Improving Diabetic Adherence Through a Diabetes Self-Management Education Program: An Evidence-Based Practice Improvement Project

BACKGROUND: Diabetes mellitus type II is a chronic, multisystem disease characterized by the body’s inability to produce enough insulin or use what the body produces appropriately. One of the biggest challenges is adherence to medication regimens and treatment plans. Current evidence suggests a diabetes self-management education (DSME) program improves A1C levels.

LOCAL PROBLEM: The setting is a small primary care office in East Tennessee with adult patients 18 years or older diagnosed with diabetes mellitus type II. Adherence to the plan of care, specifically medication adherence was identified as a problem in the clinic’s diabetic population. The aim is to address adherence by implementing a DSME program, where 60% of adults with type II diabetes mellitus who received DSME, will have an HbA1C of < 7%.

METHODS: The Evidence-Based Practice Improvement (EBPI) model provided a framework for project implementation. A questionnaire and educational packet used was created through PDSA (Plan-Do-Study-Act) cycles. Pre- and post- A1C levels were measured to evaluate change.

INTERVENTIONS: A questionnaire and educational packet were developed and administered to diabetic patients. At the 3-month follow-up patients were asked if the packet was used, what are their thoughts, and why or why not it was used.

RESULTS: Post-implementation, 35% of patients had an A1C less than 7, and 45% had an A1C greater than 7. 20% did not follow up. While our results were not statistically significant, they were clinically significant.

CONCLUSIONS: Implementing a DSME packet had a clinically significant impact on decreasing A1C levels. A lower A1C reduces costs for the clinic and contributes to a better quality of life for the patients. Sustainability plans include hosting a class to teach information in the education packet, suggesting diabetes support groups for patients, and creating a Spanish guide.