Medicine and Health Sciences Commons^™

Exploring Geriatric Self Management Of Type 2 Dm: A Systematic Review, Ahmed Gawash, David F. Lo, Kunal P. Shah, Jasmine Emanuel, Brandon Goodwin, Don D. Shamilov, Gaurav Kumar, Nathan Jean, Christian P. White

Rowan-Virtua Research Day

This review explores diabetic self-management in geriatric individuals, focusing on positive attitudes and support from family/friends as crucial for self-care optimization. A comprehensive search in health databases was conducted, which involved screening 248 participants across eight qualitative research studies. Themes emphasizing the importance of listening to one’s body, acknowledging hidden issues, and recognizing the impact of various factors on diabetes self-care were established. A holistic approach to self management, emphasizing the significance of positive attitudes, cultural sensitivity, and individual values in healthcare practices is recommended. Embracing cultural diversity and addressing barriers can enhance self-management and quality of life for geriatric …

Diabetes Health Education For South Jersey Communities, Heaven Chu, Sarah Tamous, Ashhabal Kavvi, Amin Khan

Rowan-Virtua Research Day

Diabetes is a chronic health condition that hinders the body’s metabolic process using insulin to maintain glycemic homeostasis. It is prevalent worldwide, with about 10% of the global adult population affected. Socio-economic and cultural factors and determinants make diabetes and diabetes management more of a health risk for certain populations rather than others. The prevalence of diabetes in the United States is higher than the global average and the risk factors disproportionately affect disadvantaged communities.

This study was designed to investigate health disparities in diabetes among a diverse population sample. The study included researching the disparities of diabetes patients in …

Utilizing A Community Resource For Diabetes Lifestyle Management, Max Breidenstein

Family Medicine Clerkship Student Projects

Grace Cottage Family Health & Hospital identified diabetes as a level one priority for community health improvement. VeggieVanGo is a program hosted at schools and hospitals hosted by the Vermont Foodbank which provides fresh produce to those in needs. Lifestyles modifications are essential for diabetes management including consuming fresh produce. This project sought to increase awareness of the role of diet in diabetes management for patients at Grace Cottage Hospital who may use the VeggieVanGo program.

Prevention Of Obesity-Related Morbidity & Mortality In Adults, Rachelle Virgin

Masters Theses/Capstone Projects

Poster presentation on the prevention of obesity related morbidity and mortality in adults.

Diabetic Foot Wound Care, Richard Q. Vuong

Family Medicine Clerkship Student Projects

Diabetic foot wound care educational pamphlet developed during the family medicine rotation for 3rd-year medical students. This project was developed in Brookfield, CT.

Handout To Promote Diabetes Education In Spanish Speaking Patients, Javier Rincon

Family Medicine Clerkship Student Projects

Hispanic adults are 70 percent more likely than non-Hispanic white adults to be diagnosed with diabetes by a physician. In 2017, Hispanics were twice as likely to be hospitalized for treatment of end-stage renal disease related to diabetes, as compared to non-Hispanic whites. In 2018, Hispanics were 1.3 times more likely than non-Hispanic whites to die from diabetes. Lack of readily accessible educational material in different languages can lead to educational deficits in non-English speaking patients.

Pre-Visit Questionnaire For Diabetic Patient Visits, W. Evan Shaw

Family Medicine Clerkship Student Projects

What role does a pre-visit questionnaire, such as a "diabetic distress tool," play in optimizing diabetic patient visits?

Improving Retinopathy Screening For Patients With Diabetes: Optometrists Accepting New Patients On Medicaid 
+/- Interpreter Services, Kassondra M. Little

Family Medicine Clerkship Student Projects

For patients with diabetes, screening for microvascular complications like retinopathy requires annual retinal photography or dilated fundoscopy to identify and mitigate processes that can cause preventable blindness. Yet, by measures at the state and federal level, the percent of patients achieving this care is below target. At the Community Health Centers of Burlington (CHCB), the barriers responsible for this include uncertainty among patients and providers about which local optometry offices accept Medicaid, are scheduling new patients and have interpreter services available. This project aimed to improve retinopathy counseling, the achievement of retinopathy screening and the time burden placed on providers …

The Importance Of Stigma Theory For Clinical Decisions Related To Diabetic Foot Amputations, Rachael Garcia, Callie Bartkowiak, Alison Nesbitt Do

Clinical Research in Practice: The Journal of Team Hippocrates

The authors examine the unconsidered impact of social stigma theory on the shared clinical decision-making process for a patient with foot osteomyelitis and MRSA bacteremia facing the prospect of an amputation.

Culturally Sensitive Carbohydrate Sources For Nepalese With Diabetes Or Prediabetes, Rachel Bombardier

Family Medicine Clerkship Student Projects

Over 8,000 refugees have started new lives in Vermont since 1980. Many of these people utilize the Community Health Centers of Burlington, for some this may be their first time navigating America's healthcare system. This is a daunting task due to a multitude of barriers, including missing cultural competencies in various aspects of their care. This project focuses on dietary recommendations for Nepalese patients with prediabetes and type 2 diabetes, specifically carbohydrate sources based on fiber content. Type 2 diabetes is a very prevalent chronic disease that costs Vermont $520 million each year. Understanding healthy food options in a culturally …

Tracking Home Blood Glucose Through Mychart, Zachary T. Osborn

Family Medicine Clerkship Student Projects

Self-monitoring of blood glucose (SMBG) is a crucial tool in the management of Type 1 and Type 2 diabetics on insulin, and for Type 2 Diabetics who are titrating medications and/or undergoing lifestyle changes. Patients often fail to bring in their SMBG readings (or monitor at all) for a variety of reasons, hindering efforts to adjust their therapy. This project sought to address this gap through educating patients and providers about the EPICs ability to track SMBG readings submitted through MyChart.

Tracking Home Blood Glucose Through Mychart, Zachary T. Osborn

Family Medicine Clerkship Student Projects

Self-monitoring of blood glucose (SMBG) is a crucial tool in the management of Type 1 and Type 2 diabetics on insulin, and for Type 2 Diabetics who are titrating medications and/or undergoing lifestyle changes. Patients often fail to bring in their SMBG readings (or monitor at all) for a variety of reasons, hindering efforts to adjust their therapy. This project sought to address this gap through educating patients and providers about the EPICs ability to track SMBG readings submitted through MyChart.

Preventive Medicine Screening Measures, Isaac Adams

Family Medicine Clerkship Student Projects

In order to make progress towards long-term health on a community level, it is imperative to address health needs on a population basis and using a preventive strategy to prevent the development of more serious illness. With this in mind, this project aimed to create a poster providing easy to understand information to patients with regard to health screenings. Specifically, it addressed screenings for diabetes and pre diabetes, colon cancer, lung cancer, and breast cancer.

Increasing Healthcare Delivery To The Abenaki People Through Health Screenings, Warrick Sahene

Family Medicine Clerkship Student Projects

Utilizing health screenings can increase the number of Abenaki individuals identified with comorbidities related to diabetes and hypertension. Education and resources for health maintenance are also provided to this patient population through physician counseling.

Home Exercise For Patients With Limited Access And Resources, Justin L. Esteban

Family Medicine Clerkship Student Projects

Patients with limited resources and who are socioeconomically disadvantaged, don’t have the time or resources available to partake/pursue exercise. Having a home workout program may prove to be beneficial to patients who don't have access to a gym, equipment, or are otherwise constrained by time.

Accessibility Of Nutritious And Healthy Foods To Older Adults, Kristen Wright

Family Medicine Clerkship Student Projects

Food insecurity rates are high among older adults who have chronic conditions and/or are homebound. These patients have functional limitations, comorbidities limiting their mobility, and often are socially isolated or live alone, all of which impact their ability to access or make healthy meals. As food insecurity rises, so do the health care costs related to inaccessibility to healthy food, involving the increased risk or prevalence of chronic conditions like hypertension, diabetes, and cancer. This project aimed to understand the barriers older adults face in accessing and making healthy meals, and to educate health care providers and patients on recognizing …

Tracking Home Blood Glucose Through Mychart, Zachary T. Osborn

Family Medicine Clerkship Student Projects

Self-monitoring of blood glucose (SMBG) is a crucial tool in the management of Type 1 and Type 2 diabetics on insulin, and for Type 2 Diabetics who are titrating medications and/or undergoing lifestyle changes. Patients often fail to bring in their SMBG readings (or monitor at all) for a variety of reasons, hindering efforts to adjust their therapy. This project aimed to address this issue by educating patients and attendings about EPIC's ability to log blood glucose measurements through MyChart.

Addressing Diabetes Education In Chittenden County, Varun Gupta

Family Medicine Clerkship Student Projects

The percent of adults in Chittenden County with diabetes who have received diabetes education was short of national goals. To gather more information about the problem, a NP and 2 diabetic patients were interviewed. A educational handout was created to address some of the concerns brought up that reflect some of the unmet educational needs.

Efficacy Of Diabetes Self-Management Education Administered Via Telehealth For Adults With Uncontrolled Diabetes, Tanner Free

Evidence-Based Practice Project Reports

Patient’s with a diagnosis of diabetes require significant lifestyle modification and education. The need for patient education has led to the development of diabetes self-management education (DSME) classes. Unfortunately, utilization of DSME classes is only 5% among Medicare beneficiaries and 6.8% among privately insured patients (Centers for Disease Control [CDC], 2018). The purpose of this evidence-based practice (EBP) project was to implement DSME via telehealth and assist with goal formation to help patients with uncontrolled diabetes achieve glycemic control by increasing access to crucial education. The intervention consisted of bi-weekly calls for a period of 3 months. Participant data were …

Preventive Care: Controversies, Challenges And Upcoming Changes In Guidelines, Randa Sifri, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives

• Organizations who make guidelines
• Current guidelines for average-risk adults, with a focus on guidelines with differing recommendations and challenges to implementation/operational issues
• Preview of upcoming changes in guidelines
• Cases to illustrate some of the common questions that come up in delivering office-based preventive care
• Some disclaimers

Frequently Asked Questions By Patients About Exercise, Julie Evans

Family Medicine Clerkship Student Projects

A significant portion of patient visits at Milton Family Practice are related to one or multiple aspects of metabolic syndrome. Exercise is a common topic during these visits either brought up by patients or providers. This project focused on creating a handout for patient education with answers to commonly asked questions pertaining to exercise and resources in the community.

Nutritional Barriers For Patients With Diabetes: A Quality Improvement Project, Emma C. Levine, Taylor D. Marquis

Family Medicine Clerkship Student Projects

The goal of this study was to look at health care providers perspectives on what the nutritional barriers patients with diabetes faced and compare that with the patient's perspectives. We also assessed patients knowledge on certain foods and if they have carbohydrates. We used this information to create a Notecard that could be given to patients.

Patient Education: Low-Carb Substitutes For Pre-Diabetes Management, Keira L. Goodell

Family Medicine Clerkship Student Projects

At Milton Family Practice in Milton, VT, individuals diagnosed with pre-diabetes are referred to a clinical nutritionist and sent home with patient instructions about blood sugar and carbohydrates. For those who decline a meeting with the clinical nutritionist, the patient instructions are not an adequate substitute. This project focused on the creation of a SmartPhrase to be added to patient instructions outlining common high-carbohydrate foods and options for lower-carb alternatives.

Lifestyle Changes In Diabetes Management Using Smartphone Apps, Michelle Oberding

Family Medicine Clerkship Student Projects

Type II Diabetes is a prevalent and costly disease in the state of Vermont. Making lifestyle changes decreases Hemoglobin A1c levels and the long term risk of complications from diabetes. Longitudinal programs help maintain these important changes but these programs are not always readily available. Using free smartphone apps may be an alternative for maintaining lifestyle changes.

Factors That Impact Glycemic Control In Adolescents With Type 1 Diabetes, Kelsey Mcfarling

Theses and Graduate Projects

The incidence of Type 1 Diabetes (T1D) is increasing worldwide and is diagnosed disproportionately in adolescent populations. Additionally, studies show that adolescents with T1D experience worse glycemic control during this developmental period. Maintaining glycemic control in patients with T1D decreases the risk of developing future diabetic-related complications. Factors such as race, ethnicity, gender identity, sexual orientation, socioeconomic status, and medical comorbidities influence disparities in maintaining glycemic control in adolescents. The recognition of these factors on the management of T1D through an integrative team approach leads to increased glycemic control and decreased diabetic- related complications. This paper explores the effects of …

You Don’T Have To Get Diabetes, Mitch Kaminski, Md, Mba, Nevaneva White, Dnp, Crnp, Cdces

Department of Family & Community Medicine Presentations and Grand Rounds

The goal is to streamline the steps required to make referrals to and enroll in the National Diabeties Prevention Program (DPP).

Identifying Barriers To Statin Therapy In Diabetic Patients In A Large Ambulatory Practice, Jennifer Moyer, Md, Rachel Ehrman-Dupre, Md, Andrew Rabovsky, Md, Simon Newsom, Md, Pooja Padgaonkar, Md, Julita Mitchell, Md, Sarah Hirsh, Md, Madeline Taskier, Md, Robert Wiley, Md, Lilli Flink, Md, Greta Bires, Md, Geoffrey Mills, Md

House Staff Quality Improvement and Patient Safety Conference (2020-)

Aim 1: To understand the root cause(s) for gaps in statin therapy within a large ambulatory care practice.

Aim 2: To improve provider awareness of indications for statin therapy, as recommended by the ACC/AHA guidelines.

Aim 3: To increase the proportion of patients with diabetes at our practice that are on statin therapy.

The Implementation Of Diabetic Foot Care Into Primary Care, Shelby D. Strong

Evidence-Based Practice Project Reports

Diabetes mellitus (DM) is one of the most common metabolic diseases worldwide. It can lead to complications in many parts of the body and can increase overall risk of dying prematurely (World Health Organization (WHO), 2016). Diabetic peripheral neuropathy (DPN) in the feet is one of the most frequent complications of DM (Wang et al., 2017). Other lower extremity complications which can occur as a result of diabetic foot complication (DFC) includes peripheral artery disease (PAD), infection, ulcer and amputation. One of the obstacles for preventing (DFC) is the lack of examinations of the feet in clinical practice (Feitosa et …

A Protocol To Increase Referral Rates To Diabetic Education, David M. Rokser

Evidence-Based Practice Project Reports

In 2015, approximately 30.3 million Americans, including 10.5% of the population of Minnesota, had been diagnosed with diabetes mellitus (American Diabetes Association, 2019). Increased risk of diabetic complications including neuropathy, retinopathy, nephropathy, cardiovascular disease, and chronic wounds has been associated with an elevated hemoglobin A1C (HgA1C). Formal diabetic education has been shown to be a cost-effective intervention to reduce HgA1C. The Office of Disease Prevention and Health Promotion published an objective within HealthyPeople 2020 that seeks to increase the percentage of diabetics receiving formal diabetic education in the United States from 46.9% of adults to 58.4%. The purpose of this …

Point-Of-Care Reminders To Prompt Provider Adherence With Diabetes Care Guidelines For Adults, Eric E. Spohn

Evidence-Based Practice Project Reports

Diabetes is a complex, chronic illness, and a leading cause of morbidity and mortality (ODPHP, 2019). Gaps in diabetes care exist between clinical guidelines and interventions provided in the clinical setting (ADA, 2015; Chauhan et al., 2017; Renders et al., 2001; Worswick et al., 2013). Improved diabetes management strategies and interventions among healthcare providers are essential to close the quality gap. The purpose of this evidenced-based practice (EBP) project was to prompt providers to adhere to diabetes care guidelines using a paper point-of-care reminder over a 12-week period. Provider performance rates covering four specific guidelines were measured: HbA1c, microalbuminuria, diabetic …