Project Coversheet

Date of Award


Degree Type

DNP Project

Degree Name

Doctor of Nursing (ND)




Hector R. Morales, DNP, APRN, PMH/CS-BC


Background: Current guidelines recommend metformin as the first-line agent therapy for the

management of Type 2 Diabetes (T2D) when diet and exercise are insufficient. When

monotherapy with metformin is intolerant or contraindicated, or not sufficiently effective to

reach the glycated hemoglobin (HbA1c) target, a second anti-diabetic agent as an alternative or

add-therapy to metformin is recommended by all guidelines. The quality improvement project

was initiated in the fall semester with a 10-day reflective practice log to assess my current

practice. A review of the clinical practice log allowed for evaluation of my current practice and

identify three opportunities to improve my practice. I developed three potential PICOT questions

and selected one for the QI project with the guidance of my Doctor of Nursing Practice (DNP)

chairperson. I performed a literature review in search of the best evidence-based intervention to

improve my practice. My current practice is metformin 500-1000mg twice daily as a first line

treatment for T2DM. The new evidence-based intervention that I found in the literature review

was to initiate empagliflozin 10-25mg once daily as the first line treatment or as add-on therapy

to metformin in adults 18 to 78 years of age with uncontrolled T2DM. The evidenced based QI

proposal was presented to the Internal Review Board (IRB) at The University of Texas at El Paso

(UTEP) and my worksite manager. An Approval letter was obtained from the IRB at UTEP and

work site manager before initiation of the QI project. The evidence-based QI project was

implemented for six weeks in the Spring semester.

Purpose: This Quality Improvement (QI) project aims to use a sodium-glucose cotransporter 2

(SGLT2) inhibitor alone or in combination with other agents to improve glycemic control in

patients 18 to 78 years of age with uncontrolled T2DM (HbA1c >7%) within 4 weeks.


Methods: The Plan-Do-Study-Act (PDSA) method of quality improvement was used in this

project. Baseline HbA1c levels were recorded at the first visit before initiating the intervention.

Post-intervention HbA1c levels were recorded two weeks after initiating the intervention to

assess its efficacy and tolerance of the new medication. Blood pressure and weight were

recorded on the first visit and after initiating intervention.

Intervention: The SGLT2 inhibitor, empagliflozin was selected as first-line therapy for patients

with new-onset T2DM. Empagliflozin was added as a combination treatment to the drug

regimens of patients who presented with T2DM that was not adequately controlled by

metformin. Inclusion criteria were (1) all patients 18–79 years of age who were (2) newly

diagnosed or presenting with uncontrolled T2DM (HbA1c >7%). Kurt Lewin’s three-step model

was used as the translational theoretic framework for this project. The steps included (1)

Unfreeze (i.e., acknowledging that a change is needed); (2) Change (i.e., initiate treatment with

an SGLT2 inhibitor, and (3) Refreeze (i.e., make the change permanent and continue the patient

on this drug).

Results: Nineteen patients between the ages of 23–78 years old (18 females and one male) were

identified in the QI project. The average reduction in HbA1c levels was 0.21%. Thus, the results

of this project suggested an overall trend toward improvement of glycemic control.

Conclusion: Empagliflozin provided as monotherapy or as an add-on to metformin was effective

at reducing HbA1c to improve glycemic control. Patients treated with empagliflozin also

responded with reduced systolic blood pressure and weight loss

Included in

Nursing Commons