Date of Award
Doctor of Nursing (ND)
Hector R. Morales, DNP, APRN, PHH/CS-BC
Background: The Centers for Disease Control and Prevention has identified Type 2 diabetes mellitus (T2DM) as a leading cause of death in the United States. More than 37 million people in the United States currently carry this diagnosis. Metformin and a low carbohydrate diet are currently first-line treatments for T2DM. Glucagon-like peptide 1 receptor agonists, for example, semaglutide, can be introduced to reduce circulating levels of hemoglobin A1c (HbA1c). The goal of this quality improvement (QI) project is to add semaglutide to reduce HbA1c levels to below 7.5% in T2DM patients managed with metformin alone. After completing a ten-day assessment to evaluate my current practice, a review of the evidence-based literature was performed to identify opportunities to improve the care provided to my T2DM patients. Approval by my employer was obtained. In my current practice, patients diagnosed with T2DM are provided with education on the importance of a low carbohydrate diet and weight loss and started on metformin. Results from the literature review suggested that semaglutide (0.25 mg subcutaneously delivered weekly) might be effective at reducing circulating HbA1c levels in these patients. The resulting eight-week QI project focused on reducing circulating HbA1c levels and improving overall health and quality of life in this patient population.
Methods: The Plan-Do-Study-Act (PDSA) model was used in the design of this QI project. The Q1 project was conducted over eight weeks at Village Medical in El Paso, Texas. Baseline assessments, including patient medical histories and HbA1c levels, were obtained before initiating the new intervention. HbA1c levels were re-evaluated in our office four weeks after initiating semaglutide therapy. The patients were also provided with education on low carbohydrate diets, portion control, and the importance of cardiovascular exercise. Reassessments and adjustments were made as appropriate. Intervention: Based on evidence from the literature review, semaglutide was provided to patients diagnosed with T2DM to reduce circulating levels of HbA1c. The QI project utilized the RE- AIM framework because it promotes health and translates evidence into practice for the management of chronic diseases.
Results: Fifteen patients (five males and ten females, aged 43–69 years) met the inclusion criteria for this study with baseline HbA1c levels ranging from 7.5–10.7%. At the end of the four-week trial, all patients exhibited improvements in Hb1Ac levels. Eleven patients met the stated goal and achieved levels of HbA1c that were below 7.5% (i.e., at 6.8–7.4%). The three remaining patients also presented with reduced HbA1c levels but did not meet this specific goal. One patient reported that the medication was not used as directed. Patients also reported that they were more successful at following a low carbohydrate diet and increasing exercise than they had been previously.
Conclusions: In this QI project, semaglutide was added to a pre-existing metformin regimen to reduce HbA1c levels to <7.5% in patients with T2DM to improve their overall health. Reductions in HbA1c levels may be associated with weight loss as well as reductions in blood pressure, cardiac risk factors, and the risk of kidney injury. Providing patients with evidence- based interventions and ongoing guidance will improve their overall health.
Valle, Christina, "Semaglutide Added to Type 2 Diabetes Mellitus Treatment for Improvement in Hemoglobin A1c" (2023). Cohort XI. 3.