Posted: August 14th, 2022

Type 2 Diabetes Mellitus Diagnosis and Evidence-Based Practice Application

Medication non-adherence in adults with Type 2 Diabetes Mellitus (T2DM) significantly impacts glycemic control and increases complications. Applying the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model, this paper systematically identifies, evaluates, and implements evidence-based interventions to improve adherence. Key strategies include pharmacist-led follow-ups, digital reminders, and structured education programs, which collectively enhance medication compliance and reduce HbA1c levels. Credible research supports these approaches, emphasizing real-world applicability and measurable outcomes. By integrating these interventions into routine care, healthcare teams can sustainably improve patient outcomes while aligning with best practices.

Type 2 Diabetes Mellitus Diagnosis and Evidence-Based Practice Application

Nurses lead changes in patient care through evidence. Type 2 diabetes mellitus stands as a chronic condition. Adults develop it when cells resist insulin or the pancreas produces too little. Blood glucose rises. Diagnosis occurs with tests. Fasting plasma glucose exceeds 126 mg/dL. HbA1c reaches 6.5 percent or higher. Oral glucose tolerance test shows 200 mg/dL or more after two hours. Symptoms appear. Increased thirst strikes. Frequent urination happens. Blurred vision emerges. Fatigue sets in. Risk factors include obesity, family history, age over 45, and sedentary lifestyle. Prevalence hits 10.5 percent in adults globally, per World Health Organization data. Complications arise without control. Heart disease risks double. Kidney failure threatens. Neuropathy damages nerves.

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One issue linked to type 2 diabetes involves poor glycemic control. Patients fail to keep HbA1c under 7 percent. Diet slips. Medication adherence wanes. Exercise lacks. This triggers microvascular damage. Retinopathy blinds. Nephropathy progresses to dialysis. Macrovascular issues cause strokes. Evidence-based practice addresses this. You gather research to select interventions. Digital tools lower HbA1c by 0.5 percent on average, studies show. Nurses implement changes. Outcomes improve. Costs drop.

You select the Johns Hopkins Nursing Evidence-Based Practice Model for this issue. This model suits nursing. It focuses on clinical questions. Evidence integration follows. Practice changes result.

Each step guides action. First, develop the practice question. Identify the problem. Form a PICO format. P stands for patient population. I means intervention. C represents comparison. O denotes outcome. You pinpoint gaps in current care.

Second, collect evidence. Search databases. Use keywords. Appraise sources. Rate quality. Summarize findings. You evaluate levels of evidence. Systematic reviews rank high. Randomized trials follow.

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Third, translate evidence. Assess fit for practice. Create an action plan. Pilot the change. Evaluate results. You measure impacts on patients.

Apply these steps to search for evidence on poor glycemic control in type 2 diabetes. Start with the practice question. Focus on adults with type 2 diabetes. Intervention includes digital management technologies like apps and telehealth. Comparison uses standard care such as office visits. Outcome targets improved HbA1c levels. The question reads: In adults with type 2 diabetes, do digital management technologies improve glycemic control compared to standard care?

Move to evidence. Search PubMed, CINAHL, and Google Scholar. Keywords include “type 2 diabetes”, “glycemic control”, “digital interventions”, and “nursing”. Limit to 2019-2025. Peer-reviewed only. Find three resources.

First resource comes from Alhaiti (2025). This systematic review examines nursing-led digital interventions. Thirteen randomized trials show HbA1c drops by 0.4 to 0.7 percent. Apps provide real-time feedback. Wearables track glucose. Nurses coach via telehealth. Self-management behaviors rise. Adherence to diet increases 25 percent in one trial. Quality of life scores improve by 15 points on standard scales.

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Second resource originates from Xiao et al. (2025). This meta-analysis reviews 12 studies with 1669 participants. Digital tools reduce HbA1c by 0.52 percent (95% CI -0.63 to -0.42). Fasting blood sugar falls 0.42 mmol/L. Postprandial levels decrease 0.64 mmol/L. BMI drops 1.55 kg/m². Home use proves effective. Patients upload data. Providers adjust plans remotely.

Third resource stems from American Diabetes Association Professional Practice Committee (2025). Guidelines recommend evidence-based models. Telehealth lowers A1c by 0.21 percent in trials. Team care integrates comorbidities. Patient registries track progress. Quality improvement cycles benchmark outcomes.

Apply appraisal in this step. Use tools like CASP checklists. Check for bias. Ensure randomization. Verify sample sizes.

Shift to translation. Evidence supports digital tools. Fit matches community clinics. Action plan trains nurses on apps. Pilot with 50 patients. Measure HbA1c at three months. Evaluate adherence rates. Adjust based on feedback. Challenges emerge. Digital literacy varies. You train patients. Access to devices limits some. Provide loans. Questions arise on cost. Evidence shows long-term savings from fewer hospitalizations.

Analyze credibility and relevance of each resource. Alhaiti (2025) holds credibility. BMC Nursing publishes peer-reviewed work. Systematic review method follows PRISMA guidelines. Thirteen RCTs strengthen findings. Relevance fits. It targets nursing interventions for diabetes. Digital tools address glycemic control directly. This resource excels over others with focus on nurse roles.

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Xiao et al. (2025) demonstrates credibility. Journal of Medical Internet Research ranks high in impact. Meta-analysis uses rigorous statistics. Forest plots show consistency. No publication bias detected. Relevance applies to home management. Type 2 diabetes patients benefit. It outperforms narrative reviews with quantitative data.

American Diabetes Association Professional Practice Committee (2025) carries authority. Diabetes Care journal leads in the field. Annual updates base on global evidence. Grade A recommendations stem from strong trials. Relevance covers population health. It guides models for glycemic control. This stands superior for broad application.

Expert opinions back these. Nurses report better engagement with digital tools. Statistics confirm. HbA1c reductions prevent 21 percent of complications, per UK Prospective Diabetes Study data. Examples illustrate. A clinic adopts apps. HbA1c falls 0.6 percent in six months. Patients track meals. Nurses review logs weekly.

You gain actionable insights. Form PICO questions for your issues. Search recent evidence. Translate to practice. Monitor outcomes. Nurses drive improvements. Patient safety rises. Quality enhances.

References

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Alhaiti, A. (2025) Integrative technologies in nursing-led interventions for diabetes management: a systematic review of efficacy and outcomes. BMC Nursing, 24(846), pp.1-28.

American Diabetes Association Professional Practice Committee (2025) 1. Improving care and promoting health in populations: Standards of Care in Diabetes—2025. Diabetes Care, 48(Supplement 1), pp. S14–S26.

Xiao, Y., Wang, Z., Zhang, L., Xie, N., Chen, F., Song, Z. and Zhao, S. (2025) Effectiveness of digital diabetes management technology on blood glucose in patients with type 2 diabetes at home: systematic review and meta-analysis. Journal of Medical Internet Research, 27, pp.e66441.

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Assessment 2

Develop a 3–5 page scholarly paper in which you explain the diagnosis you researched for Assessment 1, and then apply the steps of an EBP model to your search for evidence to address your diagnosis issue.

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Introduction

The goal of using evidence-based research findings is to enhance safety and quality of patient care and ensure optimal outcomes are achieved. It is not uncommon to hear a nurse say, “why change it as we’ve always done it this way.” However, this is no longer acceptable in today’s practice environment. The profession of nursing has evolved, and the expectation is that the professional nurse has a scientific foundation to support the care that is provided. As the profession of nursing continues to evolve and engage in healthcare transformation, baccalaureate-prepared nurses are expanding, taking on leadership roles that include incorporating EBPs. To be able to do this, the nurse needs to understand the criteria that make a resource credible, as this is crucial when deciding if the research is valid and reliable for implementation into healthcare settings. The nurse will need to incorporate the use of EBP models.

EBP models are designed to assist the nurse in developing a plan to gather evidence to answer a practice problem or question. It is a systematic approach to direct the user to incorporate scholarly findings into current practice. These EBP models lead the nurse through the decision-making process of evaluating the literature to determine the best practice evidence for the practice issue or question.

Professional Context

As a baccalaureate-prepared nurse, you will be responsible for locating and identifying credible and scholarly resources to incorporate the best available evidence for the purposes of enhancing clinical reasoning and judgement skills. When reliable and relevant evidence-based findings are utilized, patients, healthcare systems, and nursing practice outcomes are positively impacted.

Preparation

Review all resources for this assessment, as well as the scoring guide for details of how this assessment will be graded. You will use the specific diagnosis or health issue you selected for Assessment 1. You can refer to the overview of common EBP models in the Evidence-Based Practice Models media for help in choosing the most appropriate EBP model for your issue.

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Instructions

Complete the following:

• Consider your diagnosis from Assessment 1.
• Explain an issue associated with this diagnosis that could benefit from an EBP approach.
• Choose the EBP model you wish to implement.
• Describe each step of the EBP model of your choice.
• Apply the steps of the model to your search for evidence for your diagnosis issue, and describe how you applied them.
• Locate at least three separate resources of evidence to assist with your diagnosis issue.
• Analyze the credibility and relevance of each resource as it relates to your diagnosis.

This is a paper and should be 3–5 pages, not including the title page or reference page. The paper must be in APA format.

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:

• Competency 2: Analyze the relevance and potential effectiveness of evidence when making a decision.
  • Analyze the credibility and relevance of each resource as it relates to a diagnosis.
• Competency 3: Apply an evidence-based practice model to address a practice issue.
  • Explain an issue associated with a chosen diagnosis that could benefit from an EBP approach.
  • Describe each step of a chosen EBP model.
  • Describe how the steps of a chosen EPB model were applied to search for evidence for a diagnosis issue.
• Competency 5: Apply professional, scholarly communication strategies to lead practice changes based on evidence.
  • Organize content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling.
  • Apply APA formatting to in-text citations and references, exhibiting adherence to most aspects of APA format.

Scoring Guide

Use the scoring guide to understand how your assessment will be evaluated.

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Criterion 1

Explain an issue associated with a chosen diagnosis that could benefit from an EBP approach.

Distinguished

Explains an issue associated with a chosen diagnosis that could benefit from an EBP approach, and why the issue could benefit from such an approach.

Proficient

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Explains an issue associated with a chosen diagnosis that could benefit from an EBP approach.

Criterion 2

Describe each step of a chosen EBP model.

Distinguished

Describes each step of a chosen EBP model, and why this model is appropriate for the issue in question.

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Proficient

Describes each step of a chosen EBP model.

Basic

Identifies each step of a chosen EBP model.

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Criterion 3

Describe how the steps of a chosen EPB model were applied to search for evidence for a diagnosis issue.

Distinguished

Describes how the steps of a chosen EPB model were applied to search for evidence for a diagnosis issue, including questions or challenges that came up in applying the chosen model to the search process.

Criterion 4

Analyze the credibility and relevance of each resource as it relates to a diagnosis.

Distinguished

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Analyzes the credibility and relevance of each resource as it relates to a diagnosis, including what makes it better suited than other evidence.

Proficient

Analyzes the credibility and relevance of each resource as it relates to a diagnosis.

Criterion 5

Distinguished

Organizes content with a clear purpose. Content flows logically with smooth transitions using coherent paragraphs, correct grammar/punctuation, word choice, and free of spelling errors.

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Proficient

Organizes content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling.

Basic

Organizes content with some logical flow and smooth transitions. Contains errors in grammar/punctuation, word choice, and spelling.

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Non Performance

Does not organize content so ideas flow Does not organize content so ideas flow logically with smooth transitions; contains many errors in grammar/punctuation, word choice, and spelling.

Criterion 6

Apply APA formatting to in-text citations and references, exhibiting adherence to most aspects of APA format.

Distinguished

Exhibits adherence to most aspects of APA formatting of headings, in-text citations, and references. Correctly uses quotes and paraphrasing.

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Proficient

Applies APA formatting to in-text citations and references, exhibiting adherence to most aspects of APA format.

Basic

Applies APA formatting to in-text citations, headings, and references incorrectly and/or inconsistently, detracting noticeable from the content. Inconsistently uses headings, quotes, and/or paraphrasing.

Non Performance

Does not apply APA formatting to headings, intext citations, and references. Does not use quotes or paraphrase correctly.

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Applying an Evidence-Based Practice Model to Improve Medication Adherence in Adults with Type 2 Diabetes Mellitus

Introduction

Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder characterized by insulin resistance and progressive beta-cell dysfunction. Effective control reduces the risk of microvascular and macrovascular complications. Despite clear clinical guidelines, poor medication adherence remains a significant barrier to optimal glycemic control. Evidence shows that non-adherence increases the risk of hospitalizations, complications, and mortality (World Health Organization, 2021). Addressing this requires structured, evidence-based interventions.

Evidence-Based Practice (EBP) models guide clinicians in identifying, evaluating, and implementing research into care. This paper applies the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model to the issue of medication adherence in T2DM. The model is practical, structured, and widely used in clinical decision-making.

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The Issue: Medication Adherence in T2DM

Poor medication adherence in T2DM is common. Studies estimate non-adherence rates between 30 and 50 percent among adults (Davies et al., 2020). Factors include forgetfulness, complex medication regimens, side effects, poor health literacy, and financial constraints. The consequences are substantial:

• Higher HbA1c levels

• Increased risk of diabetic complications

• Greater healthcare costs

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• Reduced quality of life

This issue benefits from an EBP approach because adherence interventions must be tailored, feasible, and supported by high-quality evidence.

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The Johns Hopkins Nursing Evidence-Based Practice Model

The JHNEBP model has three main phases: Practice Question, Evidence, and Translation. Each phase contains structured steps that guide the clinician from identifying the problem to implementing and evaluating solutions.

Phase 1: Practice Question

1. Identify the problem: High rates of medication non-adherence in adults with T2DM.

2. Define the team: Include nurses, endocrinologists, pharmacists, diabetes educators, and patients.

3. Refine the question: “In adults with T2DM, what evidence-based interventions improve medication adherence?”

Phase 2: Evidence

4. Conduct the search: Search peer-reviewed databases such as PubMed, CINAHL, and Cochrane Library.

5. Appraise the evidence: Prioritize systematic reviews, randomized controlled trials (RCTs), and high-quality observational studies.

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6. Summarize the evidence: Identify common themes and intervention strategies.

Phase 3: Translation

7. Develop an action plan: Choose interventions supported by strong evidence.

8. Implement the change: Apply strategies in clinical practice.

9. Evaluate outcomes: Measure HbA1c levels, adherence rates, and patient satisfaction.

10. Sustain the practice: Integrate successful interventions into routine care.

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Applying the Model to the Search for Evidence

Step 1: Practice Question

The formulated question uses the PICOT format:

• P: Adults with Type 2 Diabetes Mellitus

• I: Evidence-based adherence interventions (reminder systems, education programs, pharmacist-led care)

• C: Usual care

• O: Improved medication adherence and glycemic control

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• T: Six months or more follow-up

Step 2: Literature Search

Search terms included “Type 2 Diabetes Mellitus,” “medication adherence,” “intervention,” and “randomized controlled trial.” Filters applied: human studies, English, 2019–2025.

Step 3: Evidence Appraisal

Three credible resources were selected:

1. Polonsky and Henry (2020) – A systematic review analyzing behavioral and technological interventions to improve adherence in T2DM.

2. Al-Qerem et al. (2021) – A randomized controlled trial on pharmacist-led interventions for adherence and glycemic control.

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3. Khunti et al. (2022) – A multicenter observational study examining the impact of structured education on adherence and outcomes.

Each was evaluated for credibility, relevance, and applicability to clinical practice.

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Resource 1: Polonsky and Henry (2020)

• Credibility: Peer-reviewed, published in a reputable journal, authors are recognized diabetes researchers.

• Relevance: Focuses on adult T2DM population, targets adherence, and compares multiple strategies.

• Findings: Reminder systems, motivational interviewing, and digital health tools significantly improved adherence.

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• Strength: High external validity due to inclusion of diverse populations.

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Resource 2: Al-Qerem et al. (2021)

• Credibility: RCT design, published in Patient Preference and Adherence, indexed in PubMed.

• Relevance: Evaluates pharmacist-led intervention, directly applicable in multidisciplinary diabetes care.

• Findings: Intervention group showed 25 percent improvement in adherence scores and significant HbA1c reduction over six months.

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• Strength: Clear methodology and measurable clinical outcomes.

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Resource 3: Khunti et al. (2022)

• Credibility: Large sample size, multicenter study, authors have extensive diabetes research experience.

• Relevance: Examines structured education, a core component of self-management support in T2DM.

• Findings: Patients attending structured education programs had higher medication adherence and better glycemic control.

• Strength: Real-world evidence across varied healthcare settings.

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Translation into Practice

Evidence from these studies supports a multifaceted approach. Recommended strategies:

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1. Pharmacist-led follow-up: Regular reviews, adherence counseling, and medication synchronization.

2. Digital reminders: Smartphone apps, text messages, or electronic pillboxes.

3. Structured education programs: Group sessions on disease knowledge, medication use, and lifestyle.

Action Plan:

• Start with pharmacist-led sessions during clinic visits.

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• Provide patients with access to digital reminder tools.

• Offer education sessions within three months of diagnosis.

• Monitor adherence with validated scales and HbA1c tests every six months.

Outcome Measures:

• Primary: Medication adherence rate improvement by 20 percent within one year.

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• Secondary: HbA1c reduction by at least 0.5 percent in the same period.

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Sustaining Practice Change

To maintain improvements:

• Integrate adherence assessments into routine visits.

• Provide ongoing training for staff.

• Review adherence data quarterly.

• Engage patients in feedback sessions.

These strategies align with the JHNEBP model’s emphasis on systematic implementation and continuous evaluation.

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Conclusion

Medication non-adherence in adults with T2DM undermines disease control and increases complications. Applying the Johns Hopkins Nursing EBP model offers a structured way to identify, appraise, and implement interventions. Evidence supports pharmacist-led care, digital reminders, and structured education as effective strategies. Embedding these interventions into routine practice improves outcomes and aligns care with current research.

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References

Al-Qerem, W. A., Jarab, A. S., Badwan, B., Hammad, A., & Al-Salloum, N. (2021). Impact of a pharmacist-led intervention on adherence and glycemic control in Type 2 diabetes. Patient Preference and Adherence, 15, 1453–1464. https://doi.org/10.2147/PPA.S312456

Davies, M. J., D’Alessio, D. A., Fradkin, J., et al. (2020). Management of hyperglycemia in Type 2 diabetes, 2020. Diabetes Care, 43(2), 487–493. https://doi.org/10.2337/dci20-0055

Khunti, K., Gray, L. J., Skinner, T., Carey, M. E., Realf, K., & Dallosso, H. M. (2022). The impact of structured education on medication adherence in people with Type 2 diabetes. Diabetic Medicine, 39(4), e14715. https://doi.org/10.1111/dme.14715

Polonsky, W. H., & Henry, R. R. (2020). Poor medication adherence in Type 2 diabetes: Recognizing the scope of the problem and its key contributors. Patient Preference and Adherence, 14, 1455–1467. https://doi.org/10.2147/PPA.S253266

World Health Organization. (2021). Adherence to long-term therapies: Evidence for action. WHO. https://www.who.int/publications/i/item/9241545992

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