Table 1. Interventions.

Intervention	Preassessment	Postassessment
Clinical	Lack of team communication DKA admissions without prerequisite criteria Management with sliding scale and/or NPH insulin: Fails to provide flexibility or intensiveness Patients unaware of/unable to carbohydrate count: Carbohydrate counting provides more accurate insulin dosing	Weekly multidisciplinary meetings: Scheduled patients discussed Team member roles defined a priori Implementation of DKA admission criteria: 1.5 mmol/L blood ketones, pH <7.30, serum bicarbonate <15 mmol/L and/or clinical signs of dehydration Transition patients from sliding scale to basal-bolus and insulin pump therapy: Insulin pump patient education NPs and RNs trained RD carbohydrate counting education
Educational	Staff lack knowledge regarding: Insulin pump therapy ADA guidelines Patient goal setting and self-management School RNs lack knowledge regarding: Newer insulin analogs Insulin pump therapy Hypoglycemia treatment Patients lack knowledge regarding: Sick day management Ketone testing Self-management skills and ability to make changes in insulin doses based on blood glucose levels Lack of institutionally approved and standardized diabetes education materials: Conflicting recommendations Lack of Spanish educational materials: 40% of our patients speak Spanish	Staff education: Focused on ADA guidelines for best diabetes practices Goal for educators to become CDEs: Requires knowledge, understanding, and experience in diabetes prevention and care Patient and family education: ADA recognized and based on national standards for DSMES Use of Chronicle, a diabetes management tracking database Development of patient educational materials in English and Spanish Community education Events (Family Diabetes Day and Candy Exchange): Events provide education, motivation, and support Education from diabetes educators, technology companies, etc Other events: Programs for school and home health RNs Shabbatons—programs during Shabbat for Orthodox Jewish Community Parent coffees for information and support
Structural	Poor access to appointments Increasing wait times due to 15-min appointments Lack of coordination between providers and ancillary staff	Hired physicians and staff dedicated to diabetes Increased access by doubling diabetes sessions from 5 to 10 clinics per week Clinic templates changed from 15- to 30-min visits Created faculty/NP collaboration: Alternating appointments increase patient opportunity to see providers

Abbreviations: ADA, American Diabetes Association; CDE, certified diabetes educator; DKA, diabetes ketoacidosis; DSMES, Diabetes Self-Management Education and Support; NP, nurse practitioner; NPH, neutral protamine Hagedorn; RD, registered dietitian; RN, registered nurse.