Decreasing Glycosylated Hemoglobin with Nutrition, Exercise and Bi-Monthly Telephone Calls in Patients withType 2 Diabetes Mellitus

Abstract

Background: Decreasing glycosylated hemoglobin (HbgA1c) is a primary diabetes treatment goal. Despite the simplicity of the HbgA1c goal, failure to achieve this goal is a major healthcare concern. Healthcare providers fail to adequately educate patients on how to implement behavioral modifications needed for successful goal achievement. Narrowed focused patient encounters, reliance on patient self-education, denial, and delayed follow-up appointments limit a patient’s ability to implement required behavioral changes. Aim: This study was a quality improvement intervention designed to determine whether a personalized nutrition and exercise plan in conjunction with bi-monthly telephone reinforcement calls improved the HbgA1c of patients with type 2 diabetes mellitus. Setting: The study was conducted at a community clinic located in the southeastern U.S. that provides care predominantly to the working poor and uninsured patients. Sample: Type 2 diabetic patients (n = 40) with a baseline HbgA1c > 7%. Intervention: A nurse practitioner; certified diabetic educator and an exercise physiologist developed an individualized action plan with each participant. Baseline HbgA1c values were documented and participants were scheduled for three education sessions as well as telephone calls twice monthly for three months followed by a repeat HbgA1c. Results: Pretest and posttest HbgA1c data were analyzed using the Wilcoxon T-test statistic to determine if a personalized nutrition and exercise action plan in addition to bi-monthly telephone calls to the participants contributed to a decrease in the HbgA1c. Level of significance was set at an alpha value of less 0.05. The observed value of the test statistics t = 2.2714, with df = 62, p-value = 0.01292 rejects the null hypothesis. The p-value (0.012) demonstrated a significant improvement. Conclusion: Individualized attention and frequent reinforcement facilitated patients’ need to develop and integrate self-management behaviors, thereby, reducing the HbgA1c level and helping them to reach the desired goal.