Date of Degree

12-2019

Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)

Program

Nursing

Advisor

Christina Hernandez

Advisor

Uriel Torres

Abstract

The incidence of type 2 diabetes has increased dramatically and is associated with many problems, including chronic kidney disease. The purpose of this quality improvement project was to implement two evidence-based guidelines that may detect chronic kidney disease and slow its progression in patients with type 2 diabetes by implementing angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy according to evidence-based guidelines from the American Diabetes Association. Patients with type diabetes were screened for microalbuminuria and eGFR of < 60 mL/min/1.73 m2. Based on lab results, the provider recommended either an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker to patients with as appropriate. The primary aim of this project was to achieve 80% implementation of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker for patients with type 2 diabetes who met criteria. Second, seventy to 90 percent of early progression to chronic kidney disease among those with type 2 diabetes was to be identified via blood and urine testing. One hundred and sixty-three patients with type 2 diabetes were seen during the implementation phase and screened, and one hundred and thirty-two patients who needed an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker were placed on one or the other. Thirteen patients were on an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker prior to project implementation. Introducing an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker as recommended for many patients with type 2 diabetes may slow the progression of chronic kidney disease and improve quality of life.

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