Document Type

DNP Project


School of Nursing

Date of Degree

Spring 2021


Doctor of Nursing Practice (DNP)

Primary Advisor

Dr. Joyce Knestrick, PhD, FNP-BC, FAANP, FAAN; Dr. Karen Kesten, DNP, APRN, CCNS, CNE, CCRN-K, FAAN


Diabetes; Diabetes Self-Management Education (DSME); African American


Background: Type II diabetes continues to be a pervasive issue among African American adults. Significant challenges in effective management have resulted in poor health outcomes that have disproportionately threatened the quality of life among this group and increased the risk of mortality. Diabetes Self-Management Education (DSME) has demonstrated success in improved patient management and its capacity to mitigate risks for complications. Although researchers and health institutions generally accept DSME as an effective tool for managing diabetes, limited studies exist on its efficacy for African Americans.

Purpose: This study aimed to examine the effects of DSME intervention on diabetes management among adult African American patients. Aims included improving HbA1 control, improving self-management through patient education, and decreasing modifiable risk factors of cardiovascular disease by improving blood pressure control, lowering lipid levels, and accomplishing weight reduction.

Methods: Guided by the Iowa Model, this project was conducted using a pre/post-intervention design over the course of three months. DSME was offered during practice appointments to adult African American patients in primary care. Thirty-Four participants were included in this study. Outcomes of interest included Hemoglobin A1c (HbA1c), Low-density Lipoprotein (LDL), weight, Blood Pressure (BP), patient knowledge, and patient management confidence. A paired t test was conducted for continuous variables, and a chi square test was for categorical variables.

Results: Significant improvement was observed in SKILLD assessment results (16.9% increase, p<0.001). Mixed results were discovered for Hba1c improvement; 64.7 % of participants met HbA1c <8 post DSME intervention compared to 47% pre-intervention, however, HbAlc did not meet statistical significance in aggregate (p=0.142). Improvement in LDL control was observed (+23.9%, p=0.049). Results, however, did not meet the goal of 60% of participants with controlled LDL. No significant reductions were observed with BMI (-0.2, p=0.273) and blood pressure (SBP -3.8, p=0.11; DBP - 1.6, p=0.18)

Conclusions: DSME intervention is beneficial in improving patient knowledge, glycemic control, and cholesterol. DSME may not be sufficient in improving weight and blood pressure control; however, further studies may demonstrate higher efficacy amongst these variables. DSME may be an effective tool in decreasing specific risk factors for diabetic complications among African Americans. Further studies will need to be completed to conclude the long-term efficacy of DSME.

Open Access


Included in

Nursing Commons



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