Medicine and Health Sciences Commons^™

Evaluation Of Universal Depression Screening In A Pediatric Diabetes Outpatient Clinic With The Integration Of A Depression Screening Tool Into An Electronic Health Record, Jenna Westberry

DNP Projects

Background: Depression is a significant problem for adolescents with chronic health conditions. Prevalence rates are two to three times higher in adolescents with diabetes compared to adolescents without diabetes (Badescu et al., 2016). Routine depression screening is not transpiring at rates and frequency recommended by the American Diabetes Association for this population. Implementing use of the Patient Health Questionnaire for all adolescents over the age of twelve years with Type 1 & Type 2 Diabetes Mellitus during routine health visits may improve early identification and diagnosis of depression and improve long-term health outcomes.

Purpose: The goal of this project was …

Evaluating The Feasibility And Efficacy Of A Brief Motivational Interviewing Nutrition Intervention For Women With Type 2 Diabetes In Primary Care, Charlotte M. Adams

DNP Projects

Background: The American Diabetes Association recommends lifestyle modification to prevent and treat diabetes in their 2021 Standards of Medical Care in Diabetes. Evidence suggests that motivational interviewing (MI) is an effective intervention that clinicians can use to facilitate behavior change in patients with type two diabetes.

Purpose: The purpose of this project was to evaluate a brief motivational interviewing intervention that could be delivered by a PCP to provide individualized nutrition counseling for adult women with type two diabetes in a primary care clinic in Lexington, KY. This study was a continuation of a previous quality improvement project at this …

Association Of Diabetes Prevalence With Labor Force Participation Rates In Kentucky Counties, Ryan Montgomery

MPA/MPP/MPFM Capstone Projects

Compared to other states in the USA, Kentucky has one of the highest rates of diagnosed diabetes and one of the lowest levels of labor force participation. This project employs a multivariable linear regression model to estimate the correlation between county-level diabetes prevalence and county-level labor force participation rates in Kentucky counties from 2015-2019, using publicly available data from the Centers for Disease Control’s Behavioral Risk Factor Surveillance System (BRFSS) and the U.S. Census Bureau’s American Community Survey (ACS). Labor force participation rates serve as the dependent variable and diabetes prevalence rates serve as the primary independent variable, alongside nine …

Frequency And Type Of Diabetes Screening Tests In A Sample Of Women With Polycystic Ovarian Syndrome: A Descriptive Study, Jacklyn Vollmer

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Introduction: Polycystic ovarian syndrome (PCOS) is a hormonal disorder that affects 6-12% of United States women of reproductive age. Women with PCOS are at an increased risk of developing type 2 diabetes and fall into high-risk groups for screening guidelines put out by the American College of Obstetricians and Gynecologists (ACOG). Guidelines further suggest that an oral glucose tolerance test (OGTT) be used for diabetes screening in women with PCOS as opposed to an A1C or fasting plasma glucose test. The purpose of this study is to examine rates and type of diabetes screening used among a sample of women …

The Impact Of Identifying And Addressing The Social Needs Of Patients With Type 2 Diabetes Mellitus In A Primary Care Clinic, Shelby Roberts

DNP Projects

BACKGROUND: A key aspect of successful Diabetes management is addressing social needs. Patients prefer individualized care that is tailored to their specific needs.

PURPOSE: The purpose of this Doctor of Nursing Practice (DNP) quality improvement project was to screen patients regarding their diabetes distress and social needs requirements to develop and implement individualized social needs interventions.

METHODS: Patients were included in the study if they had a Hemoglobin A1C >9. Patients were screened, provided additional check in points and social needs were addressed in conjunction with the patient’s primary care provider and onsite social worker. Post intervention …

Metabolic And Electrophysiological Effects Of Fibroblast Growth Factor 19 In The Dorsal Vagal Complex, Jordan Wean

Theses and Dissertations--Physiology

The dorsal vagal complex (DVC) is an important homeostatic regulatory center located in the hindbrain that alters vagal parasympathetic activity in response to central, viscerosensory, and humoral cues. Within the DVC, second-order sensory neurons in the nucleus tractus solitarius (NTS) integrate ascending vagal sensory input with descending regulatory inputs from higher brain areas and respond to circulating hormones and glucose. In turn, the NTS projects to the dorsal motor nucleus of the vagus (DMV) which is comprised of cholinergic motor neurons and regulates gastric motility, hepatic glucose production, and pancreatic hormone release functions, among others.

Fibroblast growth factor 19 (FGF19) …

Rates Of Diabetes Screening In Kentucky Before And After Implementation Of The Affordable Care Act (Aca), Cory Reinert

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Diabetes mellitus, commonly referred to as “diabetes”, is currently at epidemic proportions in the United States as its prevalence has drastically increased over the past several decades. The percentage of Americans with diagnosed diabetes has risen from 0.93 percent of the population in 1958 to 10.5 percent in 2018 (ADA, 2021). Diabetes also impacts record numbers of Kentucky residents.

Regular screening for those considered at-risk can encourage patients to implement lifestyle modifications, pharmacological therapy, or other interventions earlier in the course of disease. This can help prevent or delay onset of T2D and can reduce diabetes-related complications in those who …

Diabetes Locus Of Control And Depression In Older Adults With Type 1 And Type 2 Diabetes: The Study Of Longevity In Diabetes, Jahvona Pretty

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Abstract:

Objective: To determine if diabetes locus of control (dLOC) is associated with depression in older adults with type 1 and type 2 diabetes and whether this association differs by diabetes type.

Methods: Data for the current study were obtained from The Study of Longevity in Diabetes (SOLID), a prospective cohort study of aging, and diabetes. SOLID participants aged 60 and older with type 1 diabetes (T1D), type 2 diabetes (T2D), and without diabetes were recruited from members of Kaiser Permanente Northern California (KPNC). For the current study, we excluded all of the participants without diabetes since the primary exposure, …

Evaluation Of A Diabetic Point Of Care Education In Primary Care, Mary Cho

DNP Projects

BACKGROUND: Diabetes education is the cornerstone of managing diabetes. The education can be delivered in group or individual sessions. Given that group classes are not always well received, a brief five-minute point of care education was developed and incorporated into patients’ routine diabetic appointment. The effectiveness of the method is yet to be determined.

PURPOSE: The purpose of this Doctor of Nursing Practice (DNP) project was to evaluate the effectiveness and acceptability of a recently implemented diabetes point of care education as compared to patients’ usual care in an urban primary care clinic.

METHODS: An outcome evaluation using a retrospective …

An Evaluation Of Depression In Adolescents With Type 1 Diabetes Mellitus, Elleanor Gray

DNP Projects

Depression can significantly affect how adolescents with T1DM self-manage their disease. The combination of depression and diabetes is closely linked to reduction in self-care behaviors, poor treatment adherence, and sub-optimal metabolic control.

PURPOSE: The purpose of this study was to evaluate current screening for depression in adolescents with T1DM and determine the need for additional support or services to improve the quality of routine, follow-up diabetes care.

METHODS: A cross-sectional, retrospective review of electronic medical records was used to evaluate current practice of depression screening for adolescents with T1DM (11-21years) bring followed at a local pediatric diabetes center between April …

Mechanisms And Potential Therapy On Disrupted Blood Pressure Circadian Rhythm In Diabetes, Tianfei Hou

Theses and Dissertations--Pharmacology and Nutritional Sciences

Arterial blood pressure (BP) undergoes a 24-hour oscillation that peaks in the active day and reaches a nadir at night during sleep in humans. Reduced nocturnal BP fall (also known as non-dipper) is the most common disruption of BP circadian rhythm and is associated with increased risk of untoward cardiovascular events and target organ injury. Up to 75% of diabetic patients are non-dippers. However, the mechanisms underlying diabetes associated non-dipping BP are largely unknown. To address this important question, we generated a novel diabetic db/db-mPer2^Luc mouse model (db/db-mPer2^Luc) that allows quantitatively measuring of mPER2 protein oscillation …

Implementing The National Diabetes Prevention Program In Mason County, Kentucky, Cassandra Yelton

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

The National Diabetes Prevention Program (DPP) is sponsored by the Centers for Disease Control and Prevention (CDC). The program’s goal is to reduce the incidence of diabetes through dietary modification and physical activity. On one hand, the DPP is currently offered by various organizations through the country. On the other hand, the DPP is mostly unavailable in rural areas, especially the Diabetes Belt. The Diabetes Belt is in the eastern Appalachian region of the United States. People who live in this area of the country are more likely to develop diabetes than those who do not. Mason County, Kentucky has …

Aps’Aalooke Led Diabetes Prevention Program, Lucy Hollingsworth Williamson

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

The primary objective of this proposed program is to decrease the burden of diabetes mellitus type II among the Crow Indian tribe members in Montana by preventing the progression of prediabetes to diabetes. Type II diabetes mellitus (DMII), is a debilitating disease that contributes to increased morbidity and mortality, in addition to billions of healthcare costs annually. In the United States, minority populations carry a higher burden of DMII, however American Indians have the highest prevalence of all. In fact, American Indians are 2.4 times more likely to be diagnosed with diabetes than white people.

In Montana, the Crow Indian …

Assessing Patients' Perception Of Diabetic Educational Methods In An Urban Primary Care Clinic, Jennifer S. Tilley

DNP Projects

BACKGROUND: From 1980 through 2014, the number of adults with diabetes in the United States has nearly quadrupled, from 5.5 million to 29.1 million. When diabetes education is combined with appropriate medical management, this result in improved participation in diabetes self-management, improved glycemic control, and improved medication adherence. Health education materials, including diabetic education material, are often written at a higher reading level than patients with lower health literacy can understand.

PURPOSE: The purpose of this study was to evaluate the educational information, both verbal instructions as well as written material, provided to patients with type 2 diabetes mellitus This …

Oxidative Stress And Proteomic Studies Of Mammalian Models Of Age-Related Metabolic Dysfunction In Neurodegenerative Disorders, Aaron M. Swomley

Theses and Dissertations--Chemistry

Expression proteomics is the field of science wherein proteins that make up the cellular proteome are identified both by name and by fold-change. Depending on the application of proteomics, this change in level could be due to internal cellular stressors or introduction of xenobiotics. Global oxidative stress measures use immunohistochemistry to determine the relative level of oxidative stress of macromolecules within the cell. In this dissertation, both global oxidative stress measures and expression proteomics were used in a variety of mammalian models in order to determine the effects of protein upregulation, intranasal insulin administration, and resveratrol supplementation on the cellular …

Diagnostic Prevalence Of Diabetes Among Older Adults In Rural Appalachia, Gabriella Hodges

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Background

The rural, mountainous Appalachian region continuously has poorer health outcomes than the rest of the United States. This is true for many chronic diseases including diabetes: the 7th leading cause of death in the United States. This study assessed differences in the prevalence of diagnosed diabetes between older adults in rural, Appalachian counties and rural, non- Appalachian counties.

Methods

Data for the year 2013 was extracted from the Centers for Medicare and Medicaid Services (CMS) Public Use Files for Medicare beneficiaries (September 2015), which provides county level prevalence for diabetes as well as several other conditions among Medicare fee-for-service …

Evaluating The Relationship Between Diabetes And Menstrual Cycle Irregularities, Kailyn Leanne Conner

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Purpose. To evaluate the relationship between menstrual cycle irregularity and several key variables, and to determine whether the odds of diabetic women self-reporting menstrual cycle irregularities is greater than non-diabetic women self-reporting menstrual cycle irregularities.

Methods. A cross-sectional study was conducted using data from the Kentucky Women’s Health Registry from 2006 to 2014. The data was restricted based on age (used as a proxy for menopause status) and self-reported pregnancy and breastfeeding status, as well as eligibility to menstruate, yielding a final population of 4,256 participants for analysis. Basic statistical frequency analyses were conducted, stratified by menstrual cycle …

Compliance With The 2015 American Diabetes Association Screening Guidelines For Diabetes Mellitus Type 2 In Primary Care, Krista L. Johnson

DNP Projects

Purpose: The purpose of this project was to evaluate provider use of hemoglobin (HgA1c) measurement as a method of screening for Type Two Diabetes Mellitus (T2DM) per the 2015 American Diabetes Association screening guidelines in a multidisciplinary primary care clinic in Kentucky.

Methods: A retrospective electronic medical record review was conducted in a large ambulatory care clinic. A master list was compiled of all patients aged 45-89 years who were seen for any reason the first week of November 2015. A total of 127 records that met inclusion criteria were randomly selected. The proportion of patients who were appropriately screened …

The Role And Impact Of School Nurses And Intentions To Delegate Diabetes-Related Tasks Amidst Budget Cuts And Legislative Changes, Michelle J. Lineberry

Theses and Dissertations--Kinesiology and Health Promotion

As the percentage of school children with chronic conditions such as diabetes continues to rise, funding for school nurses to keep those students healthy and safe is decreasing. This dissertation includes three studies: (1) a systematic review of the literature on the role and impact of American elementary school nurses, (2) a focus group study that further examined the role of Kentucky school nurses and described their reaction to a new regulation that necessitates delegation of diabetes-related nursing tasks to unlicensed assistive personnel (UAP), and (3) a quantitative study that examined Kentucky school nurses’ past behaviors and future intentions regarding …

Regulation Of Pancreatic Β-Cell Function By The Renin-Angiotensin System In Type 2 Diabetes, Robin C. Shoemaker

Theses and Dissertations--Pharmacology and Nutritional Sciences

Diet-induced obesity promotes type 2 diabetes (T2D). Drugs that inhibit the renin-angiotensin system (RAS) have been demonstrated in clinical trials to decrease the onset of T2D. Previously, we demonstrated that mice made obese from chronic consumption of a high-fat (HF) diet have marked elevations in systemic concentrations of angiotensin II (AngII). Pancreatic islets have been reported to possess components of the renin-angiotensin system (RAS), including angiotensin type 1a receptors (AT1aR), the primary receptor for AngII, and angiotensin converting-enzyme 2 (ACE2), which negatively regulates the RAS by catabolizing AngII to angiotensin-(1-7) (Ang-(1-7)). These two opposing proteins have been implicated in the …

The Utility Of The U.S. Diabetes Conversation Map As An Intervention To Promote Diabetes Self-Management Adherence, Lisa Gale Jones

Theses and Dissertations--Nursing

Diabetes has reached epidemic levels, to the currently estimated 29 million individuals who are living with diabetes. Those with diabetes must manage their disease through a combination of medication, physical activity recommendations, and nutritional guidelines. The consequences of non-adherence to recommendations include cardiovascular disease, kidney failure, vision loss, or ultimately, death. Despite the risks of non-adherence, individuals often do not adhere to recommended treatment. Researchers have attempted to identify strategies to promote diabetes self-management adherence, thereby decreasing complications related to the disease.

Specific Aims:

1. describe the factors that prohibit individuals from adhering from diabetes self-management behaviors as well as the …

Examination Of The Prevalence And Mediating Factors Of Diabetes Diagnoses In Kentucky Women With A History Of Gestational Diabetes, Courtney Danielle Ryan

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Diabetes mellitus (DM) is an overwhelming health issue in the United States affecting 25.8 million people, which is equivalent to 8.3% of the population.1 It is the seventh leading cause of death and a major cause of serious complications such as heart disease, stroke, kidney failure, nontraumatic lower limb amputations, and new causes of blindness among adults in the U.S.1 Paralleling the obesity epidemic, the rates of DM incidence and prevalence continue to rise each year.2 One particularly troubling public health issue related to DM is that over a quarter of the people who have this disease are unaware, even …

Educational Materials And Brief Counseling Improve Diabetes Knowledge And Self-Efficacy, Tamara K. Wellman

DNP Projects

Purpose: The purpose of this study was to see if education and counseling of the Appalachian individual with diabetes and a family member/friend would improve knowledge of the disease and self-efficacy of the patient in regard to their diabetes care.

Setting: The setting was one of eight primary care offices of Our Lady of Bellefonte Hospital, Bon Secours, located in the Ashland, Kentucky.

Design: A pilot study of descriptive, comparative design was used.

Subjects: Data were collected from a convenience sample of patients with type 2 diabetes (n=15) that were established at the primary care office and their family members/friends …

An Investigation Of Perinatal Polychlorinated Biphenyl Exposure On Body Composition And Glucose Homeostasis, Cetewayo S. Rashid

Theses and Dissertations--Nutritional Sciences

Recent advancements have uncovered environmental contributions to obesity and diabetes etiology. In fact, perinatal malnutrition resulting in low birth weight (LBW) has been shown to correlate with later life obesity and impaired glucose tolerance in aged offspring. LBW can result from a myriad of developmental perturbations including macronutrient restriction, hypoxia, maternal stress and toxin exposure.

Polychlorinated biphenyls (PCBs) are ubiquitous environmental pollutants that bioaccumulate in the food chain resulting in dietary exposure in humans. Maternal and cord blood PCB levels are inversely associated with birth weight, and recent studies indicate that perinatal exposures to PCBs contribute to gender-specific obesity development …

The Influence Of Antidiabetic Medications On The Development And Progression Of Prostate Cancer, Anna Elizabeth Hitron

University of Kentucky Master's Theses

The development of prostate tumors has been linked to co-morbid diabetes mellitus (DM) in several studies, potentially through the stimulation of insulin-like growth factor receptor (IGFR). This study evaluates the effect of anti-diabetic medication use on the development of high grade tumors and time to tumor progression compared to non-diabetics. This retrospective, nested case control study identified patients with prostate cancer (PCa) from the Kentucky Medicaid Database. Cases were diagnosed with PCa and DM and using at least one of the following antidiabetic medications; sulfonylureas, insulin, metformin or TZDs. Cases were further stratified on their insulin exposure resulting from therapy. …