is needed to help break down and store glucose.

Having diabetes does not necessarily increase your risk for catching the virus but according to the Centers for Disease Control (CDC), it does increase the risk of having a more serious illness should you contract COVID-19.

These tips have been recommended as measures to take to stay healthy during a pandemic:

1. Continue taking your diabetes pills and insulin as usual.

It is important to keep your blood sugar, blood pressure and cholesterol under control so you can keep healthy. Continue taking your prescribed medications!

Always try to have at least one month’s supply of your medication available to you, including insulin. If you need refills or are having difficulty obtaining your medication, please contact your provider. We do not want you going without your medications! The only exception to this advice is if you have nausea or vomiting that prevents you from eating. In that case, you need to check your blood sugars and follow your health care providers “sick day” instructions.

2. Test your blood sugar and keep track of the results, as directed by your health care provider.

Notify your health care provider if you have unusual lows or high blood sugar results, or you are not keeping your blood sugars well controlled.

Glycemic Goals

Recommended by American Diabetes Association (ADA)

A1C – < 7%
Fasting plasma glucose – 80-130 mg/dL
Post prandial plasma glucose – < 180 mg/dL
(measured 1-2 hours after a meal)


3. Stay Active

Regular exercise can help your body use insulin more effectively, help control your blood pressure and improves your mood and sense of well-being. Aim for a minimum of 30 minutes of walking or an exercise you enjoy, five days a week.

4. Protect Your Immunity

You have heard these instructions repeatedly by now but here they are again. Wash your hands frequently, avoid large crowds and wear your face mask when running errands or when indoors with individuals other than your immediate family members. Also, this is a good time to remind you to get your flu shot!

5. Maintain a Healthy Diet

Avoid those high carbohydrate comfort foods!  Include foods that promote health and strengthen the immune system. See the following chart for suggestions from The University of Texas Southwestern Medical Center.

Diabetes and COVID19

Source: https://utswmed.org/medblog/diabetes-covid-19-risks/

6. Call your health care provider if you have concerns about your condition or feel sick.

In Closing

We cannot control everything about the virus, but we can control how we take care of ourselves. Make your health a priority and do not neglect taking your medications, eating properly, or keeping your regular appointments. If needed, a telehealth appointment can be set for you if you cannot come to the clinic in person. At Health Partnership Clinic we are here to help you keep healthy and manage your diabetes during this difficult season. If you are need an appointment with your regular provider or the diabetes clinic, please call the clinic at 913-648-2266.

Diabetes and the Role of Lifestyle Coaching

Gwen Wagner

Gwen Wagner

Post written by Gwenyth Wagner, DNP, APRN, Adult Nurse Practitioner, Health Partnership Clinic

There’s a combination of factors that help someone with diabetes get control of their blood sugar and reach their target A1C, which is typically 7.0% or lower. An A1C is sometimes referred to as the “three-month blood sugar” as it reflects the average blood sugar the patient has had over the past three months. Lifestyle changes and a multidisciplinary team approach play a key role.

Lifestyle Changes

Several of our patients from the High-Risk Diabetes Clinic (HRDC) at Health Partnership Clinic (HPC) have attributed their success in controlling their diabetes to factors such as being able to obtain access to affordable medication and receiving diabetes education. However, probably the most common factor that patients have identified has helped, is being coached on how to adjust their lifestyle. Every individual is different, and it is important to address the diet, exercise and lifestyle challenges of each patient. Having support in incorporating lifestyle changes is key to being successful in reaching and maintaining a normal A1C.

Patients in our diabetes clinic are fortunate to benefit from interaction with a Behavioral Health Clinician (BHC) who helps them address their challenges in controlling their diabetes which often includes help managing situational stressors and depression as well as making sustainable changes to their lifestyle.

“Often times we receive referrals to our HRDC due to “non-compliance,” says Cecilia Ponce, LSCSW, Behavioral Health Clinician. “When we speak to our patients about their barriers, we receive a wide range of responses: finances, transportation, knowledge, lack of support, cultural beliefs, lapse, relapse, difficulty maintaining change, adjustment to life changes, holidays, depression, anxiety, grief and loss, trauma, fear, side effects from medications in the past, physiological changes and so much more.”


Cecilia Ponce

Cecilia adds “Diabetes is a chronic illness and interventions to help our patients must address potential changes across the lifespan. The beauty of a true integrated model is that not only do we try to address what the patient is presenting with now; we are able to assess pitfalls in the past and empower them to implement their skills now and in the future.”

Multidisciplinary Team Approach

The American Diabetes Association publishes a document each year entitled “Standards of Care”, which outlines the most effective practices in diabetes care. They recommend that diabetes care should be managed by a multidisciplinary team and that lifestyle management should be a focus, not only at the time of diagnosis but as a part of all subsequent visits as well. Diabetes is not a static disease, and individuals often are presented with new challenges or changes in their lives that affect their diabetes and that need to be addressed.

We are fortunate to have BHC’s on our staff and as part of our Diabetes clinic. We believe that taking a holistic, integrated approach to health care provides the best outcomes for our patients and helps them achieve their goals.

HPC is accepting new patients of all ages. Call 913-648-2266 today.

HPC - Diabetes Lifestyle Coaching

HPC Provides Individuals with Comprehensive Diabetes Care

Gwen Wagner

Gwen Wagner

Post written by Gwenyth Wagner, DNP, APRN, Adult Nurse Practitioner, Health Partnership Clinic

In response to a challenge from Health Resources and Services Administration (HRSA) to create a quality improvement plan to address the number of patients with uncontrolled diabetes, HPC started a focused High-Risk Diabetes Clinic (HRDC) in August 2018. It takes place on Mondays and is open to any patient with an A1C greater than or equal to nine. An A1C is sometimes referred to as the “three-month blood sugar” as it reflects the average blood sugar the patient has had over the past three months. The goal for a person with diabetes per the American Diabetes Association (ADA) is to have an A1C of seven or lower. At present there are 100 patients participating in the HRDC.

There are three goals of the HRDC:

  • To improve patients understanding of effective lifestyle change and to assess and address psycho-social barriers to diabetes care.
  • To provide additional education and support for diabetes self-care especially with regards to insulin administration.
  • To remove financial barriers to obtaining insulin for self-administration and diabetes treatment.

Helping patients control their diabetes is not as simple as just providing medication or telling someone not to eat sugary foods. Diabetes can be a complex and multifaceted disease and patients need not only medication but education, counseling, support and self-management tools so that they can become experts in controlling their own blood sugars.

At HPC, we recognized the need for more comprehensive care and started the HRDC for those patients with uncontrolled blood sugars.

In the HRDC, we focus on education, counseling, mental and behavioral support along with medication management. This provides patients with comprehensive diabetes care and ultimately helps improve their quality of life. Lifestyle management is a fundamental aspect of diabetes care, and we focus on helping patients address risk factors and implement dietary and physical activity changes.

Diabetes self-management education focuses on providing individuals with the knowledge and tools they need to improve their control of diabetes. Patients are encouraged to check daily blood sugars, learn to recognize the signs of blood sugars that are too high or low and then learn how to manage those situations. They are taught how to take their medications safely, particularly insulin and even how to adjust insulin doses at home. Information about foot care and a variety of other topics are also addressed. Lastly, during clinic time a medical provider will perform necessary physical assessments and provide medication management tailored to the individual’s needs.

Medications for diabetes can be very expensive for those both with and without insurance. However, several medications prescribed are made affordable through an assistance program called the 340 B plan and through our association with AuBurn Pharmacy in Olathe. We also have been able to assist patients to obtain insulin when necessary for blood sugar control.


The Team

Special thanks to the team: Jessica Grate, MA, Adrianna Lund, MA, Cecilia Ponce, LSCSW, Behavioral Health Consultant, Gwenyth Wagner, DNP, APRN, Adult Nurse Practitioner.

Since starting the clinic, over half of our patients have A1Cs that have now fallen below nine percent, with an average individual decrease in A1C of approximately two percent. Our overall percentage of patients with diabetes who are considered “uncontrolled” (an A1C greater than nine) has dropped from 43 percent to 33 percent since the clinic began.

We hope to continue to support our patients with diabetes with the tools and resources they need to improve control of their diabetes and as a result, improve the quality of their lives.

Knowledge is Key in the Fight Against Diabetes

Gwen Wagner

Gwen Wagner

Post written by Gwenyth Wagner, DNP, APRN

November is National Diabetes Month.

This month, organizations across the country will band together to bring awareness about prediabetes and diabetes which affects more than 100 million U.S. Adults.

According to the Centers for Disease Control and Prevention (CDC) 30.3 million people in the United States have Diabetes, and 84.1 million people have Prediabetes.

You are at risk for developing prediabetes if you:

  • Are overweight
  • Are 45 years or older
  • Have a parent, brother, or sister with type 2 diabetes
  • Are physically active less than three times a week
  • Have ever had gestational diabetes (diabetes during pregnancy) or given birth to a baby who weighed more than nine pounds
  • Are African American, Hispanic/Latino American, American Indian, or Alaska Native (some Pacific Islanders and Asian Americans are also at higher risk)

The good news is that you can prevent or reverse prediabetes with lifestyle changes such as losing weight if you are overweight, eating healthier and getting regular physical activity.

If you have been diagnosed with diabetes, it is important to eat well. The first step is to make an appointment with your health care provider and discuss what changes you can make to your diet to improve your health.

The CDC recommends that half of your nine-inch plate be filled with non-starchy vegetables like leafy greens, green beans, broccoli, cauliflower, or carrots.

One-quarter of your plate should contain lean protein such as chicken, fish or lean beef. The remaining one-quarter of your plate should contain a whole grain or starchy vegetables such as potatoes, corn, peas or winter squash. You can also eat a small amount of fresh fruit.

Diabetes graphic

When you are grocery shopping, your cart should look like your plate. Half of your food items should be non-starchy vegetables like lettuce, asparagus, broccoli, cauliflower, cucumber, spinach, mushrooms, onions and peppers.

The rest of the cart should have lean proteins, whole grains, fruit, dairy, beans and starchy vegetables such as corn, peas, parsnips, potatoes, pumpkin, squash, zucchini and yams.

Here are a few tips to make grocery shopping easier:

  • Don’t go to the store hungry.
  • Make a list before you go to the store.
  • Shop the perimeter of the store first. This is usually where the healthiest foods are located!
  • Don’t purchase items that are not in your meal plan.
  • If you have favorite foods, discuss with your dietitian, how to manage eating them occasionally.
  • While at the store, don’t linger in aisles with tempting foods.

For more information and helpful tips about managing your diabetes, visit the CDC’s website at https://www.cdc.gov/diabetes/home/index.html.

To find out if you are prediabetic, take the quiz at www.preventdiabeteskc.com. This website is also a source for Diabetes Prevention Programs in the Kansas City area. Juntos provides Diabetes Prevention Classes in Spanish at HPC. Call today to find out how you can register…913-725-8676!

At HPC, we provide patient education and chronic disease management.  Though dietary measures are key in prevention and can be helpful in controlling diabetes, diet changes alone are not always enough to manage this disease. Be sure to talk to your provider about what treatment is best for you. To schedule an appointment to see a provider, call 913-648-2266.

Know Your Numbers – What is Your Risk for Diabetes?

Author: Daphne Ayn Bascom, MD PhD
Senior Vice President, Community Integrated Health
YMCA of Greater Kansas City

Dr Daphne Bascom

Daphne Ayn Bascom, MD PhD

As diabetes rates continue to rise, do you know your risk?

The YMCA of Greater Kansas City is encouraging the community to learn about the risks for prediabetes and type 2 diabetes and adopt healthy habits.

Take these three preventive steps to potentially avoid developing the disease:

  1. Learn about prediabetes.
  2. Assess your risks.
  3. Make small changes to your lifestyle.

You likely already know someone affected by diabetes or prediabetes, or are affected yourself. Statistics from the Centers for Disease Control and Prevention (CDC) show that more than one in three Americans (84 million people) have prediabetes.

Prediabetes is a condition in which a person’s blood glucose is elevated, but not high enough for a diagnosis of diabetes. Only 10 percent of those with prediabetes know they have it. But with awareness and simple actions, people with prediabetes may prevent the onset of type 2 diabetes.


In Kansas and Missouri, we have an opportunity to take charge of our health and educate others about diabetes and prediabetes. Diabetes rates continue to rise, and the rates of people with diabetes and prediabetes in Missouri and Kansas are higher than the national averages.


  • 13.2 percent of the adult population (approximately 699,992 people), have diabetes, compared to 9.4 percent of the total US population.
  • Of these, an estimated 152,000 have diabetes but don’t know it.
  • 35.9 percent of the adult population (1.6 million people), have prediabetes, compared to 33 percent nationwide.
  • Every year an estimated 32,000 people in Missouri are diagnosed with diabetes.


  • 12.6 percent of the adult population (approximately 293,860 people), have diabetes, compared to 9.4 percent nationwide.
  • Of these, an estimated 69,000 have diabetes but don’t know it.
  • 35.5 percent of the adult population (749,000 people in Kansas), have prediabetes, compared to 33 percent nationwide.
  • Every year an estimated 15,000 people in Kansas are diagnosed with diabetes.


YMCA Guest Blog DPP Flyer Pic 2As one of the leading community-based charities committed to improving the health of the greater Kansas City area, the Y wants members of our community to understand their risk for prediabetes and to take steps to avoid developing type 2 diabetes.

Developing type 2 diabetes not only puts a tremendous strain on our health care system but impacts the lives of millions of people and their families each year.

Assess your risk for prediabetes and type 2 diabetes by taking a simple test at YMCA.net/diabetes. Through this assessment, you can also learn how lifestyle choices and family history help determine the ultimate risk of developing the disease.

Making some basic lifestyle changes that contribute to weight loss and healthy living can decrease the risk of type 2 diabetes.

  • Eat fruits and vegetables every day. A plant-strong diet is a great way of reducing your risk.
  • Choose fish, lean meats and poultry without skin.
  • Aim for whole grains with every meal.
  • Be moderately active, getting at least 150 minutes of physical activity each week.
  • Choose water to drink instead of beverages with added sugar.
  • Sleep is an important part of your health and well-being. Good sleep hygiene can help reduce your risk of diabetes and obesity.
  • Speak to your doctor about your diabetes risk factors, especially if you have a family history or are overweight.


The YMCA of Greater Kansas City is helping to improve the health of our community. We offer programs including the YMCA Diabetes Prevention Program and the Y Weight Loss Program.

We also offer additional programs and seminars designed to help you make small lifestyle changes that can help improve your health and reduce your risk of developing chronic diseases such as type 2 diabetes. Membership at the Y is NOT required to participate in many of these programs.

To learn more about the YMCA of Greater Kansas City’s Health and Wellness Programs, please contact program coordinators Madison Eiberger or Rubi Lopez at HealthyCommunity@KansasCityYMCA.org or 816-285-8050.