The following article is a part of conference coverage from the 2021 American Association of Nurse Practitioners National Conference (AANP 2021), held virtually from June 15 to June 20, 2021. The team at the Clinical Advisor will be reporting on the latest news and research conducted by leading NPs. Check back for more from AANP 2021.


An individualized educational intervention provided by a nurse practitioner decreased sedentary time and hemoglobin A1c (HbA1c) levels among patients with type 2 diabetes or prediabetes, according to findings presented at the 2021 American Association of Nurse Practitioners National Conference (AANP 2021).

In 2019, the Missouri Health and Senior Services reported 15,494 emergency department visits and 18,520 hospital admissions associated with type 2 diabetes. Previous research suggests that sedentary behavior time is more strongly associated with metabolic disease risk than is lack of physical activity alone. The present study was designed to investigate the effects of individualized diabetes education to reduce sedentary behavior to less than 8 hours per day on HbA1c, attitude, and motivation to change at 6 months.  

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“I feel education is essential for long-term management of diabetes. Diabetes is progressive and individuals living with diabetes need to remain educated, as there is evolving research that may be beneficial for this population. Also, as the condition progresses the education needs to be updated,” said study author Kristina Mitchell, DNP, APRN, FNP-C, of the University of Missouri-Kansas City.  

The education program was administered at a primary care clinic, by telephone, or by telehealth. Follow-up was conducted by phone at week 1, week 2, and monthly for 6 months. A total of 30 patients aged ³13 years were recruited, and 25 participants completed all follow-up assessments.

At 6-month follow-up, changes in attitude (perceived risk of sedentary behavior), motivation to change behavior, Rapid Assessment Disuse Index (RADI) scores, and glycated hemoglobin were assessed. The RADI includes 3 Likert questions on moving on foot, stair climbing, and sitting. Attitude and motivation were assessed in a 9-question survey that included a question on motivation to change.

Key Outcomes

At 6-month follow-up, mean RADI scores decreased significantly to 32.24 (P <.001), attitude improved, and HbA1c level decreased by 0.8%. Motivation was not altered at follow-up.

Table. Changes in Sedentary Behavior, Attitude, and Motivation Among Patients With Type 2 Diabetes (N=25) Following a Diabetes Educational Intervention

Measure (mean)Baseline6 months
Motivation to change3.643.60
RADI score33.7632.24b
aMean score in 18 patients with lab values available
bP <.001

“The patients found that learning how prolonged sitting affected their overall insulin resistance and how simple changes could have a big effect on reducing their insulin resistance were most helpful,” Mitchell explained. “The frequent follow-ups helped with accountability and problem-solving.”

This study was limited by small sample size, short study duration, and lack of ethnic diversity, Mitchell noted.

Tips for Patient Engagement

For nurse practitioners who are considering implementing a similar program, Mitchell advised “there will be patients who may disengage for a time period due to other priorities but want to re-engage because of the benefit of this type of program.” She emphasized the importance of the team, stating “having others reach out to new participants and to re-engage prior participants will strengthen your program. You will be doing a lot of educating and will need a team to help with follow-up.”

Mitchell is currently working to implement this program as part of the institution’s wellness curriculum in the ‘Sleep Well, Think Well, Eat Well, and Move Well’ model.

Visit Clinical Advisor’s meetings section for complete coverage of AANP 2021. All conference sessions are available to registered attendees through August 31, 2021.


Mitchell K. Implementing individualized sedentary behavior reduction education to improve HbA1c. Poster presented at: 2021 Association of Nurse Practitioners National Conference; June 15-June 20, 2021. Poster 16.