Date of Award
Spring 5-22-2025
Document Type
Doctor of Nursing Practice Final Manuscript
Degree Name
Doctor of Nursing Practice
Department
Nursing
First Advisor
Joseph F. Burkard, DNSc, CRNA, EBP-C
Abstract
Background: Diabetes is a prevalent chronic disease in primary care affecting 38.4 million people in the United States with type 2 diabetes accounting for over 90% of cases. Effective management requires continuous care and lifestyle modifications to prevent complications and improve quality of life. Patient education on self-management is essential for enhancing knowledge and promoting lifestyle changes and emerging evidence supports the effectiveness of telemedicine and online education in diabetes care. However, primary care providers face challenges in delivering comprehensive, individualized education due to time constraints and competing priorities. Consequently, only 47.8% of adults with diabetes have received formal self-management education highlighting the need for improved educational strategies in primary care.
Purpose: A gap exists between evidence-based diabetes management and its implementation in primary care, particularly in delivering effective self-management education. While diabetes self-management education enhances patient empowerment and optimizes clinical outcomes, time constraints and limited resources often hinder its integration into practice. This project aimed to address these challenges through a literature review and the implementation of a nurse-led educational program to improve self care-management skills and glycemic control in patients with type 2 diabetes. By fostering patient education, the project seeks to empower individuals to take greater control of their health and enhance diabetes management outcomes.
Methods: An online learning module covering seven key diabetes self-management concepts was created and provided to patients, as well as monthly telephone follow-ups over six months to guide patients in establishing individualized goals and tracking their progress. The Diabetes Self-Management Questionnaire (DSMQ) was used to assess patients’ self-management skills, and hemoglobin A1c values were monitored to assess the effect of education and follow-ups in glycemic control. Clinical nursing staff, a family medicine physician and a nurse practitioner student were involved throughout the project implementation.
Results: Among the 20 participants, 10 completed the full six-month telephone visits. The overall A1c values improved by 8.3% post-intervention which was not statistically significant but showed clinical significance (p=0.091). There was a 15.8% improvement in the total DSMQ scores after the intervention which was statistically and clinically significant (p=0.041).
These findings suggest that the nurse-led education program had a positive impact on glycemic control and self care-management behaviors.
Conclusion: Successful diabetes management requires active patient engagement, with education playing a critical role in promoting self-care behaviors. This project implemented an online education module and virtual visits to enhance patients' self care-management skills and improve glycemic control. Post-intervention data showed increased adherence to self-care behaviors with most participants reporting positive changes in diet, exercise, blood glucose monitoring, and healthcare utilization. While dietary modifications showed the most improvement, physical activity changes were minimal. Although A1c levels decreased in more than half of the participants, the direct correlation between improved self-management and glycemic outcomes remains inconclusive due to potential confounding factors. Expanding these programs to include continuous, nurse-driven, personalized education could further support self care-management and individualized goal-setting, reinforcing the multidisciplinary approach needed for optimal diabetes care.
Digital USD Citation
Kim, Sue Y., "Developing and Integrating an Independent Learning Module on Lifestyle Modification to Promote Diabetes Self-Efficacy for Patients with Type 2 Diabetes" (2025). Doctor of Nursing Practice Final Manuscripts. 299.
https://digital.sandiego.edu/dnp/299
Copyright
Copyright held by the author
