Barbara Liepman, RN, MSN, CDCES, CHWC is a Pediatric Nurse Diabetes Quality Coordinator at UCSF Benioff Children’s Hospitals in Oakland and San Francisco, California. She received her MS in Nursing Administration with an emphasis on quality, and a minor in education, from the University of California, San Francisco. Liepman is also a Certified Diabetes Care and Education Specialist (CDCES) and Certified Health and Wellness Coach.

Interview with Barbara Liepman, RN, MSN, CDCES, CHWC 

In this interview, Liepman discusses her expertise in supporting people with type 1 diabetes (T1D) and working to improve patient care through the T1D Exchange Quality Improvement Collaborative (T1DX-QI).

The T1DX-QI was established in 2016 — with the support of The Leona M. and Harry B. Helmsley Charitable Trust — in an effort to refine best practices and improve daily life for people with type 1 diabetes (T1D). Growth has been tremendous, with 54 endocrine clinics from across the U.S. participating in the Collaborative. 

Fueled by top leaders in diabetes care, the T1DX-QI has become an engine of innovation and inspiration. By engaging with the shared, data-driven, and systematic methods of the T1DX-QI, clinics have seen unprecedented success in their approach to diabetes management.   

With members working closely together to identify gaps in care, discover and refine best practices, and share research — the process has become knowledge-sharing at its very best. While collated data gives clinics a clear sense of “where they are,” it also demonstrates “where they can be,” by applying shared, evidence-based methods for improving care. 

What led you to nursing and diabetes care? 

“When I was a young girl, my father made sick calls for hospitalized congregants,” explained Liepman, who had an early initiation observing healthcare from Stanford Hospital’s waiting rooms.  

“I chose nursing as a profession because I’ve always enjoyed helping people, and I was raised by parents who believed in service,” said Liepman, who went on to graduate from Columbia University with a BSN degree and began her career in inpatient orthopedics at UCSF. 

Then, in 1995, while Liepman was in graduate school pursuing an MSN degree, and simultaneously working as a nurse, her 9-year-old daughter was suddenly diagnosed with type 1 diabetes.  

“It turned my life upside down in an instant,” remembered Liepman. 

“I honestly didn’t know anything about T1D at the time. I was probably looking out the window during our lecture in nursing school because I didn’t remember the difference between T1D and T2D,” joked Liepman, who dove head-first into diabetes care — for her daughter and eventually many others, too.

In time, Liepman landed a job in remote patient monitoring with a chronic disease management company — a novel idea in the 1990s. The process was jump-started by clients entering blood glucose values into their home phone keypads, while nurses who received the data provided education and support on the other end. 

With her heart planted firmly in service, Liepman went on to become a CDCES, cementing her career in diabetes over the past 22 years and helping countless individuals along the way. 

What do you enjoy most about your work?  

“I enjoy scaling up population-wide health initiatives in order to reach larger groups of people,” said Liepman. 

“While I miss working directly with patients, especially those with diabetes, when they have ‘aha’ moments and feel supported, listened to, or understood — I know the quality work I’m doing for diabetes is really important, as well.”

Benioff Children’s Hospitals and T1DX-QI 

“When I started as the Pediatric Nurse Diabetes Quality Coordinator, the diabetes clinical team at Benioff Children’s Hospitals was already involved with the T1DX-QI,” explained Liepman, who was introduced to the T1DX-QI by Jenise Wong, MD. 

Liepman now serves as the Pediatric Diabetes QI Coordinator, along with Wong, who is the lead PI, and Angel Nip, MD, who is co-PI. In addition, as part of the BCH Quality Improvement Department, Liepman’s leadership team includes Kristine Cannon, MPH, FACHE, and Noreen Goodlow, both of whom have served as QI mentors to Liepman. 

Diabetes Quality Improvement at Benioff Children’s Hospitals 

In terms of quality work, Liepman sits on a variety of task forces. She is the QI co-lead on a T1D A1C health equity project and is also involved with an initiative to increase retinal screenings in the pediatric diabetes space.  

Moreover, Liepman is engaged with a few non-diabetes-related projects including increasing suicide screenings for pediatric patients.  

A QI initiative that Liepman is most proud of since starting at Benioff Children’s has been the development and implementation of a depression screening tool for their outpatient T1D population. 

“Screening rates increased from 29 percent to over 80 percent for patients seen in clinic,” said Liepman, whose successful initiative is now in its sustainability phase.  

“We’re involved in a variety of initiatives to decrease A1C values in publicly insured patients who have A1Cs greater than 9 percent,” explained Liepman. “At the end of the fiscal year 2022, 45 percent of this population had A1C values greater than 9. With interventions, we’ve decreased this rate to 38 percent, meeting our goal, to date, of less than 40 percent by the end of the current fiscal year.” 

By comparison, at Benioff Children’s Hospitals, only 20 percent of private pay patients had an A1C greater than 9 at the end of the fiscal year 2022.  

“This disparity between public and private pay patients is something that we continue to work on,” said Liepman.  

Benioff Children’s Hospitals have had success with initiating continuous glucose monitoring (CGM) on two subsets of hospitalized patients with T1D: Those that are public pay and newly diagnosed and those with a pre-existing T1D diagnosis admitted without a CGM, explained Liepman. In both cases, patients are being discharged from the hospital wearing a CGM. 

The next layer of the initiative is screening for social determinants of health.  

“By using input from the T1DX-QI, we’re learning the approach other organizations are taking and formalizing our screening process,” said Liepman.

What’s next? 

“I’m very interested in the concept of ‘techquity,’ to ensure technology is equitably offered and available to everyone. Again, by starting inpatients on CGMs, we’ve taken steps to improve techquity within our organization for our public pay patients and have further work in the pipeline for screening for social determinants of health,” explained Liepman.  

Another area of interest for Liepman is health numeracy and literacy — and how that applies to the use of diabetes technology. “These devices can be very complicated for people to use, and we need to be certain we’re not excluding people on these premises,” said Liepman.  

“I’d also like to see more engagement with QI work related to emotional well-being, it’s not all about the A1C,” reminded Liepman. “Emotional health is such an important part of managing chronic conditions.” 

“Finally, we’d like to examine loss to follow-up and develop interventions to bring patients back into the fold who have fallen between the cracks,” said Liepman. “This includes challenges surrounding transitions of care when adolescents age out of pediatric endocrinology. We know there’s a loss to follow up in this population, and we’d like to make improvements here.” 

What do you enjoy outside of work?  

When Liepman isn’t behind her desk, she’s likely found walking her dogs, listening to books on Audible, and enjoying time outdoors with her family.