Medicine and Health Sciences Commons^™

Reduced A1c Levels Through Diabetes Self-Management Strategies In The Teen Population: A Systematic Review, Nicole O'Neil

Master's Projects and Capstones

This project utilized current evidence-based practices to improve the diabetes education in the endocrine clinic for the adolescent population ages 15-18. Based on a clinic audit, an average hA1C level of 8.1% was revealed. The goal was to decrease these levels from 8.1% to 7.9% within 90 days through the implementation of the revised diabetes brochure. Evidence suggests the following: DSME improves clinical outcomes and quality of life; an A1C level >7% is associated with increased risks of complications ; teaching aimed at lowering glycemic levels have decreased numerous complications; there is a need to ensure age appropriate, family-centered care, …

An Evidence-Based Approach To Determine The Feasibility And Sustainability Of A Support Group For Vulnerable Populations With Diabetes In A Free Health Clinic, Shawn Hillman

Doctoral Dissertations

Purpose: People living with diabetes require the appropriate resources, education, and support to avoid long-term complications. Vulnerable people with diabetes are often lacking these vital components, resulting in higher rates of complications, and decreased quality of life. A support group for diabetes in a free health clinic is an effective venue to provide these resources. This project determined the feasibility and factors leading to the potential for sustainability of a diabetes support group for a vulnerable population in West Michigan by implementing a pilot support group. Determinants of feasibility and sustainability were participant and professional feedback, perceptions of value and …

Improving Management Of Inpatient Blood Glucose, Rachael K. Misitano

Master's Projects and Capstones

Epidemiologic studies indicate blood glucose management in the hospitalized patient population is not adequate; with approximately 30% of patients reporting values >180mg/dl. Patients with increased blood glucose levels pose a higher mortality risk as well as increased risks for dehydration, hypotension, renal injury, decreased wound healing, immunosuppression, and an overall increase in hospital length of stay (AACE, 2015). This project aims to improve inpatient management of blood glucose levels by facilitating MD-RN communication through a reduction in the current reportable blood glucose level. This project took place on a 17 bed adult medical-surgical unit at a large academic hospital in …

Effect Of Diabetes Self-Management Education On Glycemic Control, Compared To Usual Care In Type 2 Diabetic Patients At The Family Medicine Clinic, Aga Khan University Hospital Nairobi, Catherine Wanjiku Gathu

Theses & Dissertations

Background: Globally, the magnitude of disease burden associated with diabetes is high. Poor glycemic control contributes greatly to this burden, especially in the occurrence of related complications. The value of Diabetes Self-Management Education (DSME) is evident in literature, and has been recommended as a way of optimizing glycemic and metabolic control and averting early onset of diabetes complications. Usual care involves spontaneous sharing of information during medical consultations without planned structure or defined time frame. In the African setting, the effect of DSME, and how it compares to usual care, is yet to be fully explored.

Objective: To compare the …

Postcolonialism And The Marshallese Diaspora: Structural Violence And Health In The Marshallese Community In Springdale, Arkansas, Alexander J. Hirata

Master's Theses

Despite moving to the United States for better healthcare, among other benefits, Marshallese Compact of Free Association (COFA) migrants residing in Springdale, Arkansas continue to face similar acute health problems as Marshallese living in the Republic of the Marshall Islands (RMI), and often without access to health services. These problems include high rates of noncommunicable diseases, such as type 2 diabetes and thyroid cancer, as well as rare conditions such as Hansen’s Disease.

To research this, I studied the limited texts surrounding the Marshallese diaspora, as well as relevant bodies of literature: postcolonialism, Pacific migration theory, and global health and …

Circulating Angiogenic Stem Cells In Diabetes., Nagma Zafar

Electronic Theses and Dissertations

Circulating angiogenic stem cells (CACs) are rare cells found in peripheral blood that have been shown to contribute to endothelial repair and new blood vessel formation. These cells could be biomarkers and/or therapeutic targets for the assessment and prevention of cardiovascular disease (CVD), which is the leading cause of mortality globally and in the United States. Diabetes is an independent risk factor for CVD, and there are inconsistent reports on the role of CACs in diabetic vasculopathy. To study this further we tested the hypothesis that diabetes depletes circulating levels of CACs, due to hyperglycemia or insulin resistance and that …

The Effect Of The Patient Protection And Affordable Care Act On The Medicare Part D Coverage Gap As Reflected In Diabetes Medication Adherence., Jennifer A. Forristal

Electronic Theses and Dissertations

This dissertation involves an evaluation of the effect of the Patient Protection and Affordable Care Act (ACA) on diabetic medication adherence for mail order utilizers over 6 years as the Medicare Part D coverage gap begins to close. The study had 3 objectives: 1) to evaluate diabetes medication adherence of health plan members before they reach the coverage gap and then while they are in the coverage gap, 2) to compare diabetes medication adherence between two similar groups with differing benefit structures, one group with a gap in coverage as opposed to a group with no benefit changes within the …

Diabetes Self-Management Education For Adults With Type 2 Diabetes Mellitus, Rondalyn Dennis-Bradshaw

Walden Dissertations and Doctoral Studies

Diabetes, a major public health challenge in St. Kitts, has been a focus of international public health community research. Although researchers have demonstrated that diabetes self-management education is a cost-effective strategy for the prevention of diabetes-related complications, they have yet to establish whether there is adequate education occurring in treatment settings with diabetic patients. The purpose of the study was to implement and evaluate the short-term effectiveness of a diabetes self-management education intervention on diabetes-related knowledge and accepted behavioral changes to decrease risk for complications. Based on a self-care approach, this education intervention was designed to improve diabetes-related knowledge and …

Diabetes Status, Predisposing, Enabling, And Oral Health Illness Level Variables As Predictors Of Preventive And Emergency Dental Service Use, Sabha Alshatrat

Health Services Research Dissertations

The purpose of this study was to clarify the relationship between diabetes and dental service use. This study addressed the question of whether individuals with diabetes are more or less likely to utilize dental services, measured in terms of preventive and emergency services during the past year. A cross-sectional study was conducted to assess the contributions of diabetes status to dental service use, relative to the contributions of Andersen and Newman Framework of Health Services Utilization dimensions (predisposing, enabling, and illness variables) in predicting dental service utilization during the past year using a nationally representative sample from a 2001-2002 National …

An Investigation Of Health Literacy, Acculturation, Diabetes Knowledge, And Social Supports Among Latinos With Diabetes In Southern Ontario, Ivonne Aguilar

Electronic Thesis and Dissertation Repository

The prevalence of diabetes is high among Latino people. This study investigated the relationships between health literacy, acculturation, social support, and diabetes-related knowledge among Latino adults with Type 2 diabetes and informal caregivers with a family history of Type 2 diabetes. A non-experimental, cross-sectional design was used to examine these relationships among 73 adult Latino participants living in Southern Ontario. Based on Nutbeam’s conceptualization of health literacy, associations existed between health literacy, acculturation and knowledge of diabetes among Latino participants, yet the concept of social support showed no direct relationship to health literacy. This research has explored the factors that …

Monitoring Non Compliant Diabetic A1c Levels, Laura J. Tracy

Master's Projects and Capstones

The AIM of this CNL project is to identify and connect with, those diabetic patients within the out-patient clinic that are not in compliance with their A1C laboratory values. Contacting these patients to schedule follow up and re-engagement in their health care plan, may improve their overall health care outcomes and decrease their risk of more frequent or prolonged hospitalization and increased use of medications. There are over 25.6 million adult diabetic people living in the United States as of 2010. The total cost of direct and indirect medical care is 174 billion dollars as of 2007. With over 3.9 …

Polymeric Nanocarriers For Treatment Of Melanoma And Genetically Modified Mesenchymal Stem Cells To Improve Outcome Of Islet Transplantation, Vaibhav Mundra

Theses & Dissertations

Melanoma is a lethal malignancy with limited treatment options for advanced metastatic stages. New targeted therapeutic options with discovery of BRAF and MEK inhibitors have shown significant survival benefit. Despite the recent progress, inefficient tumor accumulation and dose limiting systemic toxicity remains pressing challenges for treating metastatic melanoma and there is a need for drug delivery approach to improve therapeutic index of chemotherapeutics. Nanoparticle based drug delivery represents promising approach to enhance efficacy and reduce the dose limiting systemic toxicity. Nanoparticles can be formulated either by physical encapsulation of drugs or by covalent conjugation of drugs to the polymeric backbone. …

Diabetic Ketoacidosis, Mario Bianconi

Nursing Student Class Projects (Formerly MSN)

According to “Statistics About Diabetes” (2014), in 2012, 29.1 million Americans, or 9.3% of the population, had diabetes. Additionally, of the 29.1 million, 21 million of the population were diagnosed, and 8.1 million were undiagnosed. With such a high prevalence, it is imperative that the hospital nurse is aware not only how to treat diabetes, but also how to look for complications of diabetes. One of the severe complications of diabetes is Diabetic Ketoacidosis, or DKA. DKA occurs as a result of prolonged untreated diabetes. It is the result of the body not being able to produce, or use, insulin …

Antihyperglycemic Medications And Hypoglycemia In Older Adults With Diabetes, Kristin K. Clemens

Electronic Thesis and Dissertation Repository

Background: In the last decade, several new antihyperglycemic medications have been approved to treat people with diabetes. However, the hypoglycemia risk of these medications in older adults in routine clinical practice remains unclear. Further, there is limited understanding as to how these medications are being prescribed to older adults in our region.

Methods: We carried out retrospective, population-based studies of adults age 66 and older in Ontario, Canada using linked healthcare databases. We first investigated the real-world hypoglycemia risk of 2 antihyperglycemic medications – glyburide and modified-release gliclazide. In an ecological study, we then examined trends in antihyperglycemic medication prescriptions, …

Diabetic Prevention The Hard Way: Modified Diet And Increased Exercise, Torrie Reese St.Julien

Doctor of Nursing Practice Final Manuscripts

Background and Purpose: In the United States, 79 million people are pre-diabetic: most have no symptoms. If left untreated, 37% will develop diabetes within 4 years. Fourteen percent of United States health care expenditures are related to diabetic complications. This Evidenced Based Project (EBP) involved a behavioral lifestyle change with the purpose of 7% weight loss and a minimum of 150 minutes of physical activity a week. It was also designed to reduce risk factors and glycated hemoglobin A1c (HgA1c) levels.

Methods: The interventional approach was modeled after the Diabetes Prevention Program (DPP) and Group Lifestyle Balance Program. Participants were …

Emergency Protocol Program For High School Athletes, Casandra B. Moyer

Doctor of Nursing Practice Final Manuscripts

This evidence-based project (EBP) involved development and implementation of an emergency protocol (EP) education program for high school athletes and coaches at a southern California high school. A Doctor of Nursing Practice student, collaborating with health care and athletic personnel, conducted an assessment of the high school’s EPs for management of asthma, anaphylaxis, diabetes, and heat illness. Then, an EP and educational program were created; coaches and athletes were educated on the protocol during a coaches’ meeting and practice times, respectively. All participants completed pre- and post-tests, and mean knowledge scores were compared. The overall knowledge score increased by 10% …

In-Patient Self-Management Diabetes Education, Amy Matthews

Master's Projects and Capstones

The diabetes program strives to provide diabetes self-management education to the in-patient with diabetes. The specific aim is to improve and standardize diabetes education for the inpatient with diabetes by June 2015. The microsystem is a medical surgical unit for patients 18 years and older who present with diabetes as either a primary diagnosis or secondary diagnosis. Fifty percent of the diabetes patients on this unit are ages 65-89 years old, twenty nine percent are ages 50-64. The unit has 32 beds and is filled to capacity ninety five percent of the time. The fishbone diagram revealed our microsystem lacked …

The Relationships Among School Nurse To Student Ratios, Self-Efficacy For Type 1 Diabetes Management, And Glycemic Control In Adolescents, Lori Wilt

Seton Hall University Dissertations and Theses (ETDs)

Type 1 diabetes mellitus (T1DM) is one of the most common chronic diseases of childhood. Adolescents with T1DM experience decreased treatment adherence, poor glycemic control, and acute complications more frequently than adults. Self-efficacy is the belief that one can carry out specific behaviors in specific situations and is the major determinant of intention, and has been shown to influence diabetes self-management in the adolescent.

School nurses are in a unique position to influence self-efficacy for type 1 diabetes management in adolescents. Although previous research has shown that school nurses positively influence student health outcomes in a variety of ways, there …

Transitional Care Of Adult Patients With Diabetes Following Hospitalizations, Eric Tobin

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidence-based practice project was to incorporate a diabetes transitional care program using group visits to improve self-care management behaviors and glycemic control in diabetic patients at a southern California hospital.

Background: Diabetes is a challenging healthcare problem associated with significant mortality and morbidity issues. In 2012, 29.1 million people, or 9.3% of the U.S. population, were diagnosed with diabetes, and 28.9 million of those patients were 20 years of age and older. Today, diabetes is of epidemic proportion worldwide, and a projection of 5.4% of the adult population will have diabetes by 2025. The …

Diabetes Type 2 Self-Management Education Program: Short Messaging From Patient Portal To Web-Enabled Device, Lynn S. Holcomb

Evidence-Based Practice Project Reports

Only one in eight adults with diabetes reaches target goals for disease management, which can lead to clinical complications, costly both economically and in quality and duration of human life. The standard of care is a quarterly 15-minute face-to-face visit-- arguably inadequate to impart self-care knowledge. The purpose of this EBP project was to deliver a 30-day diabetes self-management education program (DSMEP) utilizing widely accessible web-based technology to facilitate adults with diabetes to reach targeted goals. Using the Chronic Care Model as a framework, the DSMEP design was based on an extensive literature review of the delivery of DSMEP in …

The Impact Of Shift Work On Diabetes Self-Management Activities, Daniel Navarro

UNLV Theses, Dissertations, Professional Papers, and Capstones

In the United States 26 million people are affected by diabetes, which can result in microvascular and macrovascular complications. As a consequence, once a person is diagnosed with diabetes, aggressive clinical management is imperative to minimize poor glycemic control’s devastating outcomes. However, for some patients reaching optimum blood glucose levels is challenging due to the complexity of diabetes’ care. In order for patients with diabetes to achieve good blood glucose control, they must engage in self-care activities that include routine blood glucose checks, dietary control, physical activity, and routine medical provider visits, simultaneously with their medication regimen. Diabetes associated self-care …

Efficacy Of Behavioral Interventions In African-Americans With Type Ii Diabetes: A Comparative Effectiveness Analysis, Tangela Nicole Hales

Dissertations

Context: The efficiency and effectiveness of the healthcare system are prime foci for nursing research.

Objective:The purpose of this study was to review and critically appraise the current state of the evidence in the treatment of African American adults with type II diabetes. To address this objective, a systematic review was undertaken that investigated the comparative effectiveness of behavioral interventions in improving glycemic control.

Methods: Robust methodological approaches to comparative effectiveness research (CER) serve to improve the transparency, consistency, and scientific rigor of the research. The methods for this systematic review of literature followed those recommended in the Agency …

Characterization Of Ghrelin O-Acyltransferase Active Site, Leslie Patton

Honors Capstone Projects - All

Ghrelin, first discovered in 1999, is a 28-amino acid peptide hormone involved in the regulation of appetite, insulin secretion and sensitivity, and many neurological effects such as learning, memory, and depression.^1-6 Ghrelin has been identified to have a unique posttranslational octanoylation carried out by the enzyme ghrelin O-acyltransferase (GOAT). This distinctive modification is a point of interest in studying GOAT whereby blocking the acylation of the ghrelin could potentially halt the activity of the peptide hormone and provide a means of treating obesity, diabetes, and other diseases affected by ghrelin levels. The duration of my project involved working …

Diabetic Bone Marrow & Stem Cell Dysfunction, Meghan A. Piccinin

Electronic Thesis and Dissertation Repository

ii Abstract Abstract Defects in the proliferation, differentiation, and activity of bone marrow (BM)-derived vasculogenic/vascular stem cells (VSCs) have been observed in diabetes and contribute to the development of vascular complications. Diabetes leads to enhanced bone marrow adipogenesis, altering the composition of the BM stem cell (SC) niche and potentially disrupting the normal functioning of resident VSCs. Here, I establish that adipocytes have a negative influence on SC survival in culture. I also show that adipocytes and osteoblasts are responsible for the creation of distinct extracellular microenvironments, with unique expression patterns of several pro- and anti-angiogenic factors with known effects …

The Effects Of Latent Stage Diabetic Education And Tele-Health Reinforcement On The Knowledge Of Low-Income Diabetic Patients, Hannah M. Chicowlas

Honors College Theses

Diabetes is a chronic disease that affects millions globally. Poverty and obesity are factors that affect the development and progression of this disease. Although education has been identified as a factor affecting treatment adherence, on-going education for diabetes typically occurs in the early stages. This pilot study consisted of a quantitative, comparative study utilizing tele-health as the primary form of educational reinforcement for latent stage, low-income diabetics. Six clients agreed to participate. It focused on participants from a local clinic in Georgia. All participants live at or below 200% of the federal poverty guidelines. An initial survey was followed by …

Experimental Investigation On The Relationship Between Lead Exposure And Thyroids In Diabetes, Salah Sumar Ali Al-Zadjali

Dissertations

Lead exposure can cause multiple systemic toxicities, particularly affecting the hematopoietic, nervous and renal systems. However, its effects on the thyroid functions are not well elucidated and the published studies are controversial. In addition, although there are several experimental thyroid models, each one of them has its own limitations. Accordingly, in this dissertation, we investigated the possible relationship between lead exposure, thyroid functions and short-term systemic toxicity in two animal models, namely normal (non-diabetic) and diabetic animals. We also investigated the possibility of developing a hormonal thyroid model. In the non-diabetic model, Wistar rats were divided into five groups and …

Experimental Investigation On The Relationship Between Lead Exposure And Thyroids In Diabetes., Salah Sumar Ali Al-Zadjali

Dissertations

Lead exposure can cause multiple systemic toxicities, particularly affecting the hematopoietic, nervous and renal systems. However, its effects on the thyroid functions are not well elucidated and the published studies are controversial. In addition, although there are several experimental thyroid models, each one of them has its own limitations. According, in this dissertation, we investigated the possible relationship between lead exposure, thyroid functions and short-term systemic toxicity in two animal models, namely normal (non-diabetic) and diabetic animals. We also investigated the possibility of developing a hormonal thyroid model.

In the non-diabetic model, Wistar rats were divided into five groups and …

Diabetes Distress: Transforming A Practice, Goff M. Jeannie

Doctor of Nursing Practice Scholarly Projects

Diabetes mellitus affects millions of people in the United States, placing them at risk for other disease related complications. This makes the management of diabetes and the prevention of complications an important challenge. The psychological aspect of diabetes care may present a barrier to patients that inhibit them from achieving optimal self-care.

Diabetes distress (DD) is the psychological aspect of diabetes that is specific to the emotional distress caused from living a chronic disease. DD has been linked to poorer self-management behaviors which makes it a significant problem that should be taken into consideration for effective management of the diabetic …

Understanding Health Literacy Skills Of Patients With Cardiovascular Disease And Diabetes, Patrick J. Dunn

Walden Dissertations and Doctoral Studies

Health literacy is the ability to understand and act on health information and is linked to health outcomes. It is unclear how health literacy skills are developed in patients with complex conditions, such as cardiovascular disease and diabetes. The purpose of this grounded theory study was to gain perspectives of both patients and healthcare professionals on how health literacy skills were developed in patients with cardiovascular disease or diabetes. The research questions addressed how knowledge and skills were acquired, the role of digital tools, instructional strategies used by healthcare professionals, and how the instructional strategies of the healthcare professionals matched …

The Sweet Taste Of Health: A Positive Deviance Inquiry Into Communicative Acts That Lead To Effective Management Of Diabetes Among Hispanics, Claudia Martinez Boyd

Open Access Theses & Dissertations

ABSTRACT

Diabetes is among the fastest growing diseases in the world. In the U.S., Hispanics are the third most affected population. Nonetheless, there are Hispanics diagnosed with diabetes who have, against all odds, found solutions to manage their disease. This study focused on the intrapersonal and interpersonal acts and behaviors of "positive deviant" Hispanics living on the U.S. - Mexico border that effectively managed their diabetes. They are referred to as "positive deviants" because they accrue "positive" outcomes and "deviants" because they are not the norm.

A PD inquiry was conducted and twelve PD respondents between the ages of 20 …