Evidence Paper
Galen College of Nursing
NSG 4000: Application of Evidence-Based Research
Jennifer Threatt
February 4, 2024
This research describes a nurse-driven diabetes education program for Type 2 diabetes adult inpatients aged 30-70 to enhance treatment and outcomes. Hospitalized diabetics need strict supervision to prevent complications. Diabetes management needs food changes, medication adherence, and patient education, which the nurse-led intervention addresses. To determine whether this nurse-led education program lowers HbA1C after three months, the study compares it to standard care. HbA1c tests are reliable indications of glucose control over the last 90 days, making them valuable for intervention evaluation. To decrease diabetes complications, Eyth and Naik (2023) recommend keeping HbA1c below 7%, making this study important to patient outcomes. Eyth and Naik (2023) stress the necessity of an interdisciplinary approach to diabetes care and the involvement of nurses and pharmacists in patient education, medication management, and physician communication to enhance glycemic control. By assessing the efficacy of nurse-led interventions in improving patient outcomes, this discussion aims to improve Type 2 diabetes treatment.
Clinical Question
Among adult inpatients (aged 30-70 years) diagnosed with Type 2 diabetes, does the implementation of a nurse-led diabetes education program, compared to usual care without a structured education program, resulting in reduced HbA1C levels below 7% over three months?
Justification
This investigation into a nurse-driven diabetes education program for adult inpatients with Type 2 diabetes is important owing to the rising incidence of diabetes globally, especially Type 2, and the need for better treatment measures to reduce complications. 537 million individuals will have diabetes by 2030, mostly Type 2 diabetes, according to Tinajero and Malik (2021). Diabetes complications impact mortality, quality of life, and healthcare expenditures for people and healthcare systems. Cardiovascular disorders, neuropathy, and retinopathy may be prevented with good HbA1c management. Nurses are vital to patient care and education. Hence, the research focused on a nurse-led education program. Nurses may enable patients to self-manage by providing individualized dietary, medication adherence, and lifestyle advice (Melnyk & Fineout-Overholt, 2019). The study supports global patient-centered care and proactive nursing in chronic illness management. The study’s design, which compared a structured education program with ordinary care, emphasizes evidence-based practices and patient outcome improvement, which is current in healthcare. Glycemic control is important in diabetes therapy, as Eyth and Naik (2023) note that lower HbA1c levels lessen microvascular consequences, underscoring the therapeutic importance of the proposed study.
Findings
The systematic review by Holloway et al. (2023) examined whether nurse-led care lowers HbA1c in persons with Type 1 or 2 diabetes. The research included 23 trials from various nations, including tailored diabetes education, monthly phone calls, medication instruction, self-management assistance, and nurse-led diabetic clinics. Research designs included randomized controlled trials and observational studies with 319,860 individuals. Most studies focused on primary care in urban areas, and nurse-led care consistently reduced HbA1c by 0.03% to 2.0%. Six studies using information technology to enhance diabetes treatment reduced HbA1c by 0.1% to 1.4%, highlighting its usefulness. The evaluation also addressed indigenous requirements, psychological support treatments, algorithm-based medication management, and organized nurse training and support. The findings imply that nurse-led care improves glycemic control, supporting the rising acknowledgment of nurse-led clinics’ good outcomes in healthcare. The comprehensive review highlights the potential advantages of nurse-led diabetes therapies and the need for further research, especially in rural and distant locations, to identify enablers and impediments.
Romero-Castillo et al. (2022) examined how a diabetic self-management education program affected glucose levels and self-care in Type 1 diabetic (T1DM) patients. In this pilot randomized controlled study, 131 adult patients were randomly allocated to an intervention group getting the education program or a control group receiving standard education. The four-session curriculum included insulin delivery, hypo/hyperglycemia management, food, and exercise. At baseline, one month, and three months, researchers measured glucose levels, diabetes self-management using the Summary of Diabetes Self-Care Activities (SDSCA), and mental state using the Goldberg Anxiety and Depression Scale. Results demonstrated substantial gains in the intervention group over the control group. In the intervention group, target range, average glucose, and HbA1c values improved significantly. Diabetes self-care activities and knowledge were favorably related, whereas anxiety and sadness were adversely associated with glycemic control and positively associated with self-care. Three months following the instructional session, binary logistic regression showed significant differences in sensor use, knowledge, depression, and diabetes self-care between the intervention and control groups. These findings support comprehensive diabetic education programs that emphasize emotional well-being and self-care in glycemic control. Nursing-led education interventions may improve T1DM outcomes, according to the research. Nursing interventions might include organized programs to improve patient understanding, emotional regulation, and self-care, improving diabetes management and glucose control.
Yu et al. (2022) examined how a nurse-led integrative medicine-based structured education program affected self-management behaviors in newly diagnosed type 2 diabetics in a randomized controlled experiment. The study examined how the intervention affected glycemic control, diabetic self-management, and self-efficacy. There were 128 participants: 64 in the control group and 64 in the intervention group. Diabetes-specific nutrition management, blood glucose monitoring, foot care, and medication management improved significantly after the intervention. In general, nutrition, physical activity, and smoking status had no significant influence. In the intervention group, HbA1c levels dropped significantly, suggesting better glycemic management. The intervention also boosted self-efficacy at immediate post-intervention and 12-week follow-ups. The findings revealed that culturally relevant, nurse-led integrative medicine-based structured education improved diabetic self-management and glycemic control. Despite encouraging results, the study’s lack of long-term efficacy evaluation and subjective self-management behavior measuring bias should be noted. The findings suggest the implementation of organized type 2 diabetes education programs that emphasize group-based, interactive sessions and the necessity for continual reinforcement to maintain favorable effects.
Recommendations
The findings of the three articles improve diabetic bedside care. In the systematic review by Holloway et al. (2023), nurse-led care reduces glycated hemoglobin levels in individuals with type 1 or type 2 diabetes, underlining nurses’ importance in diabetes treatment. The pilot randomized controlled trial by Romero-Castillo et al. (2022) shows that a diabetes self-management education program improves glucose levels and self-care in type 1 diabetics, emphasizing the importance of structured education interventions. Yu et al.’s (2022) randomized controlled trial shows that a nurse-led integrative medicine-based structured education program improves self-management behaviors in newly diagnosed type 2 diabetics, emphasizing the importance of culturally appropriate and holistic diabetes education. From these findings, two recommendations for improving clinical practice are:
(1) Integrating nurse-led care models into diabetes management protocols to optimize glycemic control and patient outcomes, supported by Holloway et al. (2023)
(2) Implementing structured diabetes self-management education programs tailored to individual patient needs, as shown by Romero-Castillo et al. (2022) and Yu et al. (2022). These recommendations underscore multidisciplinary teamwork and patient-centered treatment.
Conclusion
This evidence paper examines a nurse-driven diabetes education program for Type 2 diabetes adult inpatients aged 30-70 to enhance treatment and outcomes. The clinical issue is whether a nurse-led diabetes education program lowers HbA1C levels below 7% in Type 2 diabetes adult inpatients over three months compared to conventional treatment. The worldwide growth in diabetes, especially Type 2, and the need for effective therapies to reduce complications, which affect mortality, quality of life, and healthcare costs, justify the study. The findings from the systematic review by Holloway et al. (2023), the pilot randomized controlled trial by Romero-Castillo et al. (2022), and the randomized controlled trial by Yu et al. Nurse-led care, diabetes self-management education programs, and integrative medicine-based education improve glycemic control, stressing nurses’ involvement in patient education, self-management, and holistic care. The research recommends incorporating nurse-led care models into diabetes management protocols and establishing organized diabetic self-management education programs customized to patient requirements to improve bedside clinical practice. These suggestions stress multidisciplinary teamwork and patient-centered methods to optimize diabetes treatment and results, supporting the objective of improving Type 2 diabetes care.
References
Eyth, E., & Naik, R. (2023, March 13). Hemoglobin A1C. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK549816/
Holloway, D., James, S., Elif Ekinci, & Craft, J. (2023). Systematic review of the effectiveness of nurse‐led care in reducing glycated haemoglobin in adults with Type 1 or 2 diabetes. International Journal of Nursing Practice. https://doi.org/10.1111/ijn.13135
Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and healthcare : A guide to best practice (5th ed.). Wolters Kluwer. (4th ed.).
Romero-Castillo, R., Pabón-Carrasco, M., Jiménez-Picón, N., & Ponce-Blandón, J. A. (2022). Effects of a Diabetes Self-Management Education Program on Glucose Levels and Self-Care in Type 1 Diabetes: A Pilot Randomized Controlled Trial. International Journal of Environmental Research and Public Health, 19(23), 16364. https://doi.org/10.3390/ijerph192316364
Tinajero, M. G., & Malik, V. S. (2021). An Update on the Epidemiology of Type 2 Diabetes. Endocrinology and Metabolism Clinics of North America, 50(3), 337–355. https://doi.org/10.1016/j.ecl.2021.05.013
Yu, X., Chau, J. P. C., Huo, L., Li, X., Wang, D., Wu, H., & Zhang, Y. (2022). The effects of a nurse-led integrative medicine-based structured education program on self-management behaviors among individuals with newly diagnosed type 2 diabetes: a randomized controlled trial. BMC Nursing, 21(1). https://doi.org/10.1186/s12912-022-00970-7
