Date of Award

Spring 5-31-2020

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Kevin J Maxwell PHD, DNP, FNP-BC

Second Advisor

Dr. John Harper III MD


An evidence-based practice (EBP) project was implemented in a primary care setting to decrease Hemoglobin A1c (HgbA1c) levels and increase self-efficacy in Type II Diabetes Mellitus (T2DM) diagnosed individuals. According to the Centers for Disease Control (CDC), 30.3 million adults have diabetes in the United States, and one in four do not know they have it (CDC, 2017). It is a disease that can be managed and reversed with standardized self-management education. Self-management interventions can improve diabetes knowledge and encourage patient participation in caring for their health (Flode, Iversen, Aarflot, & Haltbakk, 2017).

The purpose of this evidence-based project was to improve type II diabetes mellitus (T2DM) self-management through nursing education, focusing on self-efficacy and medication adherence guided by the American Association of Diabetes Educators 7 Self-Care Behaviors (AADE7). The objectives were: (a) decrease HgbA1c levels by 0.5% or more and (b) increase self-efficacy by 15% with the use of the Stanford Patient Education Resource Center’s Self-Efficacy for Diabetes questionnaire (SPSE).

Eleven participants were recruited through provider referrals, flyers, and cold calls. Inclusion criteria included a T2DM diagnosis and HgbA1c greater than or equal to 7%. It was a requirement to obtain a HgbA1c level and fill out the SPSE prior to the intervention. Each participant received personalized nurse-led education, which included healthy eating, medication adherence, exercise, healthy coping, and reducing risks.

A total of 10 participants completed the program, including obtaining HgbA1c levels three months postintervention. There was significant improvement in postintervention scores with the mean increasing from 6.16 to 7.8 (Mpre = 6.16, Mpost = 7.80 on 1 – 10 scale; t = 3.697, p < .01). HgbA1c levels decreased in seven of 10 participants (8.84 to 7.64, t=1.692, p > 0.05), suggesting possible influence in long-term self-care in most but not all patients’ pre-endocrinology referral. Due to the small sample size, there were not enough participants to show statistical significance. Expanding the project to more patients with longer follow-up could help determine if DSME has significant long-term effects on HgbA1c and self-care behaviors.