Date of Award


Degree Type

Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Scarlet R. Spain


Type 2 diabetes mellitus (T2DM) is a chronic disease characterized by increased amounts of glucose in the blood, and is the seventh leading cause of death in the United States (United Health Foundation [UHF]), 2021). T2DM can be effectively treated with medication and behavioral lifestyle modifications. Even small improvements in glycemic control can reduce the risk for debilitating complications such as heart disease, stroke, kidney disease, sepsis, and retinopathy (Wang et al., 2021, Haider et al., 2019). The purpose of this evidence-based practice (EBP) project was to identify the most effective intervention for improving medication adherence, lifestyle changes, and hemoglobin A1C (HbA1c). Participants were recruited from a primary care practice in Northwest Indiana. Eligible participants included adults aged 18 to 65 years old, with a diagnosis of T2DM, HbA1c greater than 7%, and prescribed one or more OAD medications. Participants completed a questionnaire containing the eight-item Morisky Medication Adherence Scale (MMAS-8) to assess medication nonadherence, and two Likert scale questions on diet and exercise to assess lifestyle changes before and after the 12-week practice change. HbA1c was collected prior to and after the practice change of receiving one daily one-way text message reminder to take their OAD medications, brief diabetic education, and/or motivational text messages focused on healthy eating habits and exercise. Data was analyzed using a Wilcoxon Signed Ranks matched pairs t-test to compare the pre-and post-intervention MMAS-8 scores and HbA1c data. Statistically significant differences were noted between the pre and post HbA1c levels (p-value = .002) and the pre and post MMAS-8 scores (p-value = .004). The Spearman correlation test was performed to show correlations between the pre-and post-MMAS-8 scores and HbA1c, and lastly a Kruskal-Wallis test was used to show if diet and exercise played a role in improving HbA1c. Findings from this project support the use of this simple and cost-effective mobile intervention in the management of diabetic patients in a primary care setting.

Creative Commons License

Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License
This work is licensed under a Creative Commons Attribution-NonCommercial-Share Alike 4.0 International License.

V. Silverio DNP poster.pdf (221 kB)