DNP 820 Literature Evaluation Table – DPI Intervention

Sample Answer for DNP 820 Literature Evaluation Table – DPI Intervention Included After Question

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Instructions: Use this table to evaluate and record the literature gathered for your DPI Project.Refer to the assignment instructions for guidance on completing the various sections. Empirical research articles must be published within 5 years of your anticipated graduation date. Add or delete rows as needed.

PICOT-D Question:  Among patients aged 35 and above with T2DM in an outpatient clinic, will the translation of Vaughan et al., (2021) Diabetes Self-management Education & Support tool with weekly telehealth calls compared to current practice reduce HbA1c levels to below 6.5% within 8 weeks?

A Sample Answer For the Assignment: DNP 820 Literature Evaluation Table – DPI Intervention

Title:  DNP 820 Literature Evaluation Table – DPI Intervention

Table 1: Primary Quantitative Research – Intervention (5 Articles)

APA Reference (Include the GCU permalink or working link used to access the article.)	Research Questions/ Hypothesis, and Purpose/Aim of Study	Type of Primary Research Design	Research Methodology Setting/Sample (Type, country, number of participants in study) Methods (instruments used; state if instruments can be used in the DPI project)How was the data collected?	Interpretation of Data (State p-value: acceptable range is p= 0.000 – p= 0.05)	Outcomes/ Key Findings (Succinctly states all study results applicable to the DPI Project.)	Limitations of Study and Biases	Recommendations for Future Research	Explanation of How the Article Supports Your Proposed Intervention
Vaughan, E. M., Hyman, D. J., Naik, A. D., Samson, S. L., Razjouyan, J., & Foreyt, J. P. (2021). A telehealth-supported, I ntegrated care with CHWs, and ME dication-access (TIME) Program for Diabetes Improves HbA1c: a Randomized Clinical Trial. Journal of general internal medicine, 36(2), 455-463. https://doi.org/10.1007/s11606-020-06017-4	The main of this study was to study the impacts of a telehealth-supported intervention program on individuals’ HbA1c levels as compared to the usual care.	The study design used is a randomized controlled trial	Sample/Setting:  A total of eighty-nine participants were recruited to take part in the study. The individuals must have been at least eighteen years of age and diagnosed with diabetes type 2. This research was done in a nonprofit clinic in Houston, Texas Methods: As earlier indicated, this study was a randomized controlled trial. The intervention group received an intervention named TIME which consisted of a healthcare expert mobile health communication with the participants for a year, community health worker-led group visits for half a year, and a weakly telehealth (video conferencing) coaching and training of the participants on diabetes management. The targeted primary outcome was changed in HbA1c levels. Mental stress management/ relaxation techniques survey is one of the instruments used. This instrument can be applied in the project. Data collection: data was collected through survey and chart reviews	The individuals in the intervention group recorded a decrease in HbA1c levels from baseline to six months (p-value of 0.002). More patients in the intervention than control also achieved more than half of HbA1c reductions( p-value of <0.001).	The key findings that are applicable to the DPI project are the evident improved glycemic control upon the application of the telehealth intervention to offer support in helping patients improve their glycemic control medication adherence, address concerns, and answer questions regarding diabetes care and management.	One of the study’s limitations is that the sample size used was moderate and not sufficient. The study could not assess long-term analyses such as behavioral health roles due to the duration of the study, which was short.	The researchers recommended the need for a further cost ad variable analysis of the TIME intervention using optimization strategies. Studies should be done that can improve outcome sustainability.	The article supports the proposed intervention in that by using TIME intervention which has telehealth calls as part of the components; the patients were able to achieve significant reductions in HbA1c levels.
Dong, Y., Wang, P., Dai, Z., Liu, K., Jin, Y., Li, A., … & Zheng, J. (2018). Increased self-care activities and glycemic control rate in relation to health education via Wechat among diabetes patients: A randomized clinical trial. Medicine, 97(50). https://dx.doi.org/10.1097%2FMD.0000000000013632	The aim of the study was to examine the relationship between WeChat platform-based health intervention with glycemic control among patients with diabetes.	The study design used is a randomized controlled trial	Sample/Setting: The researchers recruited a total of one hundred and twenty patients to participate in the study. The study was conducted at a hospital in Hainan medical university in China. Methods: This study was a randomized controlled trial with sixty participants randomized into the control group and the remaining sixty into the intervention group. The participants in the intervention group received usual care and educational intervention based on the WeChat platform. The trained nurses sent educational text messages to patients and collected questions from them on the messaging platform. On the other hand, the patients in the control group only received conventional diabetes care. The self-administered questionnaire was used. Data collection: data was collected through the use of questionnaires	There was a statistically significant difference in HbA1c levels between the intervention and control groups (p-value of <0.05).	From the analysis, it was revealed that the use of the telehealth platform led to a significant reduction in HbA1c levels hence better glycemic control.	Various weaknesses exist in the research. The data on self-care activities were self-reported hence may lead to bias. The findings may also lack generalizability as participants were drawn from a single hospital.	Future studies should consider a multicenter approach to improve generalizability.	This article supports the proposed intervention since it shows that the application of telehealth leads to a significant improvement in glycemic control.
Sun, C., Sun, L., Xi, S., Zhang, H., Wang, H., Feng, Y., … & Wang, G. (2019). Mobile phone–based telemedicine practice in older Chinese patients with type 2 diabetes mellitus: a randomized controlled trial. JMIR mHealth and uHealth, 7(1), e10664. https://doi.org/10.2196/10664	The purpose of this research was to explore the use of mobile phone-based telemedicine applications for managing diabetes type 2 among older patients.	The study design used is a randomized controlled trial	Sample/Setting: A total of 91 individuals were recruited to take part in the study, with 44 randomized into the intervention group while 47 were placed in the control group. The research was carried out at Jilin University in China. Methods: As earlier indicated, this research was a randomized controlled trial with intervention and control groups. The patients in the intervention groups got education regarding physical exercise, healthy diet, and medication adherence delivered through a mobile health telemedicine system and glucometer, which could transmit relevant data. On the other hand, the patients in the control group got routine care without any additional intervention. Both sets of patients were then followed at 3-month intervals. One of the instruments used in this research was the survey. The survey is also applicable in the research. Data collection: Data was collected through questionnaires.	Decreased HbA1c levels in the control group after six months (p-value of <0.05).	Among the key findings is that the use of the intervention led to a significant improvement in the HbA1c levels among patients in the intervention group. Therefore, the use of the mobile phone-based telehealth application is efficacious in improving glycemic control.	Various weaknesses and biases are evident in this study. For example, the researchers did not consider factors such as family history and environmental factors which can significantly impact diabetes care.	The researchers recommended the use of more accurate data collection methods.	This study supports the project since it has shown that the use of mobile phone-based intervention was effective in improving glycemic control among patients with diabetes.
Fortmann, A. L., Gallo, L. C., Garcia, M. I., Taleb, M., Euyoque, J. A., Clark, T., … & Philis-Tsimikas, A. (2017). Dulce Digital: an mHealth SMS-based intervention improves glycemic control in Hispanics with type 2 diabetes. Diabetes Care, 40(10), 1349-1355. https://doi.org/10.2337/dc17-0230	The main aim of this study was to evaluate the impact of a Dulce digital intervention (call to action, educational and motivational text messages) on diabetes outcomes as compared to the usual care.	The study design used in this research is also a randomized controlled trial.	Sample/setting: A total of 126 participants were recruited and randomized to either the control or intervention groups. The participants were between 18-75 years old. The setting was Riverside and San Diego counties with predominantly ethnic minorities and low-income persons. Methods: This was a randomized controlled trial entailing diabetes self-management education and support based on text messaging. The intervention was named Dulce Digital intervention which entailed a package of call-to-action, educational and motivational messages for a period of six months. The targeted outcomes include body mass index, blood pressure, lipids, and HbA1c. One of the instruments used in this study includes questionnaires. Data collection: Data was mainly collected using questionnaires at  baseline, after three months, and after six months	The patients in the intervention group showed a significantly higher reduction in the HbA1c levels over time as compared to those in the usual care (p=0.03)	There are various key findings in this study relevant to the DPI project. For example, there was a more significant reduction in the HbA1c levels among patients in the intervention group as compared to the ones in the usual care group. Therefore, the use of low-cost text messaging using mobile phones was observed to significantly improve diabetes outcomes.	The study also has various limitations. For instance, there is a possibility that the individuals who remained in the study were more engaged, as reflected in higher attrition in the intervention group. No cost-effectiveness of the project was explored.	One of the recommendations is that future research should explore how sustainable the improved glycemic control can be beyond six months. The other recommendation is that a similar study should be done to include populations at risk of diabetes.	This study supports the intervention in that the researchers used telehealth in the form of text messaging as an intervention for diabetes self-management education and support among patients with diabetes. The intervention led to better glycemic control among patients with diabetes. Therefore, its shows that the proposed intervention can succeed in the chosen population.
Warren, R., Carlisle, K., Mihala, G., & Scuffham, P. A. (2018). Effects of telemonitoring on glycaemic control and healthcare costs in type 2 diabetes: a randomized controlled trial. Journal of telemedicine and telecare, 24(9), 586-595. https://doi.org/10.1177%2F1357633X17723943	This study aimed at examining the impact of telehealth intervention on glycemic control and cost-saving among patients living with diabetes.	The study design used is a randomized controlled trial.	Sample/Setting: This study recruited a total of one hundred and twenty-six participants to take part in the study, where sixty-three participants were randomized into the control group. The remaining sixty-three were randomized into the intervention group. The participant must have attained the age of 18 years by the time of recruitment, been diagnosed with type 2 diabetes, and have access to broadband internet to be included in the study. The study was conducted in Queensland, Australia. Methods: This was randomized controlled research with HbA1c being the primary outcome. The intervention group received a telehealth intervention which was composed of video calling with the healthcare expert and the use of a tablet computer to access diabetes information and send various measurements through the internet to a database. Such data was used by the healthcare expert to formulate care plans, education, and self-management strategies. A Depression screening questionnaire (Kessler Psychological Distress Scale) and a quality of life questionnaire (12-Item Short Form Survey) were instruments used in this research. These instruments can be applied in the project. Data Collection: Data was collected from hospital records. GPs and care coordinators also collected data at baseline and after six months	reduction in the HbA1c levels in the intervention group (p-value of 0.004)	Various findings in this research are relevant to the project. For example, upon the implementation of the telehealth program, there was an improved glycemic control among the patients in the control group.	This study also has various weaknesses and biases. The researchers failed to obtain the originally calculated sample size, leading to a smaller sample size and bias. Another weakness is a possible selection bias.	The researchers recommend that similar studies be done in the future using larger sample sizes for more credible results.	This research also supports the project since the findings indicate that the use of telehealth positively impacts glycemic control among patients with diabetes.

Table 2: Additional Primary and Secondary Quantitative Research (10 Articles)

APA Reference (Include the GCU permalink or working link used to access the article.)	Research Questions/ Hypothesis, and Purpose/Aim of Study	Type of Primary or Secondary Research Design	Research Methodology Setting/Sample (Type, country, number of participants in study) Methods (instruments used; state if instruments can be used in the DPI project)How was the data collected?	Interpretation of Data (State p-value: acceptable range is p= 0.000 – p= 0.05)	Outcomes/ Key Findings (Succinctly states all study results applicable to the DPI Project.)	Limitations of Study and Biases	Recommendations for Future Research	Explanation of How the Article Supports Your Proposed DPI Project
Asante, E., Bam, V., Diji, A. K. A., Lomotey, A. Y., Owusu Boateng, A., Sarfo-Kantanka, O., … & Adjei, D. (2020). Pilot mobile phone intervention in promoting type 2 diabetes management in an urban area in Ghana: a randomized controlled trial. The Diabetes Educator, 46(5), 455-464. https://doi.org/10.1177%2F0145721720954070	This study purposed to examine the impact and feasibility of a nurse-led mobile phone intervention among patients with diabetes in self-management practice adherence and glycemic control.	This study was a pilot randomized controlled trial that compared a mobile phone call intervention to usual diabetes care.	Sample/Setting: This study had a total of sixty patients who were randomized in either the experimental or the control group in half. The research was conducted in a teaching hospital in Kumasi, Ghana. Methods: The research was a pilot randomized controlled trial with mobile phone calls (telehealth calls) as the major intervention. While the patients in the control group received usual care, the intervention group got usual care integrated with phone calls. The number of mobile phone calls received was sixteen. While the primary outcome was the A1C, the secondary outcomes were self-management and self-reported medication adherence. One of the instruments used in this study is the self-management adherence questionnaire tool which was applied in assessing the patients’ self-care and adherence to blood glucose checking, foot care, medication, exercise, and diet. This instrument can also be applied in the DPI project. Data collection: Data was mainly collected using a questionnaire.	There was a significant  reduction in A1C in the intervention group as compared to the control group (p-value is 0.004)	Various outcomes are applicable to the DPI project. For example, upon the use of the intervention after twelve weeks, the patients in the intervention showed a significantly lower A1C than the control group who only received usual care.	The study has various limitations. For example, the study may suffer from a lack of generalizability as it only included patients with raised AIC of more than 7% and on oral medication. Therefore it may not apply in all samples. The study also used questionable measuring instruments.	The study recommends undertaking future studies that incorporate other aspects such as lipid profiles. Future trials should also include qualitative evaluations to engage patients and staff in focused groups discussions or interviews to shed more light on the intervention’s mechanism of action, challenges, and success perspectives.	This study supports the proposed DPI project since it shows that the use of telehealth calls to teach and reinforce diabetes self-management practices leads to better outcomes such as glycemic control among patients with diabetes.
Poppe, L., De Bourdeaudhuij, I., Verloigne, M., Shadid, S., Van Cauwenberg, J., Compernolle, S., & Crombez, G. (2019). Efficacy of a Self-Regulation–Based Electronic and Mobile Health Intervention Targeting an Active Lifestyle in Adults Having Type 2 Diabetes and in Adults Aged 50 Years or Older: Two Randomized Controlled Trials. Journal of medical Internet research, 21(8), e13363. https://doi.org/10.2196/13363.	The aim of this study was to test the impact of mobile health and electronic health intervention (MyPlan 2.0) on physical activity and sedentary behavior among patients with diabetes.	The research design used in this study was a randomized controlled trial	Sample/Setting: This study comprised of two randomized controlled styles, with the first trial having a sample size of fifty-four while the second one had sixty-three participants. The study was carried out in Damian General Hospital and Ghent University Hospital, Ostend in Belgium. Methods: The study recruited patients of at least 50 years. The participants were allowed to choose whether to for increasing physical activity or decrease sedentary behavior. The individuals were randomly assigned with a ratio of 2:1 to the waiting-list control group or intervention group. Among the primary outcomes were self-reported and objectively measured physical activity and sedentary behavior. The study also uses various instruments such as the international physical activity questionnaire the Longitudinal Aging Study Amsterdam Sedentary behavior questionnaire. These instruments can also be applied in the project. Data collection: The collection of data was accomplished through face-to-face assessments.	A decrease in time spent sitting in the intervention group as compared to the control group (p-value of 0.09). Increase in physical exercise (p, value of 0.049). Breaks from sedentary time (p values of 0.005.	Some of the observed key findings include: The researchers observed that there was a more significant decrease in the time spent sitting down in the intervention group as compared to the control group and an increase in physical activity. Those who were in the sedentary behavior intervention group showed more increase in breaking from sedentary behavior as compared to the control group.	This study has various limitations, such as no power analysis for the randomized controlled trial two. The sample size was limited, and they only had a waiting list instead of a placebo control group.	One of the recommendations is that similar studies should be undertaken but with larger sample sizes for more valid results.	This study supports the proposed project in that it shows the efficacy of using a mobile health intervention in producing better diabetes-related health outcomes among patients with diabetes.
Yang, Y., Lee, E. Y., Kim, H. S., Lee, S. H., Yoon, K. H., & Cho, J. H. (2020). Effect of a Mobile Phone-Based Glucose-Monitoring and Feedback System for Type 2 Diabetes Management in Multiple Primary Care Clinic Settings: Cluster Randomized Controlled Trial. JMIR mHealth and uHealth, 8(2), e16266. https://doi.org/10.2196/16266	The aim of this study was to examine the clinical applicability and efficacy of a feedback system for managing diabetes based on mobile phone glucose monitoring.	The study design used in the research was a randomized controlled trial	Sample/Setting: a total of two hundred and forty-seven participants were recruited to participate in the study, with 97 randomized into the control group while the remaining 150 were randomized into the intervention group. The study was performed in large cities in South Korea, such as Seoul. Methods: The study was multicenter cluster randomized controlled trials that cover a total of thirteen primary care clinics. Participants in the control group and intervention group were offered face-to-face consultation with the physicians regarding diabetes management. The patients in the intervention group were prompted to upload the results from daily self-monitoring of blood glucose results using the mobile phone. The clinicians then sent short feedback messages to patients after reviewing the results. Some of the instruments used include the Morisky Medication Adherence Scale and the Diabetes Treatment Satisfaction Questionnaire status version. Data collection: data was mainly collected through the use of questionnaires.	HbA1c improvement (p-value of 0.03), fasting plasma glucose (p value of 0.005)	Various key findings support this study. For example, by the third month, there was more improvement on HbA1c values and fasting among the intervention group as compared to the control group. The intervention group also showed superior medication adherence and reduction in blood pressure.	The study had a notable difference in age at baseline between the control group and intervention group hence a possibility of bias. The variations in the medical team could also lead to bias. The time used for follow-up was also short.	One of the recommendations is that future studies targeting the use of mobile phone-based diabetes management systems should use longer study periods to provide better evidence.	This study also supports the project in that it demonstrates that the use of mobile phones/telehealth leads to better outcomes among patients with diabetes.
Hansen, C. R., Perrild, H., Koefoed, B. G., & Zander, M. (2018). Video consultations as add-on to standard care among patients with type 2 diabetes not responding to standard regimens: a randomized controlled trial. European journal of endocrinology, 176(6), 727-736. https://doi.org/10.1530/eje-16-0811	This research aimed at examining whether video consultations integrated with blood pressure, weight, and blood glucose measurements can positively impact glycemic control among patients with diabetes type 2,	The study design used in this research is a randomized controlled trial	Sample/Setting: This study was performed in Copenhagen, Denmark, with participants drawn from three different hospitals. A total of one hundred and sixty-five patients were recruited and randomized in ratio 1:1 to the intervention groups and the control groups. Methods: Having randomized the participants into either an intervention or control group, the study lasted for 32 weeks. The intervention was composed of monthly video conferences with the participants tasked with uploading blood sugar, weight, and blood pressure measurements. Both the intervention and the control group were followed up to six months after the end of the intervention. The main outcome of focus was HbA1c after a period of eight months. One of the tools used in this research is the Short Form 36 version 1 (SF-36) questionnaire. The tools were used in assessing the quality of life, waist/hip ratio, BMI, lipid levels, and changes in blood pressure. These tools can also be applied in the DPI project. Data Collection: The main research data were weight, blood pressure, and blood sugar measurements were recorded by patients and uploaded to the database	HbA1c improvement (p-value of 0.022),	Upon analysis of the data, this research revealed key findings that support the project. The videoconferences integrated with normal diabetes care resulted in a significant reduction of HbA1c when compared to standard care alone.	This study also had various weaknesses and biases. For example, more frequent contact with healthcare professionals could have had enhanced outcomes. Again the regulation of medication such as insulin use during the video calls would have led to the enhanced effect.	The researchers recommend that future studies should focus on meeting patients’ needs as alternative approaches. In addition, this research showed some issues with non-attendance and non-compliance to the intervention; therefore, future studies should focus on addressing non-attendance and non-compliance.	This research supports the proposed intervention in that the application of the video calls integrated with the usual or standard diabetes care led to significant improvements in HbA1c control in the intervention group.
Sarayani A, MashayekM, Nosrati M, Jahangard-Rafsanjani Z, Javadi M, Saadat N, et al. Efficacy of a telephone-based intervention among patients with type-2 diabetes; a randomized controlled trial in pharmacy practice. Int J Clin Pharm 2018 Apr;40(2):345-353. https://doi.org/10.1007/s11096-018-0593-0	The main aim of this study was to examine the impact of telephone-based intervention in improving clinical outcomes and care in type-2 diabetes management.	The study design used is a randomized controlled trial.	Sample/Setting: The study recruited a total of one hundred patients, with fifty each randomized into the control and the intervention group. The research was conducted at Tehran University of Medical Sciences in Iran. Methods: The researchers carried out a two-armed randomized controlled trial with the intervention consisting of sixteen telephone calls in three months. On the other hand, the control group only got the usual care. The participants attended a live education session before randomization on the basics of diabetes management. The major outcome considered in this study was HbA1c. Various tools were used in this research. For example, the researchers used Morisky Medication Adherence questionnaires were used in assessing medication adherence and changes in liquid profile. The other tool used is the Self-Care Activities Measure questionnaire which was used in assessing self-care practice. Data collection: The data was collected using various methods. The patient data were collected from a specific laboratory. Questionnaires were also used in collecting data.	HbA1c improvement (p-value of <0.001) in both groups	This research also has various findings that are relevant to the project. For example, upon the implementation of the intervention, the researchers noted a significant improvement in HbA1c control in both groups. However, the self-care and adherence scores improved more significantly in the intervention group as compared to the control group.	The existence of self-motivation and awareness of the kind of education among the participants could have led to bias as the participants were already willing to modify their adherence and lifestyle for better outcomes. The risk of contamination between the control and intervention groups could not be completely eliminated, hence a possibility of bias.	The researchers recommend that future studies explore the long-term impacts of interventions focused on the use of the telephone as well as test various intervention delivery methods.	This study also supports the proposed intervention since it shows that the use of sixteen telephone calls regarding diabetes management education and support led to improved glycemic control among the patients living with diabetes.
de Vasconcelos, H. C. A., Lira Neto, J. C. G., de Araújo, M. F. M., Carvalho, G. C. N., de Souza Teixeira, C. R., de Freitas, R. W. J. F., & Damasceno, M. M. C. (2018). Telecoaching programme for type 2 diabetes control: a randomised clinical trial. British Journal of Nursing, 27(19), 1115-1120. https://doi.org/10.12968/bjon.2018.27.19.1115	The aim of the study was to explore the impacts of a health telecoaching program in the management and control of type 2 diabetes.	The research design is a randomized and pragmatic clinical trial	Sample/Setting: The study had a total of thirty-one participants, where sixteen were placed in the intervention group while the rest were placed in the control group. The study was carried out in Fortaleza, Brazil. Methods: The study was a randomized and pragmatic clinical trial. An individual must have had diabetes type 2 for at least a year and at least 18 years of age to be included in the study. The control group was only given the routine diabetes care offered in the institution, while the intervention group got the routine care integrated with coaching or guidance offered via telephone calls made by nurses. The telephone calls were used to encourage adherence, lifestyle adaptation, and guidance on diabetes care and management. The calls were made two times a week for 6 months to address various aspects such as the importance of regular physical exercise and healthy eating habits, among others. No specific instruments were used in this research.	HbA1c improvement (p-value of 0.05) in the intervention group	One of the key findings relevant to the project is that upon the use of telephone calls for coaching on diabetes management and care, the researchers observed a significant improvement in glycemic control among individuals in the intervention group.	One of the weaknesses of the study is the sample size (31) which is deemed insufficient hence leading to a possible bias in the results.	The recommendation for future research is that similar studies should be carried out with a bigger sample size and for a longer period of time for better results.	This research supports the intervention since the telecoaching performed by nurses through telephone calls to educate patients on various aspects of diabetes management led to a significant increase in glycemic control among patients.
Aceti, V. M., Santoro, R. V., Velarde, L. G. C., Brandão, D. N., Cruz Filho, R. A. D., & Taboada, G. F. (2021). Educating diabetic patients through an SMS intervention: a randomized controlled trial at a Brazilian public hospital. Archives of endocrinology and metabolism, 65, 695-703. DOI: 10.20945/2359-3997000000390	The main aim of this study was to examine the clinical efficacy of a short message service sent through mobile phones as an educational intervention for patients living with diabetes.	The study design used in this research was a randomized controlled trial	Sample/Setting: This study had a total of one hundred and twenty-eight participants, with half of the participants each randomized into the control and intervention group. The research was performed in a public university hospital in Brazil. Methods: The researchers used a randomized controlled trial to randomize a total of 128 participants into either the control or intervention group. Inclusion criteria included owning a cell phone, being at least 18 years of age, and having diabetes for at least one year. The study was conducted for a period of six months, with the individuals in the intervention group receiving weakly short messages which focused on encouraging them to engage in physical exercise, healthy eating, and diabetes self-care. The SMSs also reminded the patient to take insulin and check glucose and blood pressure levels. This research did not use a specific instrument. Data collection: Patient medical records were used in collecting metabolic control and clinical data both before and after the intervention.	HbA1c improvement (p-value of 0.008) and blood pressure ((p-value of 0.017) in the intervention group	From the data analysis, the researchers revealed that the use of the intervention led to statistically significant improvements in HbA1c and blood pressure levels. Therefore, the SMS tools as an educational intervention tool were important.	The use of a non-validated questionnaire might have led to bias.	The researchers recommend that future studies should consider taking longer study times for better results. They also recommend that the short messages sent to patients should be modified and improved to keep the patient’s interests, especially in studies that take a longer duration.	The findings from this study support the proposed project since the use of the SMS sent through the cell phone as an educational and self-support tool led to significant improvement in glycemic control among patients with diabetes.
Al Omar, M., Hasan, S., Palaian, S., & Mahameed, S. (2020). The impact of a self-management educational program coordinated through WhatsApp on diabetes control. Pharmacy Practice (Granada), 18(2). https://dx.doi.org/10.18549/pharmpract.2020.2.	The aim of this study was to evaluate the impact of a WhatsApp based message-based patient-centered diabetes education program on the patient’s HbA1c levels.	The research design used is a randomized two-arm parallel interventional study.	Sample/Setting: A total of two hundred and eighteen participants were recruited to take part in the study. Those who were included to take part must have been regular users of WhatsApp and between the ages of eighteen and eighty. The research was performed at Ajman University in the United Arab Emirates. Methods: This research was a two-arm parallel randomized interventional study carried out for six months. Simple randomization was used to randomize the participants in either the control group or the intervention group. While the intervention group received education and support related to diabetes management through WhatsApp messaging, the control group only received the usual care. The content of the WhatsApp messages entailed adjusting and coping with living with diabetes, insulin use, reminders to take medication, blood glucose self-monitoring, physical activity, food portion management, and healthy eating. One of the instruments used in the study was a self-developed satisfaction tool having a three-point Linkert-type scale. This tool can also be used in the project. Data collection: Various strategies were applied in data collection. Phone calls were used to obtain HbA1c data from patients.	A significant drop in the HbA1c levels in the intervention group (p-value of 0.001) as compared to the control group (p-value of 0.032)	Various key findings are relevant to the project. Upon the use of WhatsApp messaging as a media of education among patients with diabetes, the researchers observed improvement in glycemic control as a significant reduction in HbA1c levels was observed in the intervention group. This reduction was more significant in the intervention group as compared to the control group.	The study has various weaknesses and biases. The researchers could not ascertain whether the messages were opened by the participants. The reduction of the effective sample size could have compromised the study’s power. Confidentiality was observed to be an issue as another person could access the information provided if they could access the participants’ WhatsApp messages.	The researchers recommend that future studies should consider looking into aspects such as communication levels between patient and healthcare provider, patient attitudes and behavior, and the levels of patient engagement.	This article also supports the DPI project since the research showed that the use of WhatsApp messaging as telehealth to educate patients with diabetes leads to better control of the HbA1c levels.
Majithia, A. R., Kusiak, C. M., Lee, A. A., Colangelo, F. R., Romanelli, R. J., Robertson, S., … & Zisser, H. (2020). Glycemic outcomes in adults with type 2 diabetes participating in a continuous glucose monitor–driven virtual diabetes clinic: a prospective trial. Journal of medical Internet research, 22(8), e21778. https://doi.org/10.2196/21778	The purpose of this study was to evaluate the outcomes connected with the use of a virtual diabetes clinic that combined live video consultations, connected devices, remote lifestyle coaching, and mobile phone apps.	The study design used is a prospective single-arm study.	Sample/setting: A total of fifty-five participants took part in the study out of the original sixty identified individuals. For the participants to be included in the study, they had to be at least eighteen years old and confirmed diagnosis of type 2 diabetes, own a smartphone, and be willing to use a blood glucose meter. The participants were drawn from two primary care networks, Sutter Health Palo Alto Medical Foundation, CA, USA, and Allegheny Health Network, Pittsburg, PA, USA. Methods: This study was a prospective single-arm study that evaluated the change in HbA1c levels among patients with diabetes after a period of four months. The Onduo virtual diabetes clinic was composed of live video consultations, connected devices, remote lifestyle coaching, and mobile phone apps. The core of the intervention is the interaction between the patients and the care team. The care team sent educational material through messaging using a smartphone app. In addition, the patients used an app for tracking important data connected to diabetes management and care, such as meal photos, physical activity, medication use, and blood sugar readings. Some instruments used in this study are blood glucose meters and real-time continuous glucose monitoring. These instruments are also applicable in the project. Data collection: one of the strategies used in collecting data was the use of questionnaires.	the HbA1c levels significantly dropped when the data after the intervention was compared with the baseline data (p-value of <0.001)	From the analysis of the data, it was evident that there was a significant improvement in the HbA1c levels upon the use of the intervention. The values were observed to significantly reduce both in the cases of stratification and non-stratification with the baseline. Therefore the telehealth applications applied in this research were effective for better glycemic control among patients with diabetes.	Even though this study gave promising results, it still had various weaknesses and biases. For example, the sample size was inadequate, leading to possible bias in results. The duration of the study was also short (4 months); hence might not have given the correct picture. Another weakness also comes in its design; this study lacked a randomized control arm. In addition, there is a possibility that some of the observed lowered HbA1c levels could be due to the regression to the mean.	One of the recommendations is that a similar study is carried out in the future that includes a randomized control arm. This will enable comparison with both the baseline data and between the intervention and the control group for better results.	This article also supports the project in that the researchers used various aspects of telehealth to enhance diabetes care among patients with diabetes. For example, live video consultations with the care team, the use of mobile phone messaging apps to deliver vital educational materials regarding lifestyle changes, the need to engage in physical exercises, and dietary adjustments enhanced outcomes. The intervention led to the improvement of HbA1c levels, hence supporting the project.
Guo, M., Meng, F., Guo, Q., Bai, T., Hong, Y., Song, F., & Ma, Y. (2021). Effectiveness of mHealth management with an implantable glucose sensor and a mobile application among Chinese adults with type 2 diabetes. Journal of Telemedicine and Telecare, 1357633X211020261. https://doi.org/10.1177%2F1357633X211020261	The aim of this study was to evaluate the efficacy of mobile health management with a mobile application and glucose sensor on diabetes management among patients with diabetes.	The study design used is a randomized controlled trial.	Sample/Setting:  A total of sixty-eight participants were recruited to take part in the study, with half the number randomized into the intervention group while the rest were randomized into the control group. For inclusion, the participants had to be between 18 and 75 years of age with no cognitive impairment, among other inclusion criteria. The study was carried out in a general hospital in Hangzhou city in China. Methods: The researchers used a parallel-group randomized control trial (two-arm) to draw a comparison between usual diabetes care and mobile health intervention in the management of diabetes. The intervention group in the study were offered a mhealth management strategy using mobile application and glucose sensor. As part of the intervention, the patients were expected to communicate with their health experts using mobile phones. Patients sent real-time information to the health experts, which allowed them to come up with personalized interventions to improve the diabetes outcomes among the patients. The control group was offered usual care, which entails a telephone follow-up once every week to urge the patients to go for clinic review and to obtain the patient’s glucose levels. This research used an instrument, The Diabetes Specific Quality of Life, self-reported quality of life score to evaluate the life quality of patients living with diabetes. This instrument is applicable in the project too. Data collection: Data was collected using questionnaires	HbA1c levels significantly reduced in the intervention group (p-value of <0.05).	Upon the use of mobile health management intervention, the patients recorded a significant reduction in the HbA1c levels, improved self-management, and improved quality of life among the patients with diabetes. The improved HbA1c was also found to be more significant in the intervention as compared to the control group.	This one of the studies which showed a significant improvement in HbA1c levels upon the use of the intervention. However, the study also had various biases and weaknesses. The first weakness is that participants were drawn from a single tertiary hospital in Zhejiang province, hence the potential lack of generalizability. The sample size used (68) is low and insufficient hence the lack of reduced credibility.	The researchers recommend that similar studies be conducted in the future with a bigger sample size for more credible results.	This article supports the proposed project in that the use of mobile health intervention to deliver important information to the patients led to a significant improvement in the patient’s HbA1c showing that the intervention is effective. Therefore, it supports my project, which proposes to use telehealth calls alongside DSMES tools to assess the change in HbA1c.

Table 3: Theoretical Framework Aligning to DPI Project

Nursing Theory Selected	APA Reference – Seminal Research References (Include the GCU permalink or working link used to access each article.)	The explanation for the Nursing Theory Guides the Practice Aspect of the DPI Project.
Dorothea Orem’s Self-Care theory	Denyes, M. J., Orem, D. E., & Bekel, G. (2001). Self-care: A foundational science. Nursing science quarterly, 14(1), 48-54. https://doi.org/10.1177%2F089431840101400113	This theory will be used in guiding my DNP project on diabetes management and prevention. Self-care is key in diabetes management. Therefore, the underpinnings will be key in helping the individuals evaluate themselves and choose the necessary actions required to attend to such needs by accomplishing the actions (Butts & Rich, 2018). For instance, the intervention entails the use of the Diabetes Self-management Education & Support tool on a low-calorie diet and walking 150 minutes of moderate to vigorous-intensity physical activity per week. Therefore, patients can be motivated to follow the interventions for better care. The theory underlines that self-care is learned and is more natural to adults. Therefore, it will guide the project towards promoting self-care for healthcare well-being and self-maintenance among the identified patients living with diabetes.
Change Theory Selected	APA Reference – Seminal Research References (Include the GCU permalink or working link used to access each article.)	The explanation for How the Change Theory Outlines the Strategies for Implementing the Proposed Intervention
Kurt Lewin’s change theory	Schein, E. H. (1996). Kurt Lewin’s change theory in the field and in the classroom: Notes toward a model of managed learning. Systems practice, 9(1), 27-47. https://doi.org/10.1007/BF02173417	Kurt Lewin’s change theory is one of the evidence-based change models or theories that have been widely applied in the nursing field to implement various initiatives. Kurt Lewin’s change theory is composed of three stages, unfreezing, change, and refreezing. The theory asserts that there are two types of forces, the driving forces and the restraining forces pushing in the direction that makes change happen and direction that hinder the change, respectively. As such, a change only occurs when the driving forces override the restraining forces. In the unfreezing stage, a method is proposed to help individuals move from old behavior patterns and accept change. The change or moving stage entails making changes in behavior, feeling, and thoughts. The final step, which is the refreezing stage, entails making the new change as the new habit, standard or normal. When applying the change model, the unfreezing stage will involve asserting the need for patients to have better glycemic control hence the need for more effective intervention. Therefore both the patients and the nurses will be made to appreciate the need for change. The second step will involve the implementation of the proposed intervention for better diabetes outcomes. Support is offered to nurses who carry offer the intervention to patients, and the patients are encouraged to adhere to the intervention requirements. The final step will involve making the intervention part of standard practice to ensure that patients have better outcomes.

Table 4: Clinical Practice Guidelines (If applicable to your project/practice)

APA Reference – Clinical Guideline (Include the GCU permalink or working link used to access the article.)	APA Reference – Original Research (All) (Include the GCU permalink or working link used to access the article.)	Explanation for How Clinical Practice Guidelines Align to DPI Project
	Place the primary quantitative research used in the clinical practice guidelines in Table 1. This is part of the primary quantitative research used to support your intervention.

References

Aceti, V. M., Santoro, R. V., Velarde, L. G. C., Brandão, D. N., Cruz Filho, R. A. D., & Taboada, G. F. (2021). Educating diabetic patients through an SMS intervention: a randomized controlled trial at a Brazilian public hospital. Archives of endocrinology and metabolism, 65, 695-703. DOI: 10.20945/2359-3997000000390.

Al Omar, M., Hasan, S., Palaian, S., & Mahameed, S. (2020). The impact of a self-management educational program coordinated through WhatsApp on diabetes control. Pharmacy Practice (Granada), 18(2). https://dx.doi.org/10.18549/pharmpract.2020.2.1841 

Asante, E., Bam, V., Diji, A. K. A., Lomotey, A. Y., Owusu Boateng, A., Sarfo-Kantanka, O., … & Adjei, D. (2020). Pilot mobile phone intervention in promoting type 2 diabetes management in an urban area in Ghana: a randomized controlled trial. The Diabetes Educator, 46(5), 455-464. https://doi.org/10.1177%2F0145721720954070.

Butts, J. B., & Rich, K. L. (2018). Philosophies and theories for advanced nursing practice. Jones & Bartlett Publishers.

Dong, Y., Wang, P., Dai, Z., Liu, K., Jin, Y., Li, A., … & Zheng, J. (2018). Increased self-care activities and glycemic control rate in relation to health education via Wechat among diabetes patients: A randomized clinical trial. Medicine, 97(50). https://dx.doi.org/10.1097%2FMD.0000000000013632

Denyes, M. J., Orem, D. E., & Bekel, G. (2001). Self-care: A foundational science. Nursing science quarterly, 14(1), 48-54. https://doi.org/10.1177%2F089431840101400113.

de Vasconcelos, H. C. A., Lira Neto, J. C. G., de Araújo, M. F. M., Carvalho, G. C. N., de Souza Teixeira, C. R., de Freitas, R. W. J. F., & Damasceno, M. M. C. (2018). Telecoaching programme for type 2 diabetes control: a randomised clinical trial. British Journal of Nursing, 27(19), 1115-1120. https://doi.org/10.12968/bjon.2018.27.19.1115

Fortmann, A. L., Gallo, L. C., Garcia, M. I., Taleb, M., Euyoque, J. A., Clark, T., … & Philis-Tsimikas, A. (2017). Dulce Digital: an mHealth SMS-based intervention improves glycemic control in Hispanics with type 2 diabetes. Diabetes Care, 40(10), 1349-1355. https://doi.org/10.2337/dc17-0230

Guo, M., Meng, F., Guo, Q., Bai, T., Hong, Y., Song, F., & Ma, Y. (2021). Effectiveness of mHealth management with an implantable glucose sensor and a mobile application among Chinese adults with type 2 diabetes. Journal of Telemedicine and Telecare, 1357633X211020261. https://doi.org/10.1177%2F1357633X211020261

Hansen, C. R., Perrild, H., Koefoed, B. G., & Zander, M. (2018). Video consultations as add-on to standard care among patients with type 2 diabetes not responding to standard regimens: a randomized controlled trial. European journal of endocrinology, 176(6), 727-736. https://doi.org/10.1530/eje-16-0811.

Majithia, A. R., Kusiak, C. M., Lee, A. A., Colangelo, F. R., Romanelli, R. J., Robertson, S., … & Zisser, H. (2020). Glycemic outcomes in adults with type 2 diabetes participating in a continuous glucose monitor–driven virtual diabetes clinic: a prospective trial. Journal of medical Internet research, 22(8), e21778. https://doi.org/10.2196/21778

Poppe, L., De Bourdeaudhuij, I., Verloigne, M., Shadid, S., Van Cauwenberg, J., Compernolle, S., & Crombez, G. (2019). Efficacy of a Self-Regulation–Based Electronic and Mobile Health Intervention Targeting an Active Lifestyle in Adults Having Type 2 Diabetes and in Adults Aged 50 Years or Older: Two Randomized Controlled Trials. Journal of medical Internet research, 21(8), e13363. https://doi.org/10.2196/13363.

Sarayani A, Mashayekhi M, Nosrati M, Jahangard-Rafsanjani Z, Javadi M, Saadat N, et al. Efficacy of a telephone-based intervention among patients with type-2 diabetes; a randomized controlled trial in pharmacy practice. Int J Clin Pharm 2018 Apr;40(2):345-353. https://doi.org/10.1007/s11096-018-0593-0.

Schein, E. H. (1996). Kurt Lewin’s change theory in the field and in the classroom: Notes toward a model of managed learning. Systems practice, 9(1), 27-47. https://doi.org/10.1007/BF02173417

Sun, C., Sun, L., Xi, S., Zhang, H., Wang, H., Feng, Y., … & Wang, G. (2019). Mobile phone–based telemedicine practice in older Chinese patients with type 2 diabetes mellitus: a randomized controlled trial. JMIR mHealth and uHealth, 7(1), e10664. https://doi.org/10.2196/10664

Vaughan, E. M., Hyman, D. J., Naik, A. D., Samson, S. L., Razjouyan, J., & Foreyt, J. P. (2021). A telehealth-supported, I ntegrated care with CHWs, and ME dication-access (TIME) Program for Diabetes Improves HbA1c: a Randomized Clinical Trial. Journal of general internal medicine, 36(2), 455-463. https://doi.org/10.1007/s11606-020-06017-4

Warren, R., Carlisle, K., Mihala, G., & Scuffham, P. A. (2018). Effects of telemonitoring on glycaemic control and healthcare costs in type 2 diabetes: a randomized controlled trial. Journal of telemedicine and telecare, 24(9), 586-595. https://doi.org/10.1177%2F1357633X17723943

Yang, Y., Lee, E. Y., Kim, H. S., Lee, S. H., Yoon, K. H., & Cho, J. H. (2020). Effect of a Mobile Phone–Based Glucose-Monitoring and Feedback System for Type 2 Diabetes Management in Multiple Primary Care Clinic Settings: Cluster Randomized Controlled Trial. JMIR mHealth and uHealth, 8(2), e16266. https://doi.org/10.2196/16266

Young, H. M., Miyamoto, S., Dharmar, M., & Tang-Feldman, Y. (2020). Nurse coaching and mobile health compared with usual care to improve diabetes self-efficacy for persons with type 2 diabetes: randomized controlled trial. JMIR mHealth and uHealth, 8(3), e16665. https://doi.org/10.2196/16665

Literature Evaluation Table – DPI Intervention

Learner Name:

Instructions: Use this table to evaluate and record the literature gathered for your DPI Project.Refer to the assignment instructions for guidance on completing the various sections. Empirical research articles must be published within 5 years of your anticipated graduation date. Add or delete rows as needed.

PICOT-D Question: Among adult patients with type 2 diabetes in an outpatient clinic, will the translation of Beck et al.’s research on continuous glucose monitoring increase the rate of practitioner’s ordering Continuous glucose monitoring impact HgbA1C, compared to current, in 12 weeks

Table 1: Primary Quantitative Research – Intervention (5 Articles)

APA Reference (Include the GCU permalink or working link used to access the article.)	Research Questions/ Hypothesis and Purpose/Aim of Study	Type of Primary Research Design	Research Methodology Setting/Sample (Type, country, number of participants in study) Methods (instruments used; state if instruments can be used in the DPI project)How was the data collected?	Interpretation of Data (State p-value: acceptable range is p= 0.000 – p= 0.05)	Outcomes/ Key Findings (Succinctly states all study results applicable to the DPI Project.)	Limitations of Study and Biases	Recommendations for Future Research	Explanation of How the Article Supports Your Proposed Intervention
Beck, R. W., Riddlesworth, T. D., Ruedy, K., Ahmann, A., Haller, S., Kruger, D., … & DIAMOND Study Group. (2017). Continuous glucose monitoring versus usual care in patients with type 2 diabetes receiving multiple daily insulin injections: a randomized trial. Annals of Internal Medicine, 167(6), 365-374. https://doi.org/10.7326/M16-2855.	The aim of this study was to determine the effectiveness of continuous glucose monitoring in adults living with diabetes.	Randomized controlled trial	Setting: 25 endocrinology practices (22 in the united states and 3 in Canada). 19 community-based and 6 academic centers Sample: Enrolled: 158 randomized into ration 1:1Drop outs/Adverse events: none Methods: Randomization into continuous glucose monitoring (CGM) (n=79) and control group (n=79).Participants received general guidelines about using CGMThe control group was asked to monitor their blood glucose at least 4 times dailyFollow-up visits for both treatment groups occurred after 4, 12, and 24 weeksThe CGM group had an additional visit 1 week after randomization to troubleshoot potential use problemsThe control group had 2 additional visits 1 week before the 12- and 24- week visits to initiate blinded CGM use for 1 weekBoth groups were contacted by telephone 2 and 3 weeks after randomizationThe instruments used include Clarke Hypoglycemia Unawareness Survey and the 5-level EuroQol-5Dand 5-item World Health Organization Well-Being Index. These instruments can also be applied to my project. Data collection: Glucose concentration was collected using Dexcom G4 Platinum CGM System with an enhanced algorithm (software 505) (Dexcom)Data were collected by staff who measured HbA1c levels at baseline. The patients also reported their HbA1c levels.	The HbA1c levels were significantly reduced (p= 0.022)	One of the most relevant findings is that the use of continuous glucose monitoring led to improve HbA1c levels. There was an improvement when the post-intervention and the baseline data were compared (p= 0.022)	The follow-up was only done for a duration of six months	The researchers recommend that there should be an increased prescription of continuous glucose monitoring as only a limited number of patients currently are. Additional management methods should be explored in future studies.	The use of continuous glucose monitoring led to the patients having better outcomes in terms of HbA1c levels. Therefore, continuous glucose monitoring, which has been proposed, showed good results. It may be used as a foundation to build on my project, which seeks to see if increased prescription of CGM by practitioners is effective in controlling HbA1c levels.
Gilbert, T. R., Noar, A., Blalock, O., & Polonsky, W. H. (2021). Change in hemoglobin A1c and quality of life with real-time continuous glucose monitoring use by people with insulin-treated diabetes in the landmark study. Diabetes Technology & Therapeutics, 23(S1), S-35. https://doi.org/10.1089/dia.2020.0666	The aim of this study was to determine the impact of continuous glucose monitoring on quality life indicators such as HbA1c levels among patients with diabetes.	Real-world prospective study	Setting: The study was done in USA where interested participants were sent invitations and screening questionnaires Sample: Enrolled: 248 participants;66 T2D, 182 T1DDrop outs/Adverse events: none Methods:  Customer interest was gauged from nationwide callers when they called to place their first Dexcom G6 (Dexcom, Inc., San Diego, CA)Interested customers were sent invitations and screening questionnaires. Inclusion criteria included ages 25–65 years, use of IIT, no prior CGM use.Patients were expected to upload the most recent laboratory or point of care HbA1c levels onto an online portal which were then verified by the study staff.After 12 weeks, participants returned to the portal to upload a second laboratory or point-of-care HbA1c measurementOne of the instruments used is the quality-of-life questionnaire. This instrument can also be used in my DPI project. Data collection: QuestionnairesSurveyspatients also uploaded data to the online portal.	A p= 0.001 was observed for a reduction in HbA1c levels	The analysis of the data revealed various key findings relevant to the project. For example, the reduction in HbA1c levels after implementing the intervention was found to be significant (p=0.001). There was also a notable absolute reduction of HbA1c levels among the patients upon the use of continuous glucose monitoring.	This study also had various biases or weaknesses. This study lacked a controlled group and also lack of baseline blinded continuous glucose monitoring data. There was also a possibility of heterogeneity in the method for measuring HbA1c.	Among the recommendations is that there is a need to conduct studies that focus on long-term outcomes among patients using continuous glucose monitoring.	This study also supports the proposed intervention since it shows the efficacy of continuous glucose monitoring in improving the diabetes outcomes such as HbA1c levels among patients with diabetes. It will increase the significance and relevance of my research on more prescription of CGM by practitioners.
Grace, T., & Salyer, J. (2022). Use of Real-Time Continuous Glucose Monitoring Improves Glycemic Control and Other Clinical Outcomes in Type 2 Diabetes Patients Treated with Less Intensive Therapy. Diabetes Technology & Therapeutics, 24(1), 26-31. https://doi.org/10.1089/dia.2021.0212.	The aim of the study was to examine the clinical effects of using real-time continuous glucose monitoring in patients with diabetes.	Open-label, prospective, interventional, single-arm study	Setting: Blanchard Valley Diabetes Center (BVDC), Findlay, OH, USA Sample: Enrolled: 43Drop outs/Adverse events: 5 Methods: Over the 6-month study period, patient visits occurring at initial screening and baseline, followed by clinic visits at months 3 and 6.At screening, demographic information, medical history, information about current medications, and relevant biometric measurements (weight, BMI) were obtained and documentedAt the 3- and 6-month visits, patients brought their CGM device to the BVDC where CGM data were downloaded and reviewed by investigators and patientBlood samples for HbA1c measurement were obtained and biometric measurements documented.   Data collection: Patient uploads to the portals.Data documentation by the investigators	A p =0.001 for the reduction in HbA1c	Various findings from the research are applicable to the DPI project. For example, the application of continuous glucose monitoring among patients with diabetes led to substantial glycemic improvements, such as reduced levels of HbA1c levels.	This study also had various limitations and biases. For example, there was no real baseline data as the researchers used the data obtained during the first month; hence the findings do not appropriately assess the real changes that happen relative to HbA1c levels before the intervention. The length of the study was also not sufficient to determine the sustainability of the intervention.	The researchers recommended that the eligibility requirements need to be modified to expand access to real-time continuous glucose monitoring.	Since my project aims at discovering whether increased prescription of CGM reduces the HbA1c levels in individuals with type two diabetes, this article provides significant baseline information that CGM has been effective in individuals who have used it already.
Heinemann, L., Freckmann, G., Ehrmann, D., Faber-Heinemann, G., Guerra, S., Waldenmaier, D., & Hermanns, N. (2018). Real-time continuous glucose monitoring in adults with type 1 diabetes and impaired hypoglycemia awareness or severe hypoglycemia treated with multiple daily insulin injections (Hypo DE): a multicenter, randomized controlled trial. The Lancet, 391(10128), 1367-1377. https://doi.org/10.1016/S0140-6736(18)30297-6	The main aim of this study was to determine the impact of continuous glucose monitoring on the incidence and severity of hypoglycemia.	Randomized controlled trial	Setting/Sample: The study recruited a total of 149 patients who were then randomly assigned to the control group and the real-time glucose monitoring group. The study was done in Germany Methods: One of the instruments used in the study is the questionnaires Data Collection: Data was collected through the use of questionnaires that the patients completed. In addition, the patient’s medical information was obtained from the medical records. Setting: 12 diabetes practices in Germany Sample: Enrolled: 149 participantsDrop outs/Adverse events: 8 Methods: Patients were randomly assigned to CGM or SMBG (1:1) and participants informed about their group allocationStudy was done in three phases: baseline, therapy and follow-up phaseAll participants were instructed on how to insert and secure the glucose sensor and how to calibrate the system.Participants in the CGM group received instructions on optimal use of CGM in three sessions. Topics included how to wear an rtCGM system, importance of calibration, when confirmation of results by SMBG is necessary, use of trend arrows and glucose profiles for treatment adjustments, and use and setting of hypoglycaemic or hyperglycaemic alerts.Control group participants continued SMBG measurements and received their usual care. Both groups used their respective glucose monitoring device  for the subsequent 22 weeks to make therapeutic decision.Study site clinicians were asked to review the CGM or SMBG data at each visit and during phone calls and make appropriate treatment modifications as needed Data collection: QuestionnairesMedical records	Hypoglycemic events were reduced by 72% (p =0.0001)	This research focused on hypoglycemia which has been shown to have a relationship with glycemic control. Therefore, one of the relevant findings is that the use of continuous glucose monitoring led to lower incidences of hypoglycemic events.	One of the limitations of this study is the impossibility of masking either the patients or the study staff. Informing the patient to put on the monitoring device 85% of the time could have led to selection bias. The study findings also lack generalizability.	The researchers recommend an adjustment for the multiplicity of the secondary outcomes.	People with diabetes not only go through hyperglycemic crisis, but also through hypoglycemia. The use of CGM in this research proves to be a good tool of preventing hypoglycemic crisis, which is ore common in individuals who use the Self-monitoring blood glucose (SMBG). It does so by sending an alert when the blood glucose drops below the lower limit. Due to this, it has proven to be an effective glucose control tool for both hyperglycemia and hypoglycemia crisis, hence helps to ensure that blood glucose are maintained at a normal level which is a key role in preventing diabetes associated complications.
Martens, T., Beck, R. W., Bailey, R., Ruedy, K. J., Calhoun, P., Peters, A. L., … & MOBILE Study Group. (2021). Effect of continuous glucose monitoring on glycemic control in patients with type 2 diabetes treated with basal insulin: a randomized clinical trial. JAMA, 325(22), 2262-2272. https://doi:10.1001/jama.2021.7444	The major objective of this study was to examine the effectiveness of continuous glucose monitoring among individuals with type 2 diabetes treated with basal insulin without prandial insulin.	Randomized controlled trial	Setting: 15 diabetes centers across USA Sample: Enrolled: 175Drop outs/Adverse events: none Methods: Patients were randomized into CGM (n=116) or Traditional glucose monitor (n=59)Prior to randomization, each participant used a CGM system that recorded glucose concentrations not visible to the participant (“blinded” version of the CGM device used by the CGM group) for up to 10 days.Participants in both groups were provided with a Bluetooth-enabled BGM (OneTouch Verio Flex; LifeScan) and test stripsFollow-up clinic visits for both treatment groups to review glucose data and self-titration of insulin occurred after 2 weeks and 1 and 8 months, with virtual visits by telephone after 2, 4, and 6 months.Among the instruments used in this study is the continuous glucose monitoring satisfaction scale. This instrument can be applied to my DPI project Data collection: SurveysLaboratory measurement of HbA1c levels	A p= 0.02 was observed in the reduction of HbA1c levels	Various findings found in this research are significant to the project. For instance, upon the implementation of continuous glucose monitoring among patients with diabetes, it was observed that the levels of HbA1c reduced from 9.1% at baseline to 8.0% eight months after the use of continuous glucose monitoring.	The follow-up period was insufficient as it was not clear whether the enhanced use of continuous glucose monitoring and the benefits would be sustainable for longer durations. Covid 19 limited the researchers from obtaining all of the 8-month continuous glucose monitoring or HbA1c levels data. The patients had more sustained contact with the clinical staff than usual, hence a potential lack of generalizability in areas where usual care takes place.	One of the recommendations is that longer durations for follow-ups should be done to ascertain sustainability.	This study also supports the proposed intervention since it shows the efficacy of continuous glucose monitoring in improving the diabetes outcomes such as HbA1c levels among patients with diabetes. It will increase the significance and relevance of my research on more prescription of CGM by practitioners.

Table 2: Additional Primary and Secondary Quantitative Research (10 Articles)

	Research Questions/ Hypothesis and Purpose/Aim of Study	Type of Primary or Secondary Research Design	Research Methodology Setting/Sample (Type, country, number of participants in study) Methods (instruments used; state if instruments can be used in the DPI project)How was the data collected?	Interpretation of Data (State p-value: acceptable range is p= 0.000 – p= 0.05)	Outcomes/ Key Findings (Succinctly states all study results applicable to the DPI Project.)	Limitations of Study and Biases	Recommendations for Future Research	Explanation of How the Article Supports Your Proposed DPI Project
Lind, M., Polonsky, W., Hirsch, I. B., Heise, T., Bolinder, J., Dahlqvist, S., … & Hellman, J. (2017). Continuous glucose monitoring vs. conventional therapy for glycemic control in adults with type 1 diabetes treated with multiple daily insulin injections: the GOLD randomized clinical trial. Jama, 317(4), 379-387. https://doi:10.1001/jama.2016.19976	The aim of this study was to evaluate the impacts of continuous glucose monitoring among patients with diabetes and treated with insulin injections.	Randomized controlled trial	Setting: 15 diabetes outpatient clinics in Sweden Sample: Enrolled: 161 patientsDrop outs/Adverse events: 19 patients Methods: All laboratory tests were analyzed at a central laboratorypatients completed masked CGM for 2 weeks and questionnaires.Patients were randomized 1:1 into the first treatment period to CGM using the Dexcom G4 PLATINUM stand-alone system or conventional therapy.Patients were assessed at the start of each treatment period and at weeks 2, 4, 13, and 26.HbA1c was measured at all visits in each treatment period except week 2Various instruments were used in the study, including the problem areas of the diabetes scale, hypoglycemia confidence questionnaire, hypoglycemia fear survey and Diabetes Treatment Satisfaction Questionnaire. These instruments can be applied in this project too Data collection: Questionnaires.	A p=0.001 was observed in the improvement in HbA1c levels between the intervention group and the control group.	One of the major findings is that even though both sets of patients had improvements in HbA1c levels, the groups using the continuous glucose monitoring had a significantly better outcome (p<0.001)	Among the limitations is that around 12% of participants had no follow-up data leading to analysis bias. The other limitation is that the participants could not be blinded hence the possibility of influencing the project outcomes.	The recommendations recommend that further research is needed to help assess the clinical outcomes as well as longer-term adverse impacts.	This article supports the proposed project as it indicates that using continuous glucose monitoring could be effective in making patients have better diabetes outcomes such as glycemic control. I concluded that provision of real time blood glucose levels by CGM notified the patients on critical situations, allowing them to respond using other mechanisms other than insulin, therefore, reducing patient’s reliance on it and sparing them of the expense.
Feig, D. S., Donovan, L. E., Corcoy, R., Murphy, K. E., Amiel, S. A., Hunt, K. F., … & Pragnell, M. (2017). Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicenter international randomized controlled trial. The Lancet, 390(10110), 2347-2359. https://doi.org/10.1016/S0140-6736(17)32400-5	The purpose of this project was to explore the effectiveness of continuous glucose monitoring on maternal glucose control as well as neonatal health outcomes.	Randomized controlled trial.	Setting: 31 hospitals across USA, Ireland, Italy, Spain, Scotland, England, and Canada. Sample: Enrolled: 325 patientsDrop outs/Adverse events: none Methods: Patients were randomised to receive either CGM in addition to capillary glucose monitoring (intervention)  or capillary glucose monitoring alone (control)They were trained on how to use the monitorsOne of the instruments used in this study is the HFS behavior subscale. This instrument may not be applicable in this proposed project.   Data collection: QuestionnairesReal-time sensors	A p= 0.0207 was found for the drop in HbA1c levels among women who were using continuous glucose monitoring.	Upon using the continuous glucose monitoring intervention by the women, it was noted that they had better HbA1c levels. The researchers observed a p= 0.0207 when comparing the HbA1c levels at baseline and after the use of the monitoring intervention.	This research had various limitations. One of them is that the researchers could not obtain all the data as some were lost while other participants withdrew.	Similar research should be done, but there should be multiple adjustments for multiple testing.	Even though the intervention was used among pregnant women, it showed that the use of continuous glucose monitoring is key to better management of diabetes. This therefore can be also be prescribed to pregnant mothers who suffer from diabetes, especially gestational diabetes, saving them the diabetes complications associated with pregnancy.
Reddy, M., Jugnee, N., El Laboudi, A., Spanudakis, E., Anantharaja, S., & Oliver, N. (2018). A randomized controlled pilot study of continuous glucose monitoring and flash glucose monitoring in people with type 1 diabetes and impaired awareness of hypoglycemia. Diabetic Medicine, 35(4), 483-490. https://doi.org/10.1111/dme.13561	The aim of this study was to assess the effectiveness of continuous glucose monitoring as compared to flash glucose monitoring in the management of diabetes.	Randomized controlled trial	Setting: A single site in the United Kingdom. Sample: Enrolled: 40 participantsDrop outs/Adverse events: none Methods: Patients were randomized into the flash monitoring group (n=20) while the rest were randomized into the continuous glucose monitoring group (n=20), Following 2 weeks of blinded CGMAt study enrolment, participants gave a full medical and medication history, and underwent a physical examination and electrocardiogram. Fasting venous blood tests were taken to assess HbA1c, plasma glucose, urea and electrolytes, cortisol, and serum c-peptideVarious instruments were used in the study, including the Problem Areas in Diabetes questionnaire, the Hypoglycemia Fear Score, and the Gold Score. These instruments can also be applied in the proposed study Data collection: questionnaires	A p= 0.006 was observed between the continuous blood glucose monitoring group and the flash monitoring group in terms of HbA1c level improvement.	Among the relevant findings is that the individuals who used the continuous glucose monitoring group experienced better HbA1c level improvement as compared to those in the flash monitoring group.	This study had various limitations. Among them was that the sample size was considerably small. In addition, the follow-up period was also short. The stratification at randomization was based on HbA1c alone and did not consider other factors like gender and age.	The recommendations include: A similar study should be done using a larger population. In addition, a more heterogeneous population should be used.	This article also supports the project as it shows the efficacy of continuous glucose monitoring in diabetes management, as it leads to better outcomes such as improved HbA1c levels.
Bergenstal, R. M., Layne, J. E., Zisser, H., Gabbay, R. A., Barleen, N. A., Lee, A. A., … & Dixon, R. F. (2021). Remote application and use of real-time continuous glucose monitoring by adults with type 2 diabetes in a virtual diabetes clinic. Diabetes technology & therapeutics, 23(2), 128-132. https://doi.org/10.1089/dia.2020.0396	This study was done with the aim of evaluating the relationship between continuous glucose monitoring and the HbA1c levels among patients with diabetes.	This was an observational study.	Setting: virtual diabetes clinic in USA Sample: Enrolled: 594Drop outs/Adverse events: none Methods: The real-time glucose monitoring device was remotely prescribed by an endocrinologist.One of the instruments used in this study is the continuous glucose monitoring satisfaction scale. This instrument can also be applied in the projectThe VDC care team provided training videos to help members insert the sensor and onboard to using the rtCGM device. The care team provided education to participants on rtCGM use and encouraged logging of meals, exercise, and medications in the VDC App while using rtCGM. Data collection: Surveysquestionnaires	A p=0.001 was observed for the reduction in the HbA1c levels.	The use of continuous glucose monitoring was associated with better HbA1c levels.	There was a possibility of response bias and a lack of generalizability.	One of the recommendations was that there is a need to determine the cadence of the intermittent real-time continuous glucose monitoring.	This study also supports the proposed project as it shows the importance of using continuous glucose monitoring to positively impact the patient’s HbA1c levels.
Laffel, L. M., Kanapka, L. G., Beck, R. W., Bergamo, K., Clements, M. A., Criego, A., … & Miller, K. M. (2020). Effect of continuous glucose monitoring on glycemic control in adolescents and young adults with type 1 diabetes: a randomized clinical trial. Jama, 323(23), 2388-2396. https://doi:10.1001/jama.2020.6940	The main objective of this study was to explore the impact of continuous glucose monitoring on glycemic control among patients with diabetes.	Randomized controlled trial.	Setting: 14 endocrinology practices in the USA Sample: Enrolled: 153 patientsDrop outs/Adverse events: none Methods: Participants were randomized 1:1 to undergo CGM (CGM group; n = 74) or usual care using a blood glucose meter for glucose monitoring (blood glucose monitoring [BGM] group; n = 79).Each participant was required to complete a 14- to 21-day prerandomization period using a masked CGM device in which sensor glucose values were not visible to participants.Participants in both groups received general diabetes management education and were provided a study blood glucose meter and test strips Both study groups had scheduled in-clinic visits at 4, 6, 13, and 26 weeks and contacts (via phone or video conference) at 1, 2 (in-clinic or remotely for the CGM group), and 19 weeks following randomization.Various instruments were used in this research, including the Pittsburgh Sleep Quality Index, the Hypoglycemia Confidence Scale, the Glucose Monitoring Satisfaction Survey, and the Problem Areas in Diabetes-Pediatric Survey. While some of these instruments can be used in the DPI project, some are not relevant Data collection: Medical recordsQuestionnaires.	A p= 0.01 was observed in the reduction of HbA1c levels between the intervention and control groups.	Even though both the intervention and control groups had improvements in the levels of HbA1c, the individuals using continuous glucose monitoring had significantly superior outcomes (p= 0.01)	Various limitations and biases can be associated with this research. For example, the devices used required calibrations two times a day. The intervention period was short; hence no insight into a possible extended period of time.	One of the recommendations is that a longer study period should be considered to ascertain the impact of this intervention over extended periods of time.	This article also supports the project in that the findings indicate the importance of continuous glucose monitoring in enabling patients with diabetes to achieve better HbA1c levels.
Cox, D. J., Banton, T., Moncrief, M., Conaway, M., Diamond, A., & McCall, A. L. (2020). Minimizing glucose excursions (GEM) with continuous glucose monitoring in type 2 diabetes: a randomized clinical trial. Journal of the Endocrine Society, 4(11), bvaa118. https://doi.org/10.1210/jendso/bvaa118	The aim of this study was to compare the impact of using continuous glucose monitoring and conventional medication management of type 2 diabetes on diabetes outcomes.	The study design employed was a randomized controlled trial	Setting: University of Virginia, USA Sample: Enrolled: 30 patientsDrop outs/Adverse events: none Methods: Participants were randomly assigned, by a flip of a coin in blocks of 3 by the data manager following a baseline assessment.The intervention period involved meeting in groups of 8 to 10 for 90 minutes on 4 occasions, with 1 week between sessions 1 and 2 and 3 weeks between sessions 2 and 3 and 3 and 4At each session, participants were given a 7-day Dexcom G5 sensor, and 1 month after session 4, a fifth sensor was givenThis study used various instruments, including the Medication Effect Scale, Diabetes Distress Scale, Quality of Life Scale, and Glucose Monitoring Satisfaction Survey. While some of these instruments can be applied in the research, others cannot be used. Data collection: questionnaire	A p = 0.03 was observed for the improvement of the HbA1c level.	One of the major findings is that the patients in the continuous glucose monitoring group reported improved diabetes outcomes, such as improvements in the HbA1c levels.	One of the limitations is that the sample size was small. Again the study period was short, with only a three-month follow-up period.	Similar studies should be done that considers a larger patient population and longer follow-up durations.	This research also supports the project as it shows the efficacy of using continuous glucose monitoring when compared to the usual diabetes care.
Karter, A. J., Parker, M. M., Moffet, H. H., Gilliam, L. K., & Dlott, R. (2021). Association of real-time continuous glucose monitoring with glycemic control and acute metabolic events among patients with insulin-treated diabetes. JAMA, 325(22), 2273-2284. https://doi:10.1001/jama.2021.6530	The purpose of this study was to estimate the clinical outcomes of using real-time continuous glucose monitoring among patients with diabetes.	A retrospective cohort study.	Setting: North California, USA Sample: Enrolled: 36080 patients with T2D and 5773 with T1DDrop outs/Adverse events: none Methods: Exploratory retrospective cohort study of changes in outcomes associated with real-time CGM initiation, estimated using a difference-in-differences analysis was performed.Patients were identified as real-time CGM initiators if they had a durable medical equipment vendor claim for real-time CGM supplies. Baseline for follow-up was defined by the date of the first real-time CGM claim or, for patients without a real-time CGM claim   Data collection: Ten point measurement of HbA1cintegrated health care delivery system	A p=0.001 was observed for the decline in HbA1c among patients using continuous glucose monitoring.	One of the relevant findings includes the observed reduction in HbA1c levels among patients using continuous glucose monitoring as compared to those who did not.	The study lacked the real power to detect associations between hyperglycemia and continuous glucose monitoring.	Other study designs are recommended since the findings may be susceptible to selection bias.	The article supports the proposed DPI project since it shows the efficacy of using continuous glucose monitoring in controlling diabetes.
Griauzde, D. H., Ling, G., Wray, D., DeJonckheere, M., Stout, K. M., Saslow, L. R., … & Richardson, C. R. (2022). Continuous Glucose Monitoring with Low-Carbohydrate Nutritional Coaching to Improve Type 2 Diabetes Control: Randomized Quality Improvement Program. Journal of Medical Internet Research, 24(2), e31184. https://doi.org/10.2196/31184	This study aimed to make comparisons in the changes in HbA1c levels among patients with type 2 diabetes and using either nutrition counseling or continuous glucose monitoring.	A pragmatic randomized quality improvement program.	Setting: University-affiliated family medicine clinicMichigan, USA Sample: Enrolled: 1554Drop outs/Adverse events: none Methods: The researchers  identified and randomized the entire population of adult patients with T2DM seen in the clinic to either a  (usual care) UC or an enhanced care (EC) armRoutine care included PCP follow-up and the opportunity to receive nutrition counseling with a primary care–based dietitian who counseled patients to follow the standard calorie-restricted American Diabetes Association diet without a specific emphasis on dietary carbohydrate restrictionThe enhance care arm used CGM Data collection:  Michigan Medicine web-based tool	A p= 0.04 was observed between the groups in terms of HbA1c reduction.	Among the key findings is that there was a significant reduction of HbA  q1c levels from the baseline and after 12 months following the intervention.	One of the limitations is that there is a potential lack of generalizability. The researchers did not manage to evaluate outcomes beyond one year.	One of the recommendations is that a similar study should be done for  a longer study period	This research also supports the proposed intervention since it shows that the use of continuous glucose monitoring is efficacious in controlling diabetes. Therefore, using if more patients use the CGM strategy to monitor their blood glucose, then the public will benefit a lot. This is because it will reduce the number of hospitalizations, reduce healthcare spending and increase productivity.
Dixon, R. F., Zisser, H., Layne, J. E., Barleen, N. A., Miller, D. P., Moloney, D. P., … & Riff, J. (2020). A virtual type 2 diabetes clinic using continuous glucose monitoring and endocrinology visits. Journal of Diabetes Science and Technology, 14(5), 908-911. https://doi.org/10.1177%2F1932296819888662	The purpose of this project was to examine the impact of a virtual diabetes clinic with various interventions, such as continuous glucose monitoring, on diabetes outcomes.	Experimental design	Setting: virtual diabetes clinic in 21 states across  USA Sample: Enrolled: 740Drop outs/Adverse events: none Methods: VDC is a telehealth program for people with T2D was used.The program combines mobile App technology, remote personalized lifestyle coaching from certified diabetes educators (CDEs) and health coaches, and connected tools and medical devices, including blood glucose (BG) meters and continuous glucose monitor (CGM) devices.The program is managed through an innovative software platform Data collection: Innovative database and software	A p=0.001 was observed in terms of reduction of HbA1c levels at the baseline and upon the use of the intervention.	Among the key findings is that individuals who participated in the virtual clinic while using continuous glucose monitoring had better outcomes. For example, improvements in the levels of HbA1c levels were observed.	This study had some limitations and biases. For example, there was a lack of a control group and a potential self-reflection bias. The follow-up duration was also short.	The researchers recommend a similar study with better designs, such as randomized controlled trials.	This article also supports the proposed project, as the results indicate the importance of using continuous glucose monitoring in caring for patients with diabetes. Since the diabetic patients who used CGM had better outcomes, it implied to my research that the more practitioners prescribe the intervention to more patients, the more is likely for them to reduce the use of emergency department in case of diabetes crisis, which eventually lead to better health outcomes in general.
Ruedy, K. J., Parkin, C. G., Riddlesworth, T. D., & Graham, C. (2017). Continuous glucose monitoring in older adults with type 1 and type 2 diabetes using multiple daily injections of insulin: results from the DIAMOND trial. Journal of diabetes science and technology, 11(6), 1138-1146. https://doi.org/10.1177%2F1932296817704445	The major aim of this study was to explore the effectiveness of real-time continuous glucose monitoring among adults with diabetes.	Randomized controlled trial	Setting: 29 endocrinology practices across USA and Canada Sample: Enrolled:  A total of 166 patients. 82 with T2D and 34 with T1DDrop outs/Adverse events: none Methods: Prior to randomization to either CGM or SMBG (Control), each participant used a CGM device for 2 weeks that recorded glucose concentrations not visible to the participant Participants in the CGM group were provided with a Dexcom™ G4 Platinum CGM System® with an enhanced algorithm (software 505) General guidelines were provided to participants about using CGMThe Control group was asked to perform home blood glucose monitoring at least 4 times dailyFollow-up visits for both treatment groups occurred after 4, 12, and 24 weeks.This study used various instruments. For instance, the researchers used the continuous glucose monitoring satisfaction scale. This instrument can also be used in the proposed project.   Data collection: Surveysquestionnaires	A p=0.001 was observed for the reduction in HbA1c levels after 24 weeks.	This study revealed key findings that are relevant to this study. For example, individuals who used continuous glucose monitoring had improvements in the levels of HbA1c after 24 weeks showing the efficacy of the intervention.	The researchers indicated that this study did not explore whether the use of continuous glucose monitoring would be appropriate in reducing severe hypoglycemia events.	Since the use of continuous glucose monitoring was found the be effective, it is recommended that the intervention be used more among older patients for better outcomes.	This article supports the proposed DPI project since it shows that the use of continuous glucose monitoring is key in helping patients to have better HbA1c levels hence better diabetes outcomes.

Table 3: Theoretical Framework Aligning to DPI Project

Nursing Theory Selected	APA Reference – Seminal Research References (Include the GCU permalink or working link used to access each article.)	The explanation of the Nursing Theory Guides the Practice Aspect of the DPI Project.
Dorothea Orem’s Self-Care theory	Denyes, M. J., Orem, D. E., & Bekel, G. (2001). Self-care: A foundational science. Nursing Science Quarterly, 14(1), 48-54. https://doi.org/10.1177%2F089431840101400113. Working link: https://journals.sagepub.com/doi/abs/10.1177/089431840101400113	This theory will be used in guiding my DNP project on diabetes management and prevention. Self-care is key in diabetes management. Therefore, the underpinnings will be key in helping the individuals evaluate themselves and choose the necessary actions required to attend to such needs by accomplishing actions (Butts & Rich, 2018). For instance, the intervention entails the use of continuous glucose monitoring. Therefore, patients can be motivated to follow the interventions for better care. The theory underlines that self-care is learned and is more natural to adults. Therefore, it will guide the project toward promoting self-care for healthcare well-being and self-maintenance among the identified patients living with diabetes.
Change Theory Selected	APA Reference – Seminal Research References (Include the GCU permalink or working link used to access each article.)	The explanation for How the Change Theory Outlines the Strategies for Implementing the Proposed Intervention
Kurt Lewin’s change theory	Cummings, S., Bridgman, T., & Brown, K. G. (2016). Unfreezing change as three steps: Rethinking Kurt Lewin’s legacy for change management. Human Relations, 69(1), 33-60. https://psycnet.apa.org/doi/10.1177/0018726715577707. Working link: https://psycnet.apa.org/record/2015-59100-003	Kurt Lewin’s change theory is one of the evidence-based change models or theories that have been widely applied in the nursing field to implement various initiatives. Kurt Lewin’s change theory is composed of three stages, unfreezing, change, and refreezing. The theory asserts that there are two types of forces, the driving forces and the restraining forces pushing in the direction that makes change happen and the direction that hinder the change respectively. As such, a change only occurs when the driving forces override the restraining forces. In the unfreezing stage, a method is proposed to help individuals move from old behavior patterns and accept change. The change or moving stage entails making changes in behavior, feeling, and thoughts. The final step, which is the refreezing stage, entails making the new change as the new habit, standard or normal. When applying the change model, the unfreezing stage will involve asserting the need for patients to have better glycemic control hence the need for more effective intervention. Therefore both the patients and the nurses will be made to appreciate the need for change. During this stage, the nurses involved will ensure that the patients see the urgency of the need to have well-controlled HbA1c levels.  The second step will involve the implementation of the proposed intervention for better diabetes outcomes. Support is offered to nurses who carry offer the intervention to patients, and the patients are encouraged to adhere to the intervention requirements. It is at this stage that the intervention is rolled out, and the patients are educated on diabetes self-management and the importance of continuous glucose monitoring. The final step will involve making the intervention part of standard practice to ensure that patients have better outcomes. Therefore, nurses will be advised to apply the intervention to patients with diabetes going forward for better diabetes outcomes such as glycemic control.

Table 4: Clinical Practice Guidelines (If applicable to your project/practice)

APA Reference – Clinical Guideline (Include the GCU permalink or working link used to access the article.)	APA Reference – Original Research (All) (Include the GCU permalink or working link used to access the article.)	The explanation for How Clinical Practice Guidelines Align to DPI Project
	Place the primary quantitative research used in the clinical practice guidelines in Table 1. This is part of the primary quantitative research used to support your intervention.

References

Beck, R. W., Riddlesworth, T. D., Ruedy, K., Ahmann, A., Haller, S., Kruger, D., … & DIAMOND Study Group. (2017). Continuous glucose monitoring versus usual care in patients with type 2 diabetes receiving multiple daily insulin injections: a randomized trial. Annals of Internal Medicine, 167(6), 365-374. https://doi.org/10.7326/M16-2855.

Bergenstal, R. M., Layne, J. E., Zisser, H., Gabbay, R. A., Barleen, N. A., Lee, A. A., … & Dixon, R. F. (2021). Remote application and use of real-time continuous glucose monitoring by adults with type 2 diabetes in a virtual diabetes clinic. Diabetes technology & therapeutics, 23(2), 128-132. https://doi.org/10.1089/dia.2020.0396.

Cox, D. J., Banton, T., Moncrief, M., Conaway, M., Diamond, A., & McCall, A. L. (2020). Minimizing glucose excursions (GEM) with continuous glucose monitoring in type 2 diabetes: a randomized clinical trial. Journal of the Endocrine Society, 4(11), bvaa118. https://doi.org/10.1210/jendso/bvaa118.

Cummings, S., Bridgman, T., & Brown, K. G. (2016). Unfreezing change as three steps: Rethinking Kurt Lewin’s legacy for change management. Human relations, 69(1), 33-60. https://psycnet.apa.org/doi/10.1177/0018726715577707. Working link: https://psycnet.apa.org/record/2015-59100-003

Denyes, M. J., Orem, D. E., & Bekel, G. (2001). Self-care: A foundational science. Nursing science quarterly, 14(1), 48-54. https://doi.org/10.1177%2F089431840101400113. Working link: https://journals.sagepub.com/doi/abs/10.1177/089431840101400113

Dixon, R. F., Zisser, H., Layne, J. E., Barleen, N. A., Miller, D. P., Moloney, D. P., … & Riff, J. (2020). A virtual type 2 diabetes clinic using continuous glucose monitoring and endocrinology visits. Journal of Diabetes Science and Technology, 14(5), 908-911. https://doi.org/10.1177%2F1932296819888662

Feig, D. S., Donovan, L. E., Corcoy, R., Murphy, K. E., Amiel, S. A., Hunt, K. F., … & Pragnell, M. (2017). Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomized controlled trial. The Lancet, 390(10110), 2347-2359. https://doi.org/10.1016/S0140-6736(17)32400-5

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