DOI

10.21007/con.dnp.2024.0077

Faculty Advisor

Laura Reed, DNP, APRN, FNP-BC, CNE

Document Type

Poster

Publication Date

Spring 4-14-2024

Disciplines

Diseases | Endocrine System Diseases | Endocrinology, Diabetes, and Metabolism | Health and Medical Administration | Investigative Techniques | Medicine and Health Sciences | Nursing | Nursing Administration | Quality Improvement

Abstract

Purpose/Background

Type 2 diabetes mellitus affects 13.1% of adults living in Shelby County and over 30 million adults in the United States. This chronic disease creates a higher risk of macrovascular and microvascular complications for this population resulting in poor outcomes if not properly managed. Improving glycemic control can help to improve the quality of life for people living with diabetes and reduce healthcare costs. Currently 20% of funds spent in the United States on healthcare is utilized for diabetic care. Certified Diabetes Care and Education Specialists (CDCES) primarily educate patients about managing their diabetes, including health promotion that can improve healthcare outcomes. Data shows that referrals to a CDCES by a primary healthcare provider can help improve A1c levels and diabetes management for people with poorly controlled diabetes. The purpose of this quality improvement project is to show the value of CDCES visits in patients with poorly controlled type 2 diabetes in a metropolitan underserved primary care clinic and implement a successful CDCES referral program to improve the quality of care for these patients.

Methods

A retrospective chart review was conducted in a metropolitan underserved primary care clinic in the Midsouth region for patients with type 2 diabetes mellitus over 21 years of age who received at least one diabetes education session.

Inclusion Criteria:

Speaks the English language

All races and ethnicities

Male or female

Age 21 and over

Diagnosis of type 2 diabetes mellitus

Hemoglobin A1c level greater than or equal to 8%

Demographic data, baseline HbA1c, and post-education HbA1c were extracted from 29 random charts. All patients were deidentified to only include gender (21 females, 8 males) along with HbA1c results. A two-tailed paired samples t-test was conducted to determine the mean difference in pre- and post-intervention HbA1c at baseline, 3, and 6 months.

Results

A two-tailed paired samples t-test was performed to evaluate whether the mean difference of HbA1c pre- and post-intervention by CDCES was significantly different. The observations for baseline HbA1c had an average of 9.16 (SD = 2.84). The observations for the 3-month follow-up HbA1c after CDCES visit had an average of 8.32 (SD = 2.36). The results of the two-tailed paired samples t-test was not significant based on an alpha value of .05, t(28) = 1.64, p = .113. While the results were not statistically significant (p = .113), there was a detectable decrease of the mean HbA1c after CDCES visit.

Implications for Nursing Practice

The data analysis points to the effectiveness of CDCES intervention for adults living with poorly controlled type 2 diabetes. A team-based approach to managing diabetes can be helpful to people with poorly controlled diabetes. A referral to a CDCES should be offered to any patient struggling to manage diabetes to help improve health outcomes, reduce the total cost of care, and increase the health span of these individuals. Further studies could be conducted to follow patients for an extended duration to assess the effects of CDCES intervention on long-term control of diabetes.

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