Year of Publication

2016

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Judi Daniels

Clinical Mentor

Dr. Joan Bischoff

Committee Member

Dr. Lynne Jensen

Abstract

Background: Diabetes is one of the leading causes of death and disability in the United States including Kentucky. Despite advances in medicine, the current management of type 2 diabetes mellitus (T2DM) remains challenging. Poor self-management coupled with the increasing complexity of the disease can lead to poor glycemic control.

Purpose: The purpose of this project was to examine current practices related to insulin-using patients’ treatment adherence and management of T2DM. In addition, providers’ perceptions on the management of T2DM were also assessed.

Methods: A retrospective chart review and semi-structured interviews were conducted. Patients (N = 84) with T2DM, over the age of 18, with hemoglobin A1C > 7.5% and on insulin were included in the review. Providers (N = 5) were recruited for the interviews.

Results: Despite a lack of assessment in patient adherence, glycemic control improved significantly at visit 2, demonstrated by a mean A1C reduction of 0.52% (p = 0.001). That change was found to be statistically significant between the group that received medication adjustments along with written education and those who did not receive any changes to their treatment plans. However, though not statistically significant, the most improvement in A1C was found among those who received medication changes along with verbal and written education. An inconsistency in the delivered education was also noted.

Conclusion: Overall, the gap in care is in the assessment, documentation and education process at the practice. The findings suggest a great need for improvement in assessment and documentation of patient adherence, and development of a standardized diabetes education delivery model. Information from this project will help build a foundation for future quality initiatives to improve the delivery of diabetes education at primary care practices.

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