Improving Adherence To Annual Diabetes Guidelines In Rural Primary Care, Ashley Barney

Culminating Experience Projects

Background: The American Diabetes Association (ADA) (2022) identifies comorbidity risk assessments and treatment planning as key health maintenance components for diabetic patients. However, many providers do not adhere to the recommended national guidelines (Brenner et al., 2020).

Objectives: At a rural primary care clinic, the effectiveness of implementing a checklist was evaluated to improve provider adherence to the annual diabetes guidelines set by the ADA.

Methods: A quality improvement project was initiated and guided by the Lean Six Sigma framework. The checklist was implemented to assess if providers adhered to the recommended annual diabetes guidelines. The project …

Food Insecurity In Youth And Young Adults With Diabetes: Prevalence And Association With Health Behaviors, Lauren Helene Martini

Theses and Dissertations

Given the life-long impact of diabetes(1-5), it is important to engage in behaviors that promote health and wellness to delay or prevent negative health outcomes(3, 6-10). Despite this, youth and young adults with diabetes generally do not adhere to nutritional(11-17) or physical activity(18, 19) recommendations. In households experiencing financial difficulties, especially those who are having difficulty providing sufficient food to all of its members, adhering to recommendations may be even more difficult.

The purpose of this dissertation is to better understand and contextualize food insecurity among youth and young adults (YYA) with youth-onset T1DM and T2DM. The first aim addresses …

Disparate Access To Medical Coverage Associated With Type 2 Diabetes Care In Low-Income And Rural Communities In Georgia, Crystal Alexis Symone Edwards

Walden Dissertations and Doctoral Studies

Disparate access to diabetes care in rural and low-income communities among older adults has been an ongoing issue among Americans. Type 2 diabetes in low-income and rural communities has continuously burdened many residents due to age, costs of care, income, geographic location, and education levels. Researchers have demonstrated that providing resources and tools to rural and low-income communities would assist in decreasing type 2 diabetes and increase education and awareness. The purpose of this quantitative cross-sectional study using secondary data was to examine the relationship between health insurance status and lack of access to health care resources and delay of …

Understanding Perceptions Of New-Onset Type 1 Diabetes Education In A Pediatric Tertiary Care Center, Gabriel Betancurvelez

Yale Medicine Thesis Digital Library

Background: Youth newly diagnosed with type 1 diabetes (T1D), and their families, require intensive education on the management of this chronic condition during this overwhelming period. Traditionally, our center conducts training in person during a hospital admission.

Methods: We studied family perceptions of our current patient education methods in an effort to elucidate strategies to augment education in the post-pandemic environment, where provider time in the room and visitation rules may limit face-to-face encounters.

Results: 25 families completed the survey (distributed to 156 in total, with approximately 21% response rate). The mean age at diagnosis was 9.52 ± 4.29 years …

Effects Of Social Determinants On Access To Care Among Patients With Diabetes In Florida, Nekeisha Latoya Walker

Walden Dissertations and Doctoral Studies

Diabetes imposes a major burden on society, especially in the state of Florida, in the form of increased medical costs, lost productivity, early mortality, and intangible costs in the form of diminished quality of life. Access to diabetic care affects health administration in Florida by impacting the overall cost of treating the condition. Limited access to care can lead to an increased risk of complications resulting in a higher cost of treatment. The purpose of this quantitative study was to determine whether access to care dependent variables (access to doctors and length of time since last routine checkup) were associated …

Relationship Between Childhood Trauma, ,Adverse Childhood Experiences, And Self-Management Of Type 1 And Type 2 Diabetes, Deserie J. Otoole

Walden Dissertations and Doctoral Studies

AbstractPoorly controlled diabetes is the result of lack of self-care, which contributes to complications, ill quality in life, the rise in health care costs, and early death. The purpose of this quantitative, nonexperimental study was to examine the extent to which diabetes type (Type 1 and Type 2), childhood trauma, and adverse childhood experiences predict diabetes self-management (glucose management, dietary control, physical activity, health care use, total self-management). Contemporary trauma theory suggests that early childhood trauma results in negative health-related consequences in adulthood. Standard multiple regression analyses showed that (a) higher levels of physical neglect and emotional abuse predicted poorer …

Providing Diabetes Education To Improve Staff Nurses' Knowledge, Marcia A. Patterson

Walden Dissertations and Doctoral Studies

Diabetes mellitus is a chronic metabolic disease that affects over 34.2 million or 10.5% of the U.S. population and ranks as the seventh leading cause of death. Tennessee's diabetes prevalence rate is ranked 45th overall in the nation, with 14.9% of the population affected, and in the local area for this project, the rate is greater than 15%, creating a public health concern. Despite its prevalence, there is still a wide gap in knowledge among nurses on diabetes management. The practice-focused question for this project addressed whether a staff education program would improve nurses' knowledge regarding diabetes. The significant gap …

Risk Factors Associated With The Development Of Type Ii Diabetes-Related Complications, Jessica Danielle Lucas Williams

Walden Dissertations and Doctoral Studies

By 2040, it is estimated that 642 million people ages 20 to 79 will have Type II diabetes, thereby making it a heavily studied topic among scholars. As more people are diagnosed with Type II diabetes each year, the literature is slowly shifting to long-term complications. However, the many risk and protective factors that exist have created gaps in the literature. The purpose of this study was to determine the relationship between participation in diabetes self-management classes, mental health, physical health, BMI, smoking status, exercise, and possible diabetes complications (diabetes-related retinopathy and diabetes-related kidney disease). The gap in the literature …

Disparate Access To Medical Coverage Associated With Type 2 Diabetes Care In Low-Income And Rural Communities In Georgia, Crystal Alexis Symone Edwards

Walden Dissertations and Doctoral Studies

Disparate access to diabetes care in rural and low-income communities among older adults has been an ongoing issue among Americans. Type 2 diabetes in low-income and rural communities has continuously burdened many residents due to age, costs of care, income, geographic location, and education levels. Researchers have demonstrated that providing resources and tools to rural and low-income communities would assist in decreasing type 2 diabetes and increase education and awareness. The purpose of this quantitative cross-sectional study using secondary data was to examine the relationship between health insurance status and lack of access to health care resources and delay of …

Improving Self-Efficacy Of Primary Care Providers With Assessment Of Diabetic Peripheral Neuropathy, Kimberly Paddock Farr

Walden Dissertations and Doctoral Studies

AbstractDiabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes. DPN contributes to significant pain, debility and injury to diabetic patients. The majority of diabetic patients are managed in the primary care practice (PCP) setting. A local chapter of a nurse practitioner association identified a lack of knowledge of current evidence-based guidelines for effective screening and assessment of DPN in the PCP environment. The practice-focused question for this project was to determine if an educational intervention on evidence-based screening and assessment would improve nurse practitioner’s knowledge with DPN screening and diagnosis in PCP. Mezirow’s transformative theory of …

Effects Of Social Determinants On Access To Care Among Patients With Diabetes In Florida, Nekeisha Latoya Walker

Walden Dissertations and Doctoral Studies

Diabetes imposes a major burden on society, especially in the state of Florida, in the form of increased medical costs, lost productivity, early mortality, and intangible costs in the form of diminished quality of life. Access to diabetic care affects health administration in Florida by impacting the overall cost of treating the condition. Limited access to care can lead to an increased risk of complications resulting in a higher cost of treatment. The purpose of this quantitative study was to determine whether access to care dependent variables (access to doctors and length of time since last routine checkup) were associated …

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 …

The Role Of Herbal Medicines In Central American Indigenous Communities; Improving Accessibility To Type 2 Diabetes Mellitus Treatment, Sarai Ortega

CMC Senior Theses

Indigenous communities in Central America have used various plant medications to treat illnesses and diseases for centuries. Clinicians must consider improving traditional healthcare methods that are intrinsic to indigenous communities in order to increase access to effective treatments, particularly for diseases that these communities are more at risk for. This work aims to propose a method to identify whether traditional preparations of five plants (Anacardium occidentale L., Hamelia patens Jacq., Momordica charantia L, Neurolaena lobota L. R. Br. Ex Cass., and Tecoma stans L. juss. ex Kunth) can reduce blood glucose levels in rats with type two diabetes. Additionally, …

Improving Self-Efficacy Of Primary Care Providers With Assessment Of Diabetic Peripheral Neuropathy, Kimberly Paddock Farr

Walden Dissertations and Doctoral Studies

AbstractDiabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes. DPN contributes to significant pain, debility and injury to diabetic patients. The majority of diabetic patients are managed in the primary care practice (PCP) setting. A local chapter of a nurse practitioner association identified a lack of knowledge of current evidence-based guidelines for effective screening and assessment of DPN in the PCP environment. The practice-focused question for this project was to determine if an educational intervention on evidence-based screening and assessment would improve nurse practitioner’s knowledge with DPN screening and diagnosis in PCP. Mezirow’s transformative theory of …

Examining The Oxidative Stress Effects In Rats Exposed To 2-Aminoanthracene In Utero And High Fat Diet Three Months After, Brianna A. Lanoix

Honors College Theses

Polycyclic aromatic hydrocarbons are organic compounds that are created synthetically or found in partially burned oil, gasoline, and coal. 2-aminoanthracene (2AA) is a common example of a PAH and can affect lipid and carbohydrate metabolism and resulting in inflammatory problems and oxidative stress. The objective of the research project is to investigate oxidative stress in relation to diabetes in rats exposed to 2AA in utero and a high fat diet later in life. Pregnant dams were separated into treatment groups based on their dosages of 2AA; 0 mg/kg (control), 50 mg/kg (low), 100 mg/kg (high). During the gestation -postpartum period, …

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 …

Diabetes Prevention And Management Education For Punjabi-Sikh Older Adults, Mandeep K. Gill

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: South Asians from Bangladesh, Pakistan, and India have a higher prevalence of diabetes than the general global population and are also more susceptible to developing diabetes due to biological and lifestyle factors. The South Asian diet is high in refined grains and monounsaturated fatty acids, increasing the risk of diabetes.

Local Problem: Congregants of a Sikh gurdwara (place of worship) lacked knowledge of diet and lifestyle in relation to preventing and managing diabetes. Many senior congregants have been diagnosed with diabetes or are at high risk of developing the disease.

Methods: Knowledge of diabetes prevention and management were …

Process Evaluation Of A Community Asset Mapping Protocol For Diabetes Prevention And Management, Andrea Peterson

Capstone Experience

Prediabetes and type 2 diabetes mellitus (DM) are highly prevalent conditions with new diagnoses occurring each year (Centers for Disease Control and Prevention, 2022a). Type 2 DM negatively impacts many aspects of life, to include social, financial, cultural, and everyday living. Asset mapping is a useful tool to build upon existing resources to help community members identify and expand services based on understanding the interconnected systems that influence type 2 DM prevention, screening, education, and care management. An Asset Mapping Protocol was created and piloted through a rural community coalition in Nebraska. The protocol includes an activity for community stakeholders …

Diabetes Self-Management Education And Support: Understanding Knowledge And The Impact, Christina Dietz

All Dissertations

Diabetes has reached epidemic proportions in the United States. To address this, many organizations employ diabetes self-management education and support (DSMES) programs to aid in managing the impact of increasing prevalence. The purpose of this dissertation is to examine the impact of two Upstate South Carolina DSMES programs on several process and outcome measures for adults with diabetes, while also identifying current primary care provider DSMES knowledge and perceptions in an Upstate South Carolina health system.

This dissertation found inconclusive results on the impact of DSMES on PCP utilization, retinal exam screening, nephropathy attention, HDL, LDL, TC, and TG. DSME …

The Molecular Basis Of Diabetic Cardiomyopath, Ahmed Salaheldin Mustafa Ali Sultan

Dissertations

Diabetes mellitus (DM) is a major and worsening global health problem. Type 2 diabetes mellitus (T2DM) accounts for more than 90% of DM and the global epidemic of obesity largely explains the dramatic increase in the incidence and prevalence of T2DM over the past 20 years. Cardiovascular complications are the major cause of morbidity and mortality in diabetic patients. The electrocardiogram (ECG) of diabetic and obese patients is frequently disturbed. The aim of this project was to characterize and clarify the molecular basis of electro-mechanical dysfunction in the hearts of type 2 diabetic and type 2 diabetic/obese rats. Experiments were …

Improving Measurements And Self-Management Skills Of Cardiovascular Disease By Incorporating A Healthy Lifestyle In Hispanic Adults: A Promotoras Led Program, Kelly Llewellyn

Doctor of Nursing Practice (DNP) Manuscripts

Hispanic community members face unique challenges related to language barriers, culture, access to care, and trust in healthcare providers. Hispanic community members have a higher incidence of cardiovascular diseases and diabetes than their non-Hispanic counterparts. Hispanic males were most likely to die of cardiovascular disease in 2017 (CDC, n.d.a), and for females, death from cardiovascular disease was only second to cancer (CDC, n.d.b.). Hispanics are 70% more likely to be diagnosed with diabetes than non-Hispanics (Office of Minority Health, nd.) Promotoras are trusted members of the Hispanic community who can assist healthcare providers in providing disease prevention education and self-management …

Diabetes Mellitus Type 2, Jyoti Adhikari

Nursing Student Class Projects (Formerly MSN)

Diabetes Mellitus is a metabolic disorder that affects millions of people. The trend continues to be upward. Youth and children are not exempt from this. It is a chronic metabolic disorder characterized by persistent hyperglycemia. Causes are impaired insulin secretion, resistance to the peripheral action of insulin, or both. There are three types of diabetes: type 1, type 2, and gestational. Type 2 DM accounts for around 90% of all cases of DM. In type 2 DM, the body's response to insulin diminishes causing insulin resistance. It is commonly seen in people older than 45 years old but increasingly seen …

An Evaluation Of A Multidisciplinary Implementation Of Evidence Based Practice In Prediabetes, Emily Sisco

Dissertations

Abstract

Problem Over 70% of prediabetic patients progress to full diabetes. There are over 80 million American adults who are diabetic. Diabetes is the costliest chronic disease that often leads to many other health issues.

Methods This QI project utilized a descriptive observational design. Quantitative data was collected via retrospective chart review. Primary data collected was documentation of a patient visit to the registered dietician and the hemoglobin A1c (HbA1c) of patients who followed up in the office after the referral.

Results Eight patients followed up to the office for a second visit (n=8). Four patients did see the registered …

Medication Therapy Management Implementation In Conjunction With A Rural Health Clinic In Minnesota: A Cqi Impact On Diabetes Metrics, Abigail Sirek Pharmd

Theses and Dissertations

The purpose of this continuous quality improvement project was to implement a pharmacist-led Medication Therapy Management (MTM) clinic in rural, central Minnesota and assess the impact on patients’ healthcare over a six-month period. Patients were identified through the clinic’s diabetes registry, which included patients 18 through 75 years old with a diagnosis of diabetes not meeting all five D5 goals, as recommended by the Minnesota Community Measurements, independently referred by the provider, or be identified by their insurance company as a patient that would benefit from an MTM visit. The D5 focuses on blood pressure and blood sugar control, appropriate …

The Role Of Age Ligand And Rap1a In Myofibroblast Signaling Cascade In Type 2 Diabetes Mellitus-Induced Cardiomyopathic Conditions, Camilla Puglia

Honors Theses

Diabetes is one of the leading causes of death in the United States, taking more than 90,000 lives annually. Type 2 diabetes mellitus-induced cardiac fibrosis is a common condition seen in diabetic patients. The AGE/RAGE signaling cascade has been strongly associated with this supposed cardiac fibrosis along with hyperactive myofibroblasts which excessively remodel extracellular matrix tissue, leading to damaged and enlarged heart muscle tissue. In diabetic patients, Advanced Glycation End Products (AGEs) are produced in abundance and accumulate in the extracellular matrix of heart tissue. To investigate the role of of the AGE ligand on fibroblast behavior, increasing amounts of …

The Effect Of Age Concentration And Glucose Levels In Rage-Mediated Cardiac Fibroblast Migration In Type 2 Diabetes, Lorral Kanauss

Honors Theses

Diabetes is one of the largest health concerns in the United States. Its continuous increase in prevalence has led to it being one of the largest healthcare costs and consistently listed as one of the leading causes of death. That being said, diabetes also increases the risk of other health conditions, one of which is cardiovascular disease. Left ventricle hypertrophy resulting in the stiffening of the left ventricle and diastolic dysfunction is one form of cardiovascular disease associated with diabetes. Thought to be impacted by decreased fibroblast migration in the extracellular matrix, the experiments performed in this study seek to …

Assessing Preventative Lifestyle Interventions In The Filipino-American Population To Decrease Risk Of Type Ii Diabetes, Brandon Christopher Flores

Nursing | Senior Theses

Background

Type II Diabetes is a concerning global health issue and must be addressed. Given the unfortunate risks of T2D in the Filipino populations, prevention efforts must begin in this select population. There is strong empirical support for utilizing lifestyle interventions such as nutrition and physical exercise to prevent these diseases in adults; but it is not clear whether the same holds true for Filipino populations.

Objective

This thesis examines lifestyle management efforts such as weight reduction, family support, nutrition changes, and physical activity to prevent type 2 diabetes in Filipino-Americans.

Methods

The methods of the thesis will present a …

Benefits Of Fasting In Adults Long Term, Talea Jones

Nursing | Senior Theses

In nursing education, we are often taught that through diet, exercise and medications one is able to live a healthy life. Fasting is not a subject that readily comes to mind as a way to prevent chronic illnesses from occurring. However, for years, cultures have used fasting as a way to replenish themselves and to clean themselves as if they were new beings. Nursing education does not highlight the process of fasting in any way close to the extent that medications are prescribed to control illnesses.

There are many types of fasting that are used in the United States. Fasting …

The Effects Of Time Restricted Feeding On Markers Of Type 2 Diabetes, Brooke Martin

Biological Sciences Undergraduate Honors Theses

Type 2 diabetes is one of the fastest growing chronic diseases in the country, comprising 10% of the American population. Obesity rates are at an all-time high and greatly increase risk factors for developing diabetes. Insulin resistance is the main feature of type 2 diabetes and causes management of the disease to be extremely difficult. Currently there are different possible treatments for type 2 diabetes including medication and dieting. However, diets involving fasting, though high in popularity, do not have a lot of evidence regarding their ability to prevent the development of type 2 diabetes.

Time restricted feeding (TRF) is …