week 7_POWEPONT- KEY STAKEHOLDER

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Nursing Problem Statement: Enhancing Glycemic Control in Black Adults with Type 2 Diabetes through Continuous Glucose Monitoring

Introduction

Type 2 diabetes has been one of the most urgent problems in the health of the population in the United States, where racial and ethnic minorities are disproportionately represented. The rates of diabetes complications such as kidney disease, retinopathy, neuropathy, and cardiovascular morbidity are higher in Black adults than in their White counterparts (Ebekozien et al., 2024). Ineffective glycemic control, especially where hemoglobin A1C (HbA1C) is above 9 per cent, dramatically raises the chances of emerging complications, hospitalization, and death. Although evidence-based guidelines suggest that Continuous Glucose Monitors (CGMs) should be used to enhance glucose management, their uptake among underserved Black adults is low due to barriers, including cost, limited access, and the absence of culturally specific education (Anderson et al., 2022; Shiyanbola et al., 2022).

The overall aim of this problem statement is to establish the difference between the current conditions of diabetes management in the chosen community-based primary care clinic and the preferred conditions after the application of evidence-based interventions. The proposed doctoral nursing practice (DNP) initiative will aim at improving the glycemic control of Black adults aged between 40 and 70 years with uncontrolled Type 2 Diabetes (HbA1c ≥9%) by increasing the utilization of CGMs via culturally sensitive interventions and community collaborations.

Current State of the Problem

Uncontrolled diabetes disproportionately impacts Black adults, and disparities in care continue to create inequities in health outcomes. Data were collected from our clinic's diabetes registry as part of a population health analysis (January–August 2025). The primary care clinic at the practicum site found that nearly 35 percent of Black patients with diabetes had an HbA1c above 9 percent, compared to 18 percent of non-Black patients. Clinic providers noted that not all eligible Black adults were using CGMs, with reports indicating that fewer than 10 percent of eligible adults were utilizing them. Patients cited affordability, unfamiliarity with the technology, and inadequate provider education on CGM use as barriers.

These results align with national data, which indicate that underserved groups encounter ongoing challenges in adopting diabetes technology, including insurance coverage restrictions, limited digital literacy, and structural disparities (Ebekozien et al., 2024). The existing situation is an indication of a disconnect between evidence-based care requirements in using CGMs as the primary factor in successful diabetes self-management and the reality of low-level adoption among the Black patients of the clinic.

Desired State After Evidence Implementation.

The goal is to significantly enhance glycemic control among Black adults with uncontrolled Type 2 Diabetes by increasing the use of CGM devices and participation in culturally relevant diabetes self-management programs. Evidence shows that using CGMs lowers HbA1c levels, improves patient engagement with care, and enables timely interventions by healthcare providers (Anderson et al., 2022). After implementing these evidence-based strategies, the clinic aims to reduce the number of eligible Black adults by increasing CGM use by at least 40 percent within 12 months. Additionally, it aims to decrease the proportion of Black adults with an HbA1c level of 9 percent or higher by 25 percent. Strengthening patient-provider relationships and engagement through culturally relevant education and community involvement.

Implement sustainable machinery and systems in a manner that provides equal access to CGM technology, regardless of socioeconomic status.

The intended condition may be defined as not only improved health outcomes but also the shift toward health equity, following national priorities in diabetes care (Weeks et al., 2024).

The Literary Evidence.

Recent studies highlight the effectiveness of technology-based and culturally-specific approaches in reducing disparities in diabetes management among black adults.

Technology-Based Interventions

A meta-analysis and systematic review conducted by Anderson et al. (2022) found that CGMs and other technology-based interventions would improve diabetes management in Black and Hispanic patients. These strategies have lowered HbA1c levels and enhanced medication adherence and self-efficacy among patients with diabetes. However, the paper emphasized the need to address access disparities to maximize benefits.

Ebekozien et al. (2024) also opined that the distribution of technology in diabetes can fairly recreate the results for underserved populations. They applied their efforts to formulating interventions that would reduce the cost-prohibitive threats and provide culturally sensitive care to maximize uptake and adherence.

Culturally Differentiated Programs.

The discussion conducted by Shiyanbola et al. (2022) has demonstrated the effectiveness of culturally specific diabetes self-management programs when supplemented with peer support from similar racial backgrounds. Their feasibility study found that such programs had a positive impact on beliefs about diabetes, medication adherence, and led to improved glycemic control among African American populations.

Similar findings were echoed by others, who reported the same outcome in a systematic review of community-based education programs. The review discovered that culturally relevant interventions have a positive and substantial effect on diabetes-related outcomes in Black communities. This cultural adaptation of the content, along with consideration of health beliefs and the community's location, increased patient attendance and the program's results.

The study conducted by Weeks et al. (2024) provided validation that faith-based education programs are particularly effective among Black communities. They concluded that incorporating self-management education into African American churches amplified their involvement and sustainability, and that community institutions trusted by the community had the most significant impact on reducing chronic disease disparities.

All these articles imply interventions that rely on the use of CGM technology along with culturally sensitive education and community engagement, as the most promising solutions to the disparity in the outcomes of diabetes management among Black adults.

Evidence-Based Intervention Proposed.

The intervention proposed in the practicum site implies a three-level intervention:

Expand Access to CGMs: Wage war on insurance companies and community organizations to reduce monetary obstacles. Train clinicians to prescribe and support the use of CGM in a way that ensures equal distribution.

Culturally Specific Education: Develops diabetes self-management learning programs in a culturally responsive manner for the Black adult community through peer support and community leaders. The source of learning will be grounded in both the practical use of CGMs and perceptions towards the management of diabetes.

Community Engagement: Collaborate with religious institutions and the community to deliver interventions in environments of trust, thereby enhancing participation and sustainability.

It has been proven that these approaches can be integrative to enhance the adoption of CGM and improve glycemic outcomes (Shiyanbola et al., 2022; Weeks et al., 2024). The intervention also complies with the recommendations of the American Diabetes Association on equity-based diabetes care.

Disparity between Present and Desired Situ.

As can be seen, a care gap exists. Although CGM technology is available and proven to be beneficial, its limited access and use among Black adults in the practicum location remain a problem. The current state can be described in terms of low adoption rates and a high incidence of the HbA1c rate. In contrast, the desired state is preconditioned by the popularity of CGM, cross-cultural-based education, and the degree of improvement in glycemic control.

To close this gap, it is essential to address structural, cultural, and educational barriers. The literature is very supportive of interventions that extend beyond the prescription of technology, including the inclusion of culturally relevant and community-based interventions to build trust and empowerment in patients. Unless such efforts are made, differences in diabetes outcomes will persist.

Nursing Practices Implications.

Advanced practice nurses are well-positioned to lead interventions that address both clinical and social determinants of health. By incorporating culturally specific and technology-based interventions for managing diabetes, nurses can enhance health equity and achieve improved outcomes for vulnerable populations. The project aligns with the Doctor of Nursing Practice (DNP) task of translating evidence into practice and systems-level change leadership (Chism, 2023).

Moreover, the nursing competencies of advocacy, cultural competence, and evidence-based practice, as discussed by Finkelman (2023), are also reflected in the intervention. Nurses in community-based clinics should not only deliver high-quality care but also address the systemic barriers to access to lifesaving technology.

Conclusion

Black adults with uncontrolled Type 2 Diabetes are a grave problem that can be resolved. Glycemic control and technology uptake have gross inequalities, and a minority of less than 10 percent of eligible adults with diabetes are adopting CGMs in their practice, yet the technology is standard among the community. Evidence on the application of evidence-based interventions, providing CGM access along with culturally specific education and community engagement, is widely evident in the literature. The identified gap that the proposed intervention will address is the disparity between the current state of poor outcomes in the healthcare system and the desired state of improved glycemic control, patient empowerment, and equal access to technology. Nursing leadership, evidence-based practice, and community collaborations will transform the outcomes of diabetes within the target population through this project.

References

Anderson, A., O'Connell, S. S., Thomas, C., & Chimmanamada, R. (2022). Telehealth interventions to improve diabetes management among Black and Hispanic patients: a systematic review and meta-analysis. Journal of Racial and Ethnic Health Disparities, 9(6), 2375-2386. https://doi.org/10.1007/s40615-021-01174-6

Ebekozien, O., Fantasia, K., Farrokhi, F., Sabharwal, A., & Kerr, D. (2024). Technology and health inequities in diabetes care: How do we widen access to underserved populations and utilize technology to improve outcomes for all?.  Diabetes, Obesity and Metabolism,  26, 3-13. https://doi.org/10.1111/dom.15470

Shiyanbola, O. O., Maurer, M., Schwerer, L., Sarkarati, N., Wen, M. J., Salihu, E. Y., ... & Williams, S. D. (2022). A culturally tailored diabetes self-management intervention incorporating race-congruent peer support to address beliefs, medication adherence, and diabetes control in African Americans: a pilot feasibility study.  Patient preference and adherence, 2893-2912. https://doi.org/10.2147/PPA.S384974

Singh, H., Fulton IV, J., Mirzazada, S., Saragosa, M., Uleryk, E. M., & Nelson, M. L. (2023). Community-based culturally tailored education programs for black communities with cardiovascular disease, diabetes, hypertension, and stroke: systematic review findings.  Journal of racial and ethnic health disparities,  10(6), 2986-3006. https://doi.org/10.1007/s40615-022-01474-5

Weeks, C. E., Waldrop, J., & Jessup, A. (2024). Tailoring African American Faith community-based diabetes self-management Education.  Journal of Christian Nursing,  41(2), 96-102. DOI: 10.1097/CNJ.0000000000001152