Louise Herrington School of Nursing, Baylor University, Dallas, TX, USA
Louise Herrington School of Nursing, Baylor University, Dallas, TX, USA.
J Dr Nurs Pract. 2024 Aug 5;17(2):86-99. doi: 10.1891/JDNP-2023-0060.
Despite the innovative advancements in diabetes care, providers may not recognize patients with type 2 diabetes mellitus (T2DM) who qualify for a continuous glucose monitoring (CGM) device or the benefits of a telemedicine program for improving self-management behaviors. This quality improvement (QI) project aimed to determine if an advanced practice registered nurse (APRN)-led telemedicine program using CGM could improve glycemic control and self-management in patients with insulin-dependent T2DM. A 6-week telemedicine program was developed and implemented using the CGM's time-in-range to deliver patient-specific education. Clinical metrics were collected at each visit. All patients completed a pre- and postintervention Diabetes Self-Management Questionnaire-Revised (DSMQ-R) survey. A repeated measures analysis of variance revealed that the telemedicine program had a statistically significant impact on time-in-range outcomes, (2, 14) = 18.203, < .001. Paired-samples tests indicate that APRN-led education improved body mass index, (8) = 4.232, = .002; decreased systolic blood pressure, (8) = 2.90, = .010, and diastolic blood pressure, (8) = 3.21, = .007; and increased self-management skills as evidenced by DSMQ-R, (8) = -5.498, < .001. This QI project highlights multiple interventions for improving diabetes management in a primary care facility. An APRN-led telemedicine program integrating CGM time-in-range data can improve glycemic control and self-management skills in patients with T2DM who administer insulin.
尽管在糖尿病护理方面有创新进展，但医疗服务提供者可能无法识别符合条件的 2 型糖尿病患者（T2DM），也无法认识到连续血糖监测（CGM）设备或远程医疗计划对改善自我管理行为的益处。这个质量改进（QI）项目旨在确定由高级实践注册护士（APRN）领导的使用 CGM 的远程医疗计划是否可以改善依赖胰岛素的 T2DM 患者的血糖控制和自我管理。开发并实施了一个为期 6 周的远程医疗计划，使用 CGM 的时间范围内数据提供患者特定的教育。每次就诊时都会收集临床指标。所有患者都完成了干预前后的糖尿病自我管理问卷修订版（DSMQ-R）调查。重复测量方差分析显示，远程医疗计划对时间范围内的结果有统计学上的显著影响，（2, 14）= 18.203, <.001。配对样本检验表明，APRN 领导的教育改善了体重指数，（8）= 4.232, =.002；降低了收缩压，（8）= 2.90, =.010，舒张压，（8）= 3.21, =.007；并提高了自我管理技能，如 DSMQ-R 所示，（8）= -5.498, <.001。这个 QI 项目强调了在初级保健机构中改善糖尿病管理的多种干预措施。APRN 领导的整合 CGM 时间范围内数据的远程医疗计划可以改善接受胰岛素治疗的 T2DM 患者的血糖控制和自我管理技能。
