NR 505 WEEK 7 EBP/ EVIDENCE BASED PRACTICE PROJECT: TYPE II DIABETES

Diabetes Self-Management Topic to be discussed • Practice Issue • PICOT Question • Literature Review • Recommendations PRACTICE ISSUE Area of interest • Type II Diabetes (T2DM) • Self-Management • Practice issue and how it relates to NP practice • Impacts on health outcomes TYPE II DIABETES Define T2DM: • What is Type II Diabetes? • Costly to society • In America, diabetes will increase by 54% by 2030 • Highly preventable with lifestyle interventions PICOT QUESTION • P (Population) Patients with T2DM • I (Intervention) Will self management tools including in person counseling reduce HbA1c • C (Comparison) Self management in person interviews compared to technology-based application • O (Outcome) Improved or decreased HbA1c levels • T (Time frame) Time 3 months to 1 year • PICOT question: In adult patients with type II DM, who follow self-management education including via in person counseling have have decreased HbA1c level in contrast to those, who use technology-based app to self manage diabetes 3-12 months (T)? LITERATURE REVIEW • 10 articles reviewed • Implementation of self management education + in person counseling versus technology-based application • Common themes • Insight and perspective LITERATURE REVIEW Evidence: DSME Tools that promote self-management behaviors • Group sessions assist patients in managing their disease • Assisting with implementing personal goals that are realistic and evaluating progress • Peer groups provide additional learning and support • Ethnic Minority People with Diabetes & Traditional Educational Setting LITERATURE REVIEW • In person counseling versus technology-based application for DSME • Literature shows patients strictly utilizing technology-based application for DSME • Technology-based diabetes interventions have an effect on (−0.2%) of HbA1c, and in the mobile phone group (−0.5). Text messaging, used as educational tool, improved outcome of A1C of 0.53%. was reported RECOMMENDATION IMPLEMENT GLUCOSE SELF-MONITORING PROGRAM Self-monitoring glucose raises patient's awareness Although successful this intervention is primarily used in conjunction with monitoring dietary habits Community based programs are cost – effective and achieve good outcomes Key stakeholders: • Health Care Providers • Health insurance companies • Patients RECOMMENDATIONS: IDENTIFY KEY STAKEHOLDERS RECOMMENDATIONS: ANALYZE FIT, FEASIBILITY, AND APPROPRIATENESS Does this recommendation add value? Does it improve clinical outcomes Would it improve patient or provider satisfaction Would it reduce the cost of care Would this change improve unit operations Fit, feasibility and appropriateness CONCLUSION REFERENCES Bene, B. A., O’Connor, S., Mastellos, N., Majeed, A., Fadahunsi, K. P., & O’Donoghue, J. (2019). Impact of mobile health applications on self-management in patients with type 2 diabetes mellitus: protocol of a systematic review. BMJ Open, 9(6), e. Jimenez, G., Lum, E., & Car, J. (2019). Examining Diabetes Management Apps Recommended From a Google Search: Content Analysis. JMIR MHealth and UHealth, 7(1), e11848. Mensa-Wilmot, Y., Bowen, S.-A., Rutledge, S., Morgan, J. M., Bonner, T., Farris, K., Blacher, R., & Rutledge, G. (2017). Early Results of States’ Efforts to Support, Scale, and Sustain the National Diabetes Prevention Program. Preventing Chronic Disease, 14. Rowley, W. R., Bezold, C., Arikan, Y., Byrne, E., & Krohe, S. (2017). Diabetes 2030: Insights from Yesterday, Today, and Future Trends. Population Health Management, 20(1), 6–12. Sherifali, D., Berard, L. D., Gucciardi, E., MacDonald, B., & MacNeill, G. (2018). SelfManagement Education and Support. Canadian Journal of Diabetes, 42, S36–S41. REFERENCES Schmittdiel, J. A., Gopalan, A., Lin, M. W., Banerjee, S., Chau, C. V., & Adams, A. S. (2017). Population Health Management for Diabetes: Health Care System-Level Approaches for Improving Quality and Addressing Disparities. Current Diabetes Reports, 17(5). Schub, E. B., & Walsh, K. C. (2017). Evidence-Based Nursing Practice: Implementing. CINAHL Nursing Guide Shirinzadeh, M., Afshin-Pour, B., Angeles, R., Gaber, J., & Agarwal, G. (2019). The effect of community-based programs on diabetes prevention in low- and middle-income countries: a systematic review and meta-analysis. Globalization and Health, 15(1). Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H., Maryniuk, M. D., Siminerio, L., & Vivian, E. (2016). Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Clinical Diabetes, 34(2), 70–80. Van Smoorenburg, A. N., Hertroijs, D. F. L., Dekkers, T., Elissen, A. M. J., & Melles, M. (2019). Patients’ perspective on self-management: type 2 diabetes in daily life. BMC Health Services Research, 19(1).