Document Type
DNP Project
Publication Date
2025
Degree Name
Doctor of Nursing Practice
Faculty Advisor
Dr. Kerry A. Milner, DNSc, APRN, FNP-BC, EBP-C
Abstract
Significance and Background
Incarcerated individuals have a higher incidence of type 2 diabetes (T2D) than the general population and face unique challenges in managing their condition. These include limited access to nutritious food, disruptions in the healthcare continuity, and socioeconomic barriers such as unstable housing and unemployment. Upon release these challenges can compromise glycemic control.
The Transitions Clinic Model supports formerly incarcerated individuals in managing chronic conditions, including T2D during their reintegration. Continuous Glucose Monitors (CGM) have been shown to improve glycemic control and self-efficacy, leading to reductions in Hemoglobin A1c (HbA1c) levels. This project aimed to implement a CGM workflow at a federally qualified health center (FQHC) in Connecticut to improve glycemic control in this patient population.
Project Goals
The primary goal of this project was to implement a CGM workflow to achieve a 0.5% reduction in HbA1c among 75% of patients with T2D on insulin within three months. A secondary goal was to increase CGM usage by 10% among patients with T2D on insulin within the same timeframe.
Methods
A CGM prescribing protocol was developed through provider and staff interviews at the FQHC. Staff received education on the new protocol, which was implemented over three months, from November 7, 2024, to February 7, 2025. As part of the workflow, patients met with the diabetes specialty nurse for diabetes management and CGM education. During these visits, CGM reports were obtained and sent to the prescribing provider for review. Data collected included baseline and post-intervention HbA1c levels, average blood glucose time-in-range, time-above-range, and time-below-range.
Results
This project demonstrated significant improvements in glycemic control among 17 participants with T2D using CGM. After three months, average HbA1c decreased from 9.14% to 7.67%, and CGM use increased, with seven prescriptions issued and five patients attending follow-up visits. Time-in-range improved by 19.65%, while time-above-range decreased by 19.5%. The average blood glucose level dropped from 185 mg/dL to 147.8 mg/dL.
Conclusion
Results indicate that integrating CGM with diabetes education and follow-up care can improve glycemic control for individuals with T2D, particularly those transitioning from incarceration.
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-Share Alike 4.0 International License.
Recommended Citation
Mason, L.E. (2025). Improving hemoglobin A1c levels in a FQHC: A quality improvement project [Unpublished DNP project]. Sacred Heart University.
Comments
A DNP project submitted in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice, Sacred Heart University Davis & Henley College of Nursing.