Date of Award

January 2026

Document Type

Thesis

Degree Name

Doctor of Nursing Practice (DNP)

Department

Yale University School of Nursing

First Advisor

Neesha Ramchandani

Abstract

AbstractDisparities and Barriers in the Utilization of the Novel Glucose-Lowering Therapies for Type 2 Diabetes Diabetes mellitus affects approximately 38 million Americans, and 90–98% diagnosed with type 2 diabetes. It is the most expensive chronic disease in the United States, with an annual cost of $413 billion, and is associated with increased risk of cardiorenal complications that might be prevented with treatment. Newer glucose‑lowering therapies, glucagon‑like peptide‑1 receptor agonists (GLP‑1 RA) and sodium–glucose cotransporter‑2 inhibitors (SGLT2i), provide significant glycemic and cardiorenal benefits and are recommended first or second‑line treatments. Despite these benefits, their use remains limited due to barriers such as side effects, cost, limited awareness of therapeutic advantages, and disparities related to socioeconomic status. The objective of this quality improvement project was to develop and implement a multifaceted protocol to reduce disparities and barriers in the utilization of GLP‑1 RA and SGLT2i. The protocol included assessment of barriers, patient and staff education, close monitoring, and structured coordination of care. Pre‑ and post‑implementation data were compared to evaluate changes in prescribing patterns, medication access, adherence, and glycemic outcomes. Following implementation, new prescriptions increased by 16% (p < .001), and medication fill rates increased by 7% (p < .05). Medication side effects were notably the most common barrier to adherence; however, discontinuation rates decreased by 7% (p < .001). No significant disparities were observed by age, gender, race, or insurance type. Mean A1c improved significantly, decreasing from 9.5% to 7.4% after therapy initiation (p < .001). These findings demonstrate that a multifaceted protocol can reduce barriers to therapy, improve adherence, and improve glycemic

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 10/06/2027

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