Cardiovascular Risk and Blood Pressure Control in Patients with Diabetes at Federally Qualified Health Centers: Baseline Findings from the Office-GAP IMPACT (Office-Guidelines Applied to Practice Improving Diabetic Patients’ Adherence to Treatment and Prevention of Cardiovascular Disease) Program

Q: What are the key findings of this study?

Patients with diabetes at FQHCs had low baseline BP control, with Saginaw County patients having 60% lower odds of BP <130/80 mmHg vs Ingham County.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Type 2 diabetes and cardiovascular risk factors (n=392). Intervention: Clinic location in Saginaw County vs. Ingham County (baseline analysis of the Office-GAP IMPACT trial) vs. Clinical sites in Ingham County, Michigan (reference group). Primary outcome: Baseline blood pressure control defined as BP < 130/80 mmHg (OR 0.40, 95% CI 0.21-0.77).

Nephertiti Efeovbokhan; Karen Kelly‐Blake; Denise White-Perkins; Zhehui Luo; Adesuwa Olomu

doi:10.1007/s40615-026-03143-3

August 5, 2026Journal of Racial and Ethnic Health DisparitiesOpen Access

Cardiovascular Risk and Blood Pressure Control in Patients with Diabetes at Federally Qualified Health Centers: Baseline Findings from the Office-GAP IMPACT (Office-Guidelines Applied to Practice Improving Diabetic Patients’ Adherence to Treatment and Prevention of Cardiovascular Disease) Program

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Key result

Saginaw County FQHC patients show ~60% lower odds of blood pressure control than Ingham County.

OR 0.40
95% CI 0.21-0.77
n=392

Why the study?

What are the baseline prevalence rates and demographic/geographic associations of blood pressure and glycemic control among patients with poorly controlled type 2 diabetes receiving care at Federally Qualified Health Centers in Michigan?

Key Points

To describe baseline demographic and clinical characteristics and examine factors associated with blood pressure and glycemic control among patients with diabetes receiving care across Federally Qualified Health Centers in Michigan.
Baseline analysis of the Office-GAP IMPACT randomized trial enrolling 392 patients with diabetes across 17 clinical teams in 12 Federally Qualified Health Centers in three Michigan counties (Ingham, Saginaw, and Alcona).
Clinical teams were randomized to an intervention arm (Office-GAP plus texting) or an enhanced control arm (texting only).
Demographic factors, cardiometabolic risk conditions, blood pressure, and HbA1c levels were evaluated using baseline clinic and survey data.
Among 392 participants, 68% had self-reported hypertension, 72% had hyperlipidemia, 43% had depression, 26% were current smokers, and 64% had HbA1c ≥ 9.
Blood pressure control was low: only 26% achieved BP < 130/80 mmHg and 60% achieved BP < 140/90 mmHg, with mean systolic and diastolic blood pressure of 135.5 ± 18.2 mmHg and 80.6 ± 11.2 mmHg.
Adjusted odds of BP control below 130/80 mmHg were significantly lower in Saginaw County compared with Ingham County (OR = 0.40, 95% CI = 0.21, 0.77), while odds of BP control below 140/90 mmHg were significantly lower in Alcona County (OR = 0.31, 95% CI = 0.15, 0.66).

Study Design

Type

Cross-Sectional (n=392)

Randomization

Seventeen clinical teams in 12 FQHCs were cluster-randomized with equal probability into intervention (Office-Gap + Texting) vs. enhanced control (Texting only); however, this paper reports a cross-sectional analysis of baseline data prior to intervention effects

Multicenter

Yes

Structured PICO

What are the baseline prevalence rates and demographic/geographic associations of blood pressure and glycemic control among patients with poorly controlled type 2 diabetes receiving care at Federally Qualified Health Centers in Michigan?

P

Population

392 adults with poorly controlled type 2 diabetes (HbA1c >= 8; mean age 55.9 years, 60.2% female) receiving primary care across 12 Federally Qualified Health Centers in three Michigan counties evaluated at baseline.

E

Exposure

Geographic county location (Alcona, Ingham, and Saginaw counties) and individual-level baseline demographic and clinical characteristics (Note: parent trial randomizes teams to Office-GAP patient activation/shared decision-making + Way to Health texting vs. texting only, but this paper is a baseline cross-sectional analysis).

C

Comparator

Ingham County clinical sites (reference group for county comparisons; parent trial control is enhanced control receiving Way to Health texting only).

O

Outcome

Baseline blood pressure control (defined as BP < 130/80 mmHg and BP < 140/90 mmHg) and glycemic control (defined as HbA1c < 9%).surrogate

Main Result

Odds Ratio: 0.4 (95% CI 0.21–0.77)

Absolute Event Rate: 20% vs 39.7%

Limitations

Comorbid conditions other than diabetes were based on patient self-report, which could be influenced by recall bias, privacy concerns, or lower levels of health literacy
Data obtained from the electronic health record is limited by data completeness, accuracy, and standardization
Study was based in FQHCs in three counties in Michigan, limiting generalizability to other geographic locations
Potential for communication discordance despite English language proficiency inclusion criteria
Reflects cross-sectional baseline data only; longitudinal analyses are needed to determine outcomes over time
Comorbid conditions other than diabetes were based on patient self-report, subject to recall bias, privacy concerns, or lower health literacy
Electronic health record data is limited by completeness, accuracy, and standardization
Limited generalizability as the study was conducted only in FQHCs in Michigan
Cross-sectional baseline analysis only; longitudinal follow-up is needed to assess intervention impact over time

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Patients with poorly controlled diabetes receiving care at Federally Qualified Health Centers exhibit a high burden of cardiovascular risk factors (72% hyperlipidemia, 70% obesity, 68% hypertension) and suboptimal blood pressure control (only 26% < 130/80 mmHg), with significant geographic variation across counties.

Abstract

Background The rate of diabetes and blood pressure (BP) control are low, particularly in patients with diabetes receiving care from federally qualified health centers (FQHCs). The Office-Gap IMPACT study (Office-Guidelines Applied to Practice Improving Diabetic Patients’ Adherence to Treatment and Prevention of Cardiovascular Disease) is a patient activation intervention to improve care and health outcomes for patient with diabetes and cardiovascular disease in FQHCs and community health centers. Objectives This baseline analysis of the Office-GAP IMPACT study (1) aimed to describe the individual-level demographic and clinical characteristics of patients with diabetes enrolled in the Office-GAP study, (2) assess the associations between these characteristics and baseline BP and glycemic control, and (3) assess the differences in BP and glycemic control in three different counties in Michigan. Methods We enrolled 392 patients with diabetes in 17 clinical teams in 12 FQHCs located in three counties in Michigan. Teams were randomized into intervention, Office-Gap + Texting (group 1) vs. enhanced control, Texting only (group 2). Baseline demographic and clinical data were analyzed. Results Among 392 patients, 68% had self-reported hypertension, 72% had hyperlipidemia, 30% had BMI < 30, 26% were current smokers, and 43% reported depression. Overall, 64% had HbA1c ≥ 9. Among those with hypertension, 26% achieved BP < 130/80 mmHg and 60% achieved BP < 140/90 mmHg. Conclusion Patients with diabetes receiving medical care at FQHCs are a diverse demographic population. The high prevalence of cardiovascular disease risk factors and the low rate of BP control in this demographic is a huge concern.

Discussion

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Cite This Study

Efeovbokhan et al. (2026) conducted a cross-sectional in Type 2 diabetes and cardiovascular risk factors (n=392). Clinic location in Saginaw County vs. Ingham County (baseline analysis of the Office-GAP IMPACT trial) vs. Clinical sites in Ingham County, Michigan (reference group) was evaluated on Baseline blood pressure control defined as BP < 130/80 mmHg (OR 0.40, 95% CI 0.21-0.77). Patients with diabetes at FQHCs had low baseline BP control, with Saginaw County patients having 60% lower odds of BP <130/80 mmHg vs Ingham County.

synapsesocial.com/papers/6a758bd0847ab6d26c01f62c https://doi.org/10.1007/s40615-026-03143-3

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Cardiovascular Risk and Blood Pressure Control in Patients with Diabetes at Federally Qualified Health Centers: Baseline Findings from the Office-GAP IMPACT (Office-Guidelines Applied to Practice Improving Diabetic Patients’ Adherence to Treatment and Prevention of Cardiovascular Disease) Program

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Cardiovascular Risk and Blood Pressure Control in Patients with Diabetes at Federally Qualified Health Centers: Baseline Findings from the Office-GAP IMPACT (Office-Guidelines Applied to Practice Improving Diabetic Patients’ Adherence to Treatment and Prevention of Cardiovascular Disease) Program

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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