New NCQA Report Highlights Progress in Diabetes Care and Opportunities for Improvement

Diabetes touches nearly every corner of the healthcare system. Affecting more than 40 million Americans, it is one of the nation’s most prevalent and costly chronic diseases. Diabetes care extends beyond blood sugar management. The condition is associated with increased risks of heart disease, kidney failure, stroke, blindness and amputation, which makes high-quality, coordinated care essential to reducing complications and improving long-term outcomes. A new NCQA report, Diabetes Quality: National Trends, Gaps in Care and Opportunities for Improvement, funded and supported by The Leona M. and Harry B. Helmsley Charitable Trust, examines national performance on HEDIS® diabetes quality measures and highlights strategies high-performing health plans use to drive improvement. 

“For people living with diabetes, better outcomes start with understanding where care is working and where gaps remain,” said Sarah Shih, Vice President of Quality Sciences at NCQA. “Measurement provides that insight, helping health plans, providers and policymakers target improvement efforts, allocate resources effectively and reduce the burden on patients.” 

By offering a national view of performance across key diabetes quality measures, the report highlights where progress is being made and where additional attention is needed.  

“This report provides a clear picture of where care stands for people with diabetes in the U.S.,” said Laurel Koester, Program Officer in the Type 1 Diabetes Program at The Helmsley Charitable Trust. “At Helmsley, we’re committed to improving access to high-quality care, everywhere, and that’s why we’ve supported NCQA—leaders in measuring quality clinical care.”  

The findings paint a nuanced picture: while diabetes care is improving in important areas, persistent gaps remain.

Beyond Blood Sugar: Taking a Whole-Person Approach to Diabetes

Despite significant advances in diabetes treatment and technology, managing diabetes remains complex. New medications, continuous glucose monitoring, automated insulin delivery systems and digital health platforms are transforming diabetes care, but successful care extends beyond glycemic management. 

People with diabetes often need support monitoring blood pressure, cholesterol, kidney and eye health, while also overcoming barriers such as medication adherence, behavioral health challenges and limited access to care. Factors like transportation, healthy food and affordable medications can significantly influence an individual’s ability to self-manage their condition and avoid complications. 

The report reinforces a growing recognition across the healthcare system: improving diabetes outcomes requires comprehensive clinical support and resources that help individuals manage their health in everyday life. 

Progress Is Encouraging Yet Uneven Across Diabetes Care

The report offers encouraging evidence that diabetes care is moving in the right direction. Between HEDIS Measurement Years 2023 and 2025, health plans across commercial, Medicaid and Medicare populations improved performance on several key measures, including glycemic control, blood pressure control and kidney health evaluation. The largest gains were in kidney health evaluation, reflecting the growing adoption of guideline-recommended kidney health monitoring practices. Glycemic status results also improved across all three product lines during this period, suggesting better glycemic management among members with diabetes. 

However, progress has not reached all areas of care. Performance on diabetic eye exams and statin therapy has largely plateaued, leaving opportunities to better prevent vision loss and cardiovascular complications among people with diabetes.  The report also found wide variation across health plans, with top performers consistently achieving markedly better results than their peers. That gap shows room to improve across population groups and product lines. Closing it and accelerating the adoption of proven strategies will be essential to turning progress into better outcomes for everyone living with diabetes.

Persistent Care Gaps Continue to Shape Outcomes

Despite overall improvements, significant differences in diabetes outcomes by population persist. The report notes that diabetes prevalence is highest among American Indian/Alaska Native, Black and Hispanic populations, as well as lower-income individuals and those living in rural communities.

For example, Glycemic Status <8.0% results showed lower performance among American Indian or Alaska Native populations in commercial and Medicare plans and among Hispanic or Latino populations across all three product lines. 

On the Emergency Department Visits for Hypoglycemia in Older Adults measure, dual-eligible Medicare beneficiaries experienced higher rates of hypoglycemia-related emergency department visits than non-dual-eligible beneficiaries. These findings suggest that broader social, economic and clinical risk factors may contribute to higher-than-expected emergency department use among dual-eligible beneficiaries, which reinforces the need for additional support and targeted interventions to prevent avoidable use. 

Lessons From High-Performing Health Plans

NCQA interviewed six high-performing health plans to better understand the strategies supporting their diabetes quality performance. Despite serving different populations and markets, several common themes emerged. High-performing plans: 

• Demonstrated a strong organizational commitment to quality. 

• Used value-based payment arrangements that incentivized diabetes outcomes. 

• Regularly shared actionable performance data with providers. 

• Invested in systematic approaches to identifying and closing care gaps. 

• Conducted proactive outreach to members. 

• Fostered strong collaboration between health plans and clinicians. 

• Supplemented these efforts by addressing social and behavioral factors that affect an individual’s ability to manage diabetes successfully. 

Together, these practices highlight the importance of combining data-driven quality improvement with patient-centered support systems that extend beyond traditional clinical care.

Turning Progress into Better Outcomes

The report delivers a message of cautious optimism. National performance on several key diabetes measures is improving, and high-performing health plans demonstrate that meaningful gains are achievable. 

At the same time, stalled progress in some areas and substantial variation across health plans make it clear that important challenges remain.  As diabetes continues to grow in prevalence, improving outcomes will require sustained investment in quality measurement, preventive care, care coordination and strategies that address social factors affecting health. The findings provide practical insights for health plans, policymakers, clinicians and employers seeking to improve diabetes care. Most importantly, they demonstrate that better outcomes are achievable when organizations combine strong leadership, actionable data, proactive care management and whole-person support to help people with diabetes live healthier lives. 

Acknowledgments

This research was made possible with funding and support from The Leona M. and Harry B. Helmsley Charitable Trust. Download the full report here. 

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).