Diabetes Self-Management Education for Type II Diabetic Adults in a Free Clinic
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Nicholas, Lisa F.
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Abstract
Problem: Diabetes mellitus (“diabetes”) is a chronic disease that affects millions, with uncontrolled type II diabetes as the eighth leading cause of death in the United States. The American Diabetes Association (ADA) recommends Diabetes Self-Management Education (DSME) to help patients achieve and maintain glycemic control. There is no standardized DSME program in a free, urban community health clinic serving patients over 18 years old. Over 75% (N=22) of patients seen have uncontrolled diabetes, indicative of an average blood sugar of 154 mg/dL (8.6 mmol/L). Purpose: This quality improvement project aims to identify patients with uncontrolled diabetes and implement a DSME program, a validated and evidence-based research intervention, that will help patients gain a deeper understanding of their condition and reduce the risk of developing diabetes- related complications. Methods: The quality improvement project was implemented over 15 weeks. Eligible patients were identified by the clinic staff by their HbA1C levels. After providing verbal consent to participate in DSME, patients completed a baseline diabetes self-efficacy questionnaire and received a glucometer kit. Based on the questionnaire results, education was tailored to individual needs, with patients receiving education from a nurse or nutritionist. Patients tracked their fasting blood glucose and were asked to follow up in three weeks, where their levels and self-efficacy were reassessed. Results: In total, there were 43 patients identified as eligible to participate in DSME, and 18 patients received DSME. Four patients followed up after three weeks to take a second diabetes self-efficacy survey, and three out of the four patients returned with their fasting blood glucose logs. DSME positively impacted the diabetic patients’ self-efficacy scores, and two out of three patients saw a decrease in their fasting blood glucose over three weeks. Conclusions: There is a need for DSME in outpatient settings, and the diabetes self-efficacy scale can be used to provide tailored DSME for diabetic patients. Patients with uncontrolled diabetes will continue to be identified by the staff in the clinic, and a nutritionist will be on board to continue providing DSME to eligible patients.
