Diseases Commons^™

Utilization Of Depression Screening In Patients With Type 2 Diabetes Mellitus, John T. Norris Bsn, Rn, Dnp-Pmhnp Student, Robin Gordon Bsn, Rn, Dnp-Pmhnp Student, Margaret Harvey Phd, Aprn-Bc, Acnp, Chfn, Laura Reed Dnp, Fnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background

Type 2 diabetes is a chronic metabolic disorder affecting millions of individuals worldwide. Research has shown that individuals with diabetes are at a higher risk of developing depression in comparison to those of the general population. Depression affects the individual's emotional well-being and has a significant impact on the management and outcomes of diabetes (Mather, 2022). This research study aims to investigate the feasibility and effectiveness of implementing the Patient Health Questionnaire-9 (PHQ-9). The PHQ-9 is one the most effective assessment tools available to identify symptoms of depression (Celik, 2020).

Methods

In this retrospective chart review, at least 50 …

Evaluating The Effectiveness Of Sglt2i Or Glp1ra Vs. Sulfonylurea Initiation After Hospital Admission For Congestive Heart Failure And Type Ii Diabetes Mellitus: A Scoping Review, Alyssa Ptacek Bsn, Rn, Amber Majors Bsn, Rn, Tracy Mcclinton Dnp, Aprn, Agacnp-Bc, Carrie Harvey Phd, Aprn-Bc, Acnp, Chfn

Doctor of Nursing Practice Projects

Purpose/Background

The need for effective pharmacological management in patients with congestive heart failure (CHF) and type II diabetes mellitus (T2DM) is an ever-growing task for healthcare providers, especially in the primary care setting. Patients with multiple comorbidities are less likely to adhere to required rigorous medication schedules and lifestyle modifications, resulting in accelerated disease progression and defeated efforts of healthcare providers. Traditionally, sulfonylureas have been the medication management of choice by healthcare providers due to their affordability compared to modern medication. Current guidelines recommend that individuals with poor glycemic control could benefit significantly from using older sulfonylureas with other antidiabetic …

The Impact Of Patient And Provider Education On Statin Therapy Initiation And Adherence In Type Ii Diabetics, Jane Harlan Bsn-Rn, Lindsey Jacobsen Bsn-Rn, Emily Easterly Bsn-Rn, Mitch King Bsn-Rn, Laura Reed Dnp, Aprn, Fnp-Bc, Cne

Doctor of Nursing Practice Projects

Purpose/Background

Type 2 diabetes mellitus (T2DM) is a common, chronic disease that increases the risk of coronary artery disease and stroke fourfold, which makes protecting cardiac function a priority. The American Diabetes Association (ADA) and American Heart Association (AHA) recommend the prescription of statins to reduce cardiovascular complications. Unfortunately, provider and patient adherence to this recommendation is poor.This study aimed to determine if shared-decision making and patient follow-up within a 6 month period of being newly diagnosed with T2D has an effect on the initiation rate of statin therapy.

Methods

In this retrospective study we requested data from the University …

Effect Of Certified Diabetes Clinical Education Specialists On Adults With Type 2 Diabetes, Rachel Faller, Tracy Gregory, Michelle Jones, Peyton Barnett, Laura Reed Dnp, Aprn, Fnp-Bc, Cne

Doctor of Nursing Practice Projects

Purpose/Background

Type 2 diabetes mellitus affects 13.1% of adults living in Shelby County and over 30 million adults in the United States. This chronic disease creates a higher risk of macrovascular and microvascular complications for this population resulting in poor outcomes if not properly managed. Improving glycemic control can help to improve the quality of life for people living with diabetes and reduce healthcare costs. Currently 20% of funds spent in the United States on healthcare is utilized for diabetic care. Certified Diabetes Care and Education Specialists (CDCES) primarily educate patients about managing their diabetes, including health promotion that can …

Barriers To Screening For Diabetic Retinopathy: A Scoping Review, Amy Cooper Rn, Bsn, Lajerica Bates Rn, Bsn, Julie Bridges Rn, Bsn, Laura Reed Dnp, Fnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background

More than 34 million people in the United States have diabetes. Diabetic retinopathy (DR) is a major complication of diabetes and a leading cause of vision loss. Risk factors for diabetic retinopathy include Type 1 and Type 2 Diabetes, hypertension, smoking, and being African American or Hispanic/Latino. This scoping review seeks to analyze the current research on ways to increase vision screenings, thus reducing cases of diabetic retinopathy in adults.

Methods

Between September 2020 and November 2021, a search was conducted using PubMed, EBSCOhost, Medline, and CINAHL to identify articles using keywords such as diabetic retinopathy and ophthalmology. This …

Multimorbidity In Diverse Populations: Stratified Analysis Of Race/Ethnicity, Age, Obesity, And Healthcare Costs, Manal Alshakhs

Theses and Dissertations (ETD)

This research aims to fill an essential gap in understanding how Body Mass Index (BMI) cutoffs relate to multimorbidity across races in the United States (US). Given the significant and growing rates of obesity and multimorbidity, as well as the known differences in healthy fat distribution among different races, this is an important area of research. BMI is a widely used but imperfect measure of obesity, as it does not account for differences in body composition. However, it is still used as a diagnostic tool. It is vital to ensure that the cutoffs used to define obesity are appropriate for …

Efficacy Of Various Interventions For Achieving Target Hba1c Levels For Patients With Type Ii Diabetes Mellitus And On Exogenous Insulin, Caitlin S. Welch, Archie Troxel

Longitudinal Scholar's Project

Objective: To learn the rates at which patients at UT Family Medicine–St. Francis (UTFM–SF) with type II diabetes mellitus are being prescribed recommended medications—namely metformin, sodium-glucose cotransporter 2 (SGLT2) inhibitors, and glucagon-like peptide 1 receptor agonists (GLP1RAs)—whether these rates correspond to the severity of hyperglycemia (as indicated by HbA1C level). A secondary goal of the study was to investigate if HbA1C levels are being checked at recommended intervals.

Methods: A retrospective chart review was conducted using records of patients seen at the clinic in the previous four years between the ages of 18 and 65 who had visits with ICD …

Investigating The Correlation Between Lpr & Obesity, Andrew S. Franklin Bs, Chad A. Nieri Bs, M. Boyd Gillespie Md

Longitudinal Scholar's Project

Objectives: To determine whether Drug-Induced Sleep Endoscopy (DISE) findings of Laryngopharyngeal Reflux (LPR) correlate with obesity, gender, Epworth Sleepiness scale, and OSA severity.

Study design: Single center retrospective cohort study.

Methods: Patients greater than 18 years of age who underwent DISE by one surgeon at a tertiary care center from July 2016 to July 2022 were included. DISE findings, patient characteristics, demographics, polysomnogram(s), and Epworth Sleepiness Scale(s) were extracted. Fisher’s exact test was used to compare categorical variables, and independent sample t-test was used to compare continuous variables. All statistical analyses were performed using IBM SPSS Statistics 28.

Results: …

Prevention Of Diabetes-Related Hospital Readmission Following Initial Diagnosis Of Diabetes In Patients Over The Age Of Fifty: A Scoping Review, Nathan Miller Dnp, Agacnp, Fnp, Jasmine Harris Dnp, Fnp, Michael Clardy Dnp, Agacnp, Diana Dedmon Dnp, Acnp, Fnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background: By reviewing multiple studies related to the treatment of patients with new diagnoses of diabetes, this scoping review will endeavor to determine which interventions, when implemented for patients over 50 years old which are newly diagnosed with type 2 diabetes, can decrease the likelihood of hospital readmission related to diabetes within 90 days when compared with those patients who did not receive or participate in follow-up.

Methods: For resources to be eligible to review they had to be from 2015 or after. Studies selected included patients over the age of 50 newly diagnosed with type 2 diabetes subject to …

Interventions To Improve Adherence To Recommended Diabetic Retinopathy Screening In Adult Patients With Diabetes Mellitus: A Scoping Review, Clare Anderson Bsn, Rn, Dnp, Fnp, Sarah May Bsn, Rn, Dnp, Fnp, Diana Dedmon Dnp, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background Diabetic retinopathy (DR) is the leading cause of blindness in adults. Current guidelines recommend that all patients with type 2 diabetes mellitus (T2DM) have a DR screening (DRS) upon diagnosis of T2DM and then annually, but the adherence rate is only approximately 60%. This scoping review aims to evaluate the effectiveness of primary care providers (PCPs) employing strategies to increase compliance with annual DRS among adult patients with T2DM.

Methods Between September 2021 and January 2022, a literature review was performed to collect studies evaluating interventions to increase adherence to DRS. Individual searches of PubMed, SCOPUS, and CINAHL were …

Using Digital Storytelling To Assess Patient Experience With Management Of Diabetes In Everyday Life (Model) Study Intervention, Arati Joshi

Longitudinal Scholar's Project

African Americans are disproportionately affected by obesity-associated diabetes compared to their White counterparts. While social determinants of health may contribute to their poor health outcomes, studies have shown that pragmatic primary care-based interventions can be effective in improving the management of obesity-associated diabetes. The Management of Diabetes in Everyday Life (MODEL) is a pragmatic randomized comparative effectiveness trial of three approaches (health coaching, text-messaging, and enhanced usual care) to supporting medically underserved African American patients with uncontrolled diabetes in improving their self-care decisions. The purpose of this study is to assess the effect of the MODEL program participation on the …

Feasibility And Acceptability Of Using Mobile Health Apps In Underserved Patients With Diabetes, Jieyu Luo

Theses and Dissertations (ETD)

Introduction. Diabetes mellitus is a condition with a growing morbidity and mortality burden. An estimated 30 million adults currently live with diabetes, with each individual spending over $9500 annually on medical care. The successful management of diabetes is a lifelong endeavor. This involves balancing a variety of factors including diet, medications, and glucose monitoring. It has been well established that successful control of diabetes depends largely upon patients’ daily lifestyle habits and activities. Not all patients, however, have the resources necessary for effective diabetes management. Health disparities lead to a higher rate of diabetes development in minority and poor populations. …

Effects Of Social Determinants Of Health In Progression To Type 2 Diabetes, Folabi I. Ariganjoye

Applied Research Projects

The prevalence of prediabetes and diabetes in the United States and around the world has increased faster than expected in the last 30 years. The economic burden this costs a nation can be astronomic both in terms of expense and loss in productivity. One-third of U.S. adults, 86 million people, have prediabetes. Effective management is needed that can reach these 86 million, and others at high risk, to reduce their progression to diagnosed Type 2 diabetes. After the literature review, there was not enough literature to support how these led to the progression to diabetes. The abundant literature is centered …

Effectiveness Of Ehr-Depression Screening Among Adult Diabetics In An Urban Primary Care Clinic, Filipina C. Schnabel Md, Mph, Msn, Fnp-Bc, Danielle Aldridge Msn, Fnp-C, Laura Reed Dnp, Fnp-Bc

Doctor of Nursing Practice Projects

Background Diabetes mellitus (DM) and depression are important comorbid conditions that can lead to more serious health outcomes. The American Diabetes Association (ADA) supports routine screening for depression as part of standard diabetes management. The PHQ2 and PHQ9 questionnaires are good diagnostic screening tools used for major depressive disorders in Type 2 diabetes mellitus (DM2). This quality improvement study aims to compare the rate of depression screening, treatment, and referral to behavioral health in adult patients with DM2 pre and post-integration of depression screening tools into the electronic health record (EHR).

Methods We conducted a retrospective chart review on patients …

Time To First Blood Glucose Determination And Administration Of Intravenous Glucose At Birth In Extremely Low Birth Weight Infants, Jihan Esmail, Ramasubbareddy Dhanireddy Md

Longitudinal Scholar's Project

Background: Extremely low birth weight (ELBW) infants are prone to hypoglycemia unless intravenous glucose is administered within an hour (golden hour) of life. These infants often require resuscitation at birth, but monitoring and intervention for hypoglycemia may be delayed.

Objectives: (1) Study the time to first blood glucose determination and IV glucose administration at birth in ELBW infants, (2) determine the incidence of hypoglycemia, <47mg/dl, and severe hypoglycemia, <40mg/dl, at admission, (3) determine risk factors for hypoglycemia, and (4) compare clinical outcomes at discharge between hypoglycemic and euglycemic infants.

Methods: 244 ELBW (≤1000g birth weight) infants born during Jan 2017- Feb 2020 at the Regional One Health NICU, Memphis, TN were included in the study. Data collected included maternal and infant clinical, demographic, and outcomes …

Hyperglycemia During The First Three Days Of Life Increases The Risk Of Retinopathy Of Prematurity In Extremely Low Birth Weight Infants, Jihan M. Esmail, Ramasubbareddy Dhanireddy Md

Longitudinal Scholar's Project

Background: The association between hyperglycemia and ROP has been inconsistent in previous studies. Extremely low birth weight (ELBW) infants are at high risk for ROP. They also experience hypoglycemia initially and hyperglycemia while receiving IV glucose infusion. The effect of initial hypoglycemia on hyperglycemia associated ROP risk is unknown.

Objective: To study the effect of initial hypoglycemia and subsequent hyperglycemia during the first three days of life on the incidence of ROP and severe ROP in ELBW (birth weight ≤1000g) infants.

Methods: Clinical and demographic data were collected from 227 ELBW infants born during the years 2017-2019 at the Regional …

Using Preliminary Data And Prospective Power Analyses For Mid-Stream Revision Of Projected Group And Subgroup Sizes In Pragmatic Patient-Centered Outcomes Research, Elizabeth A. Tolley Md, Satya Surbhi Md, James E. Bailey Md

Faculty Publications and Presentations

Pragmatic clinical trials are commonly used in patient-centered outcomes research to assess heterogeneity of treatment effects. Patient-Centered Outcomes Research Institute (PCORI) methodology standards for assessing heterogeneity of treatment effects are extremely rigorous, but their implementation in real-world settings can be difficult. Predicting recruitment effectiveness and subgroup characteristics is often challenging and may require mid-stream revision of projected group and subgroup sizes. Yet, little real-world data are available to demonstrate methodologically valid approaches to address situations where such revisions are necessary. These data were used for mid-stream revision of group and subgroup sizes in the Management of Diabetes in Everyday Life …

Effective Measures Of Weight Gain Five Years Post-Kidney Transplantation, Tara Calico Cherry

Theses and Dissertations (ETD)

BACKGROUND: Weight gain is commonly observed post-kidney transplantation and is associated with unfavorable health outcomes, such as graft loss, new onset diabetes, and cardiovascular disease. The purpose of this study was to determine the most effective measure for assessing body composition after kidney transplantation.

DESIGN: The study was a descriptive correlational follow-up study from a single kidney transplant site.

SUBJECTS: A total of 45 eligible patients from a 2007-2011 parent study were selected, ages of 37 to 78.

MEASUREMENTS: Body composition was obtained 5–8 years posttransplant via anthropometric measures (waist circumference, body mass index, and dual energy X-ray …

Hit Identification For Pkcζ Inhibitors: Structure-Based Optimization, Virtual Screening, And Biological Evaluation, Xiaoxin Wu

Theses and Dissertations (ETD)

Protein kinase C ζ (PKCζ) is believed to be a promising target for the treatment of some diseases, including inflammatory diseases, obesity and diabetes. Hit identification of PKCζ inhibitors was conducted by structure-based modification, virtual screening and biological evaluation. Among all the compounds selected and synthesized, compound JW-1-60A showed moderate activity against PKCζ at 30 μM and 100 μM. The molecular modeling studies showed that the binding mode of JW-1-61A was very close to the binding mode of JP-3-149, a reported PKCζ inhibitor with very potent activity, which might partially explain the moderate activity of JW-1-61A. Based on the structure …

The Role Of Drak2 In T Cell Function And Autoimmunity, Tarsha L. Harris

Theses and Dissertations (ETD)

The immune system utilizes many regulatory mechanisms to limit immune responses and ensure that immune cells target foreign pathogens and not healthy cells of the body. However, some immune cells can escape these checkpoints and attack the body’s healthy cells, leading to tissue destruction and devastating autoimmune disorders. For example, multiple sclerosis (MS) occurs when immune cells attack the myelin sheath surrounding neurons of the central nervous system (CNS). Likewise, the destruction of pancreatic islet cells by dysregulated immune cells leads to type 1 diabetes (T1D). Remarkably, there are more than 80 types of autoimmune diseases. An estimated 50 million …

An Examination Of Factors That Influence Health Behaviors Among Low Income African American Women With Type 2 Diabetes In Memphis, Tn: A Qualitative Inquiry Using Mixed Methods, Adole Muruako

Theses and Dissertations (ETD)

Obesity and type 2 diabetes are increasing health concerns in the United States, particularly among women and minorities. Generally, research has highlighted the health disparities that exist among African American women, especially as these disparities relate to obesity and type 2 diabetes. In Memphis, TN, the ZIP codes of 38106 and 38109 have the highest rates of diabetes hospitalizations in the city. Further, African American women in Memphis, TN have been identified as being most vulnerable to experiencing a potentially avoidable hospitalization due to chronic disease. The purpose of study was to identify factors that may impact African American overweight/obese …

Hemoglobin A1c And The Diagnosis Of Diabetes And Prediabetes In Children And Adolescents, Jennifer Mcguire Hitt

Theses and Dissertations (ETD)

Although the American Diabetes Association (ADA) adopted the use of the glycated hemoglobin (A1C) test as a method of diabetes and prediabetes diagnosis, the ADA has not developed firm guidelines concerning the use of the A1C test in children and adolescents, as research has not validated thresholds in this group. Diabetes and prediabetes are diseases influenced by multiple factors, including race and ethnicity, age, vitamin D deficiency, and body mass index (BMI). The purpose of this study was to determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the A1C test compared to the gold …

Effect Of Nedd4 Haploinsufficiency On Insulin Sensitivity, Adiposity And Neuronal Behaviors, Jingjing Li

Theses and Dissertations (ETD)

The neural precursor cell expressed developmentally down-regulated gene 4 (NEDD4) is a HECT-type E3 ubiquitin ligase that has received broad attention in recent years. Many of its reported substrates are active players in metabolism, implying a potential role of NEDD4 itself in metabolic regulation. Since homozygous Nedd4 deletion leads to embryonic or perinatal lethality, we investigated the function of NEDD4 in metabolic regulation in vivo, using Nedd4- haploinsufficient mice in a high fat diet-induced obesity (HFDIO) model.

Our studies show that Nedd4-haploinsufficient mice fed a normal diet (ND) exhibited decreased body weight in both genders and proportionally reduced tissue mass …

Beta-2-Adrenergic Receptor Regulates Insulin Signaling To Reduce Cell Death In Müller Cells, Robert Jason Walker

Theses and Dissertations (ETD)

No abstract provided.

Compound 49b: A Novel Beta-Adrenergic Receptor Agonist In The Treatment Of Diabetic Retinopathy, Kimberly Williams-Guy

Theses and Dissertations (ETD)

Diabetic retinopathy is the leading cause of blindness in working Americans. While there are therapeutic regimens for the disease, more effective methods are needed. We have previously shown that a non-specific beta-adrenergic receptor agonist, isoproterenol, was effective in preventing functional and morphological changes associated with diabetic retinopathy in the rat. Isoproterenol also produced left ventricle remodeling suggesting it entered the systemic circulation. We therefore synthesized various novel beta-adrenergic receptor compounds and screened these compounds in vitro for their ability to reduce markers of inflammation and apoptosis. Of the various compounds tested, Compound 49b was able to reduce both inflammation and …

Metabolic Syndrome, Inflammation, Heart Rate Variability, And Fitness In Obese African American Youth, Belinda J. Fleming

Theses and Dissertations (ETD)

Purpose. The purposes of this dissertation were to (1) explore the relationships among fitness, heart rate variability (HRV), inflammation and components of the Metabolic Syndrome in obese African American youth participating in a supervised weight management program, (2) examine the effect of change in severity of obesity on these variables, and (3) identify predictors of weight loss.

Method. This study consisted of a post-hoc analysis of existing pre and post-intervention data obtained from 50 African-American youth (70% female, aged 7-18 years). Anthropometric assessment of height, weight, waist circumference, systolic blood pressure, body mass index, body mass index percentile …

Associations Among Health Literacy Levels And Health Outcomes In Pregnant Women With Pregestational And Gestational Diabetes In An Urban Setting, Rosemary Ann Mclaughlin

Theses and Dissertations (ETD)

Purpose/Objectives: Poor health literacy is a problem for over 45% of American adults and is associated with a variety of adverse health outcomes. Low health literacy has been associated with poor prenatal care utilization and a higher likelihood of poorer glycemic control. Poor glycemic control can lead to poor birth outcomes for both the mother and infant. Health literacy levels of pregnant women with diabetes can influence these outcomes and need to be known early in the pregnancy. Interventions can influence tighter glycemic control and lessen the impact of diabetes for the mother and infant. Therefore, the purpose of this …

Gastric Myoelectrical Activity In Patients With Diabetes, Sandra Luberata Holmes

Theses and Dissertations (ETD)

This descriptive, correlational study investigated the associations among gastric myoelectrical activity (GMA), upper gastrointestinal (GI) symptoms, and glucose control. The study also attempted to determine whether any relationship existed between upper GI symptoms, glucose control, age, or length of diagnosis and pattern of GMA identified using electrogastrography (EGG). A total of 25 persons participated in the study. The sample was comprised of 7 healthy controls, 5 patients diagnosed with type 1 diabetes, and 13 patients diagnosed with type 2 diabetes. Electrogastrography was performed for 30 minutes in the fasting state and continued at 30-minute intervals for a total of 1-1/2 …

Measurement Of Autonomic Function In Renal Disease And Diabetes, Ann King Cashion

Theses and Dissertations (ETD)

Renal disease and diabetes lead to dysautonomia resulting in consequences ranging from gastroparesis to sudden death. New technologies to detect dysautonomia, such as 24-hr heart rate variability, are being evaluated and compared to traditional evoked tests. These advances have, however, lead to a lack of standardization in testing batteries, procedures, and reporting formats. This series of 3 studies psychometrically assessed measures of autonomic function (AF) and explored relationships among objective and subjective measures in healthy adults and uremic patients. Participants underwent evoked tests that included change in heart rate with deep breathing and Valsalva. In addition, measures of 24-hr HRV …