Introduction
The rising rates of type 2 diabetes are a national and global problem that impacts the world’s population and depletes countries’ financial resources. In 2017, more than 6% of people in the world had type 2 diabetes, and this number is expected to continue increasing in the following years (Centers for Disease Control and Prevention [CDC], 2021). At the same time, there is no cure for diabetes, and the primary strategy is the management and prevention of comorbidities (Khan et al., 2020). However, the development of diabetes can be prevented, and its impact can be lessened through various approaches.
The purpose of the proposed (DNP) project is to examine whether a Diabetes Self-Management Education and Support (DSMES) program can produce positive health effects on adults with type 2 diabetes. This paper presents the proposed project’s problem and selected solution. First, an assessment of the current issue is presented, discussing the severity of type 2 diabetes in the United States and the examined practicum site. Second, scholarly evidence about interventions is synthesized, demonstrating the main themes in peer-reviewed research papers and showing how they support the chosen intervention.
Next, the implementation is examined, including a description of the intervention, its rationale, the instruments used for data collection, and the project plan with milestones. In the next segment, the ways of evaluating project outcomes are presented. The paper presents an analysis of existing evidence to support the intervention aimed at improving the health outcomes of adults with type 2 diabetes.
Assessment
As mentioned above, diabetes is a global issue, and its negative impact is also substantial in the United States. According to the data presented by the CDC (2021), approximately 37 million Americans have a form of diabetes, which is more than 10% of the country’s population. One in four of them does not have an official diagnosis, which interferes with proper treatment and education (CDC, 2021). Notably, most people with diabetes – more than 90% – have type 2 diabetes, which develops due to external and behavioral factors (Khan et al., 2020). These numbers demonstrate a high prevalence of this disease in the population.
The dangers of diabetes are not limited to its symptoms. Type 2 diabetes is a serious condition that puts people at an increased risk of comorbidities, such as heart disease, kidney failure, stroke, and more (Khan et al., 2020; Lau et al., 2019). On the monetary side, diabetes results in increased medical costs and puts many households in a difficult financial situation (CDC, 2021; Khan et al., 2020). Thus, the problem of diabetes continues to become more pressing each day.
At the practicum site, diabetes is a common problem among patients. As the incidence of diabetes increases with age, facilities that serve many older clients have a higher rate of patients with diabetes (Khan et al., 2020). At the practicum site, the charts and nurses’ comments reveal an increasing prevalence of type 2 diabetes diagnosis and a high risk of prediabetes for many patients. Moreover, many patients who have not been diagnosed or have been diagnosed recently demonstrate a lack of understanding of the condition. One can use patient charts and records to collect the data from the practicum site. The rates of diabetes among patients can be gathered through health information systems.
Planning: Evidence Synthesis
The evidence on managing diabetes includes extensive information on education and support-based interventions. In the case of type 2 diabetes, learning is focused on showing patients how to maintain a lifestyle that controls blood glucose levels, hemoglobin levels, and other health indicators (de Melo Ghisi et al., 2020; Dong et al., 2018; Güner & Coşansu, 2020; Li et al., 2020; Marciano et al., 2019). However, the central theme evident across all studies is the necessity of enhancing self-management (de Melo Ghisi et al., 2020; Dong et al., 2018; Güner & Coşansu, 2020; Hermanns et al., 2020; Li et al., 2020; Marciano et al., 2019). Educational materials provide information on the development of problem-solving skills and offer knowledge about diabetes symptoms, risks, and treatment options.
While the authors’ goals seem to align, their strategies for educating patients vary greatly. Some interventions take the form of one-on-one or group conversations and presentations, while others employ applications, SMS reminders, and artificial intelligence (de Melo Ghisi et al., 2020; Dong et al., 2018; Güner & Coşansu, 2020; Hermanns et al., 2020; Li et al., 2020; Marciano et al., 2019). The evidence-based practice (EBP) intervention can be completed both online and offline, using additional technology and new advancements. One of these interventions is based on the DSMES program, recognized by the American Diabetes Association (ADA).
Nevertheless, all studies show that education about type 2 diabetes management presents significant positive changes in participants’ health, including fasting blood glucose and hemoglobin levels (de Melo Ghisi et al., 2020; Dong et al., 2018; Güner & Coşansu, 2020; Hermanns et al., 2020; Li et al., 2020; Marciano et al., 2019). Moreover, another common outcome among all educational programs is the increased awareness of the risks of diabetes and ways to lower them through daily activities (de Melo Ghisi et al., 2020; Hermanns et al., 2020; Marciano et al., 2019).
Studies that utilize the DSMES program have shown similar results, increasing patient knowledge and improving health outcomes (Marciano et al., 2019; Powers et al., 2020). The evidence suggests that all selected studies achieved their goal of improving the patients’ knowledge and health outcomes. Overall, education is an intervention that can be implemented in medical facilities to enhance people’s preparedness for living with diabetes.
Implementation
The proposed DNP project is based on the DSMES toolkit and includes education and support for adults with type 2 diabetes. During this intervention, nurses educate patients on managing diabetes. The learning process is divided into several categories: nutrition, lifestyle changes, exercise, diabetes and other diseases, and quality of life (Marciano et al., 2019; Powers et al., 2020). As a result, patients are provided with a self-management plan that they can use in their daily lives after completing the intervention. This approach makes the program more effective than a simple educational program. Moreover, the project also includes self-reporting and self-control for the participants, who track their progress.
The presence of previous studies and assessments by healthcare organizations can explain the use of a DSMES toolkit as the basis of this intervention. DSMES has been shown to improve health outcomes and patients’ quality of life while also being a cost-effective measure for practice change (CDC, 2021; Powers et al., 2020). Combining these factors makes the project easier to implement in a DNP project. Moreover, this provides a rationale for selecting a specific educational and support structure, as it can be supported by existing scholarship and further researched and replicated in future studies.
The chosen data collection instrument is a blood test, as the primary measurement is the patient’s fasting blood glucose. Therefore, no other tools are necessary, eliminating the need to ensure their validity. The project implementation plan is divided into eight weeks. During the first week, nurses will educate patients about DSMES, and their pre-intervention blood glucose levels will be recorded.
The second week will be devoted to providing the patients with the necessary tracking resources. The milestones include collecting data from all participants and completing the learning sessions. Next, the patients will enter a phase of self-reporting, for which the milestone is to gather feedback about the tool’s effectiveness and changes in daily life. During week 6, the data collection process will be completed with a second blood test. During weeks 7 and 8, the milestones are to finish the data analysis and discuss the results, answering the PICOT question.
Evaluation
The main measurable outcome of the present project is a reduction in patients’ fasting blood glucose levels. This particular measure is easy to track and quantify, and the evaluation process will be based on the national standards for diabetes management. Fasting blood glucose levels equal to or above 126 mg/dL (7 mmol/L) indicate diabetes, while levels below this threshold suggest either a normal level or prediabetes (Dall et al., 2019). Therefore, this threshold will serve as the benchmark for the project. Smaller changes in fasting blood sugar levels will be analyzed to see whether any improvement follows the intervention.
Conclusion
Type 2 diabetes is a problem on a global scale, and its prevalence among patients in the practicum site supports the national data. The synthesis of available evidence demonstrates that educational programs for diabetes self-management lead to improved health outcomes and increased patient preparedness for living with diabetes. The proposed intervention is an education and support program based on the DSMES toolkit. The intervention will be implemented over eight weeks, and the primary evaluation method will be measuring participants’ fasting blood glucose levels before and after the intervention.
References
Centers for Disease Control and Prevention. (2021, December 21). Diabetes Self-Management Education and Support (DSMES) Toolkit: Background.
Dall, T. M., Yang, W., Gillespie, K., Mocarski, M., Byrne, E., Cintina, I., Beronja, K., Semilla, A. P., Iacobucci, W., & Hogan, P. F. (2019). The economic burden of elevated blood glucose levels in 2017: Diagnosed and undiagnosed diabetes, gestational diabetes mellitus, and prediabetes. Diabetes Care, 42(9), 1661-1668.
de Melo Ghisi, G. L., Aultman, C., Konidis, R., Foster, E., Tahsinul, A., Sandison, N., Sarin, M., & Oh, P. (2020). Effectiveness of an education intervention associated with an exercise program in improving disease-related knowledge and health behaviours among diabetes patients. Patient Education and Counseling, 103(9), 1790-1797.
Dong, Y., Wang, P., Dai, Z., Liu, K., Jin, Y., Li, A., Wang, S., & Zheng, J. (2018). Increased self-care activities and glycemic control rate in relation to health education via WeChat among diabetes patients: A randomized clinical trial. Medicine, 97(50), 1-5.
Güner, T. A., & Coşansu, G. (2020). The effect of diabetes education and short message service reminders on metabolic control and disease management in patients with type 2 diabetes mellitus. Primary Care Diabetes, 14(5), 482-487.
Hermanns, N., Ehrmann, D., Finke-Groene, K., & Kulzer, B. (2020). Trends in diabetes self-management education: Where are we coming from and where are we going? A narrative review. Diabetic Medicine, 37(3), 436-447.
Khan, M. A. B., Hashim, M. J., King, J. K., Govender, R. D., Mustafa, H., & Al Kaabi, J. (2020). Epidemiology of type 2 diabetes–global burden of disease and forecasted trends. Journal of Epidemiology and Global Health, 10(1), 107-111.
Lau, L. H., Lew, J., Borschmann, K., Thijs, V., & Ekinci, E. I. (2019). Prevalence of diabetes and its effects on stroke outcomes: A meta‐analysis and literature review. Journal of Diabetes Investigation, 10(3), 780-792.
Li, J., Huang, J., Zheng, L., & Li, X. (2020). Application of artificial intelligence in diabetes education and management: Present status and promising prospect. Frontiers in Public Health, 8, 173.
Marciano, L., Camerini, A. L., & Schulz, P. J. (2019). The role of health literacy in diabetes knowledge, self-care, and glycemic control: A meta-analysis. Journal of General Internal Medicine, 34(6), 1007-1017.
Powers, M. A., Bardsley, J. K., Cypress, M., Funnell, M. M., Harms, D., Hess-Fischl, A., Hooks, B., Isaacs, D., Mandel, E. D., Maryniuk, M. D., Norton, A., Rinker, J., Siminerio, L. M., & Uelmen, S. (2020). Diabetes self-management education and support in adults with type 2 diabetes: A consensus report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. Diabetes Care, 43(7), 1636-1649.
