Doctor of Nursing Practice Program

• Committee Chair Name & Credentials:
  Laurie Connors, DNP, APRN, FAANP
• Committee Member Name & Credentials:
  Brian Widmar, PhD, RN, ACNP-BC, CCRN, CNE, FAANP, FCCM

DNP Project Abstract

Post Kidney Transplant Diabetes Education and Evaluation Positively Impacts Outcomes

Purpose
Diabetes mellitus (DM) is the leading cause of end-stage kidney disease (ESKD) and accounts for one-third of all patients initiating renal replacement therapy worldwide. However, the outcomes of patients with DM treated with dialysis or kidney transplant remain inferior to those without DM, and graft survival remains the lowest among patients with DM. Psychological disorders also have been frequently associated with poor outcomes in those with a DM diagnosis. The aim for the project is to investigate the impact of an interactive and collaborative education program on DM disease management to improve glycemic control and mitigate psychological distress associated with a poor understanding of diabetes management in transplant recipients with DM.

Methods
A single center, program evaluation utilized a retrospective chart review with a pre- and post- survey to assess glycemic control (HbA1c) and psychological distress (Diabetic Distress Scale) before and after educational sessions. The project received institutional review board approval, and informed consent was obtained from all participants. The surveys were distributed to a convenience sample of eleven kidney transplant recipients who were 1 year or less post-transplant with a documented diagnosis of DM as the cause of ESKD. An evidence-based written education were developed and utilized as the content outline for at least 2 hours of multidisciplinary diabetic educational sessions.

Results
Participation in a post-transplant tailored, multidisciplinary diabetic educational session resulted in a reduction of HbA1c [7.98 (SD 1.29) vs. 6.94 (SD 1.21)] and psychological distress as measured by Diabetes Distress Scale [2.14 (SD 0.57) vs. 1.39 (SD 0.89)]. The median time of education provided was 2.5 hours (IQR 2.5-2.75).

Implications for Practice
Participation in a post-transplant tailored, multidisciplinary diabetic education can improve glycemic control and mitigate the psychological distress in kidney transplant patients with DM comorbidity. Potential for further education on disease process would positively impact outcomes in transplant patient with DM.