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Revisions of a Clinical Practice Guideline for Diabetes Management Protocol Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2020 Revisions of a Clinical Practice Guideline for Diabetes Management Protocol Daniel O. Huston Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Nursing Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Health Sciences This is to certify that the doctoral study by Daniel Huston has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Diane Whitehead, Committee Chairperson, Nursing Faculty Dr. Amy Wilson, Committee Member, Nursing Faculty Dr. Melanie Braswell, University Reviewer, Nursing Faculty Chief Academic Officer and Provost Sue Subocz, Ph.D. Walden University 2020 Abstract Revisions of a Clinical Practice Guideline for Diabetes Management Protocol by Daniel O. Huston MS, Walden University, 2009 BS, Roberts Wesleyan College, 2005 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University February 2020 Abstract Management of type 2 diabetes mellitus (T2DM) is essential from cost and treatment perspectives. In 2017, costs associated with diabetes management in the United States amounted to approximately $327 billion. The treatment of T2DM has been in a dynamic state for the past several years with the arrival of new classes of medications and new data supporting the use of diabetes medications to reduce risks from cardiovascular disease and slow the decline of renal function. This project explored the current evidence on treatment of T2DM to support changing either the flow of the current protocol algorithm or the medications identified in the algorithm. Current evidence and guidelines for the treatment of T2DM were reviewed and critically appraised using the levels of evidence for prognostic studies guideline. Knowles’s theory of adult learning guided this project. Current evidence supported the recommendation to maintain the current protocol algorithm. A 2-member expert panel AGREE II tool review revealed their support of the current protocol. The expert panel indicated strong agreement with 98% of the items and agreement with the remaining 2%. The recommendation to continue the protocol algorithm was presented to the diabetes council. Treating T2DM patients using the most current recommendations can support improved quality of life for patients and families. Decision-making authority by nurse-led groups such as the diabetes council will promote positive social change within the organization. Revisions of a Clinical Practice Guideline for Diabetes Management Protocol by Daniel O. Huston MS, Walden University, 2009 BS, Roberts Wesleyan College, 2005 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University February 2020 Dedication I dedicate this paper and project to all those who have diabetes and to those who manage patients with diabetes. To my professional and personal family, for all the diligent and challenging roles they play in their treatment of persons with diabetes. Acknowledgments Thank you to the Walden University staff and facility members for their patience and support through this entire program. Thank you specifically to Dr. Diane Whitehead, who, as my instructor, was so much more, serving as a mentor and supporter of my trials and tribulations. Lastly, thank you to my loving wife, Bonny, for being supportive of me when I lost faith and drive to complete this project and for being my driver for project completion. Table of Contents List of Tables ..................................................................................................................... iv Section 1: Nature of the Project ...........................................................................................1 Introduction ....................................................................................................................1 Problem Statement .........................................................................................................1 Purpose ...........................................................................................................................2 Nature of the Doctoral Project .......................................................................................3 Significance....................................................................................................................4 Summary ........................................................................................................................5 Section 2: Background and Context ....................................................................................6 Introduction ....................................................................................................................6 Concepts, Models, and Theories ....................................................................................6 Relevance to Nursing Practice .......................................................................................8 Metformin (Biguanide) ........................................................................................... 9 Liraglutide (Victoza®; Glucagon-Like Peptide 1 Receptor Agonist [GLP1]) ..................................................................................................... 11 Empagliflozin (Jardiance®; Sodium Glucose Cotransporters [SGLT2 Inhibitor]) .................................................................................................. 12 Linagliptin (Tadjenta®; Dipeptidyl Peptidase-4 [DPP-4] Inhibitors) .................. 13 Sulfonylureas ........................................................................................................ 13 Thiazolidinediones ................................................................................................ 14 i Additional Medications ......................................................................................... 15 Local Background and Context ...................................................................................15 Role of the DNP Student..............................................................................................16 Role of the Project Team .............................................................................................16 Summary ......................................................................................................................17 Section 3: Collection and Analysis of Evidence ................................................................18 Introduction ..................................................................................................................18 Practice-Focused Question...........................................................................................18 Evidence Generated for This Project ...........................................................................18 Evidence Generated for the Doctoral Project ..............................................................19 Step 1: Critically Appraise the Evidence .............................................................. 19 Step 2: Synthesize the Evidence From the Literature ........................................... 25 Step 3: Develop the Revised Guideline ................................................................ 26 Step 4: Expert Panel Review ................................................................................. 26 Step 5: Finalize Guideline ..................................................................................... 27 Step 6: Present to Organization ............................................................................. 27 Summary ......................................................................................................................27 Section 4: Findings and Recommendations .......................................................................28 Introduction ..................................................................................................................28 Findings and Implications ............................................................................................28 Recommendations ........................................................................................................31 ii Strengths and Limitations of the Project ......................................................................31 Strengths ............................................................................................................... 31 Limitations ............................................................................................................ 32 Summary ......................................................................................................................33 Section 5: Dissemination Plan ...........................................................................................34 Analysis of Self ............................................................................................................34 Summary ......................................................................................................................35
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