Category: Diabetes

Introduction

All forms of diabetes affect numerous individuals across the nation and remain the most prevalent non-infective disease among patients. The following study would focus on the age group that is predominantly affected by life-changing diabetes, individuals aged sixty-five or older (LeRoith et al., 2019). Information can be primarily gathered from the emergency room and hospitalization records, as these databases may assist in depicting the severity of the condition and ways in which treatment is currently operating. Similarly, this data may be compared to less life-threatening forms of diabetes in order to observe changing trends of the condition.

The study can analyze documents and data that have been acquired over the past year in order to allow for a broader and more inclusive investigation. Similarly, this time frame allows for a better perception of trends as the long-term analysis may be more prone to depicting details that would be missed in a more short-term approach. Because the health information review will occur within a designated population and facility, a longer timeframe also will produce more data which can reduce errors or inaccuracies that are usually more common with smaller sample sizes.

The data gathering process will target personal health records which will allow the researchers to observe severity, hospitalization counts, and the background and age of the patients. Additionally, the treatment options and effectiveness can be incorporated into the investigation in order to observe the health trends for the targeted population. Because the study will observe both general hospitalization records and emergency room visits, it is vital to collect these documents from admission, ER, and other offices within the facility. However, with the sensitivity of these documents, it is vital that patient consent is respected and provided before the data can be viewed, collected, and analyzed.

Personnel Requirements

The study will require certain personnel to perform research tasks while other staff members will be expected to provide their best cooperation with the project. The individuals whose cooperation will be necessary include emergency room nursing staff and doctors, nurses within the facility, doctors and physicians specializing in diabetes, and other caregivers that interact with patients within the sixty-five or above age bracket. This specific age group has recently shown that treatment is effective when individualized and this may also be prominent within the current study (Schernthaner & Schernthaner-Reiter, 2018). Other staff will require managers and administrative workers who maintain health records and hospitalization data. Similarly, all health workers that are directly involved with treatment or medication would also be required to participate. However, the majority of the facility staff would only be required to be open to interviews and descriptions of the state of patients and the effects of the condition and the treatment.

The project will be fundamentally supported by staff members that will conduct investigative actions throughout the facility. These tasks will likely include the collection of health records, communication with other hospital staff, and the analysis of gathered data. As such, these physicians or hospital staff will require either data-management training or aid in the form of specialists. The project would benefit from the development of data analysis skills provided to the staff involved in the study.

Conclusion

The study aims to observe the current trends of patients with diabetes aged sixty-five or older within the selected health care setting. It is integral to observe changes in the severity of the condition as well as the effectiveness of current treatment. The use of a one-year record and the provision of adequate training to the involved staff is likely to introduce a detailed and accurate picture of health trends among diabetes patients in the selected age bracket.

References

Schernthaner, G., & Schernthaner-Reiter, M.H. (2018). Diabetes in the older patient: heterogeneity requires individualization of therapeutic strategies. Diabetologia, 61(1) 15031516. Web.

LeRoith, D., Biesells, G J., Braithwaite, S. S., Casanueva, F. F., Draznin, B., Halter, J. B., Hirsch, I.B, McDonnell, M. E., Molitch M. E., Murad, M. H., & Sinclair, A. J. (2019). Treatment of diabetes in older adults: An endocrine society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 104(5), 15201574. Web.

Introduction

The patient had been hospitalized with high blood sugar levels of 128 mg/dl on two separate tests indicating he had a diabetic condition. She had been pre-diabetic for the last few months. However, despite several interventions, the patient developed diabetes. Additionally, she also had an upper respiratory disease that interfered with her daily tasks. Upon admission, the patient had bradypnea which is an abnormal breathing rate of ten breaths per minute. Notably, she had increased her breaths per minute to twenty-eight in the previous forty-five minutes. The possible interventions had been performed on the patient but was not been helpful or effective. For instance, inhalers, oxygen, and breathing treatments had been used on this patient with no significant change in the vitals. Moreover, the body temperatures of this patient were thirty-nine degrees Celsius upon admission. Various interventions had been undertaken to try to lower the temperatures at no change. The patient also claimed to have a migraine headache which we tried intervening with the use of pain relievers. Twenty minutes after the administration of pain relievers, her headache stabilized.

Background

Mary is sixty-five years of age and she was diagnosed with prediabetes three months ago. Possible interventions to prevent the development of diabetes type two were unable to succeed. For the previous three months, Mary was under medication, maintaining a healthy diet, and doing the recommended physical exercises. Mary is a mother of two girls and one boy. Marys son who is eleven years old was born with a diabetic condition. The patient and her family reside near industrial areas. The condition of the residential place can be attributed to respiratory infection because of industrial-produced gases. Recently, Mary has been stressed over her firstborn daughter who divorced a month ago. Julian, her firstborn daughter, has requested to be informed in case of any patient change in the current condition. It should be noted that Marys earlier illnesses are related to the situation she is experiencing currently. Additionally, her locality affects the identified respiratory infection.

Assessment

The patients blood sugar levels and temperature have gone up for the last forty-five minutes. The normal intervention associated with using insulin to control hyperglycemia has been ineffective in this patient. Normally, insulin is used to control hyperglycemia for inpatients in critical conditions (Dhatariya et al., 2020). Variable rate of intravenous insulin infusion has been administered at no significant change on the vitals. As for the high-temperature control, the patient has been allowed to rest to minimize unnecessary use of energy, which may be the possible cause of high temperatures. Paracetamol and ibuprofen have been administered to lower the high temperatures. Additionally, more fluids have been recommended to the patient in form of water and juices. However, all these interventions have not brought any significant change. As for respiratory infections, breathing treatment and inhalers have been ineffective in correcting the condition. The migraine headache was relieved using painkillers a few minutes after the patients admission.

Conclusion and Recommendations

The physician should be called immediately to assess the patients condition further. The doctor may change the medical prescription of the patient if that could address her health situation. The patient can be requested to stay without food for some time to check if the blood sugar levels can reduce. As for the fever, the room needs to be aerated and medication changed. The respiratory infection should be attended to by immediate intubation. A physician or the rapid rescue team should be notified to further assess the patient. A change in breathing treatment prescription should be adopted because the patients body could be resistant to the already-used medication.

Reference

Dhatariya, K., Corsino, L., & Umpierrez, G. E. (2020). Management of diabetes and hyperglycemia in hospitalized patients. Endotext [Internet]. Web.

The prevalence of diabetes mellitus is increasing worldwide every day. The causes of the growth in disease are complex, but the main ones are partly due to a large number of overweight people, including those with obesity, partly to low-quality food. The condition causes several social complications: a constant rise in the number of patients, the chronic nature of the disease, which leads to the reduction of life expectancy with the deterioration of its quality. In recent years, it has been considered not only as a severe disease but also as an essential medical and social problem, which is today very relevant in all countries of the world.

Diabetes mellitus is a metabolic disease in which the body lacks insulin, and the blood sugar content exceeds its norm. Blood sugar is necessary because when it splits, the bodys cells get energy. For glucose to penetrate cells, the hormone insulin is needed. It is produced by the pancreas. Due to the failures of this organ and lack of insulin, sugar accumulates in the blood, and cells do not receive energy. It causes a condition called hyperglycemia, which is dangerous for almost all systems of the body.

There is a relationship between well-being and the spread of common diseases does exist. Diabetes mellitus is an incurable disease, so it is crucial to carry out prevention, and in case of the first symptoms, to turn to endocrinologists. The condition requires control and a thoughtful approach throughout life with significant financial expenses. For the patient, the main thing is to learn managing diabetes with the doctors help so that the illness does not interfere with normal life. The more a person knows about the disease, the better he or she learns elementary techniques of control of this condition and competently corrects, with the help of diet, blood sugar level. Endocrinologists around the world believe that the best prevention of diabetes is a healthy lifestyle, which contributes to the preservation of health and full life.

Poor quality of life leads to widespread diabetes mellitus, especially among low-income communities. The gap in access to treatment of this disease leads to harmful and often irreversible health effects. Due to a lack of resources and a large number of patients, doctors cannot achieve a reduction in the prevalence of the disease (Chow et al., 2018). It creates an ethical dilemma that is not sufficiently studied. These contradictions with the standard requirements to the quality of citizens life, in particular the universal accessibility of medical services, continue to arise due to the low income of part of the population today (Basu & Sharma, 2018). For these reasons, there is a need to recognize the lack of available resources and to seek solutions.

Thus, the poor cannot afford quality products to compile a useful diet to prevent disease. Moreover, they cannot afford a doctors visit and medicines necessary for treatment. Guided by a deontological approach or rules-based ethics, the government must take care of each of its citizens, accepting their equality (Mandal et al., 2016). It initially undertakes to provide citizens with equal access to health services. It means ensuring social equality among all members of society. However, it is usually not economically beneficial for the whole country. In any state, there is a contradiction between the economic and social components of health services. One of the problems of the American system of medicine is the lack of availability of health services for those who do not have private health insurance due to unemployment or low wages.

To solve this problem, severe restrictions must be imposed at the level of state and local government. Hustead (2018) emphasizes the importance of cooperation between representatives of all stakeholders in making long-term decisions. Even more critical factor is the work of local authorities (Gittelsohn & Trude, 2017). In terms of transformational leadership, its representatives need to work closely with low-income communities (Barr & Dowding, 2019). There is a need to raise their awareness of the disease, its dangers, and possible ways of its prevention. On the level of the state government, it could be, for example, control of the content of fats and sugar in products by particular standards so that the population could always choose healthier food. More competent urban planning can force citizens to ride a bicycle and walk. Moreover, entrepreneurs should be responsible for the quality of food and should not advertise harmful food.

Thus, the number of people who have diabetes is continuously increasing and maintaining normal life and activity with this disease requires significant financial waste. It leads to the need to prevent the illness through proper nutrition and adherence to healthy lifestyle principles. The prevalence of diabetes mellitus among the poor is particularly relevant, as it is often not possible for them to purchase quality products and observe a diet. It creates an ethical dilemma that requires the attention of the authorities. With a well-thought-out approach and close cooperation of medical personnel, representatives of the underserved population, local authorities, progress can be made on this issue. It is necessary for the security and maintenance of an adequate standard of living for citizens.

References

Barr, J., & Dowding, L. (2019). Leadership in health care. Sage Publications Limited.

Basu, S., & Sharma, N. (2018). Under-recognised ethical dilemmas of diabetes care in resource-poor settings. Indian J Med Ethics, 3(4), 324-326.

Chow, C. K., Ramasundarahettige, C., Hu, W., AlHabib, K. F., Avezum, A., Cheng, X., & Yusuf, S. (2018). Availability and affordability of essential medicines for diabetes across high-income, middle-income, and low-income countries: A prospective epidemiological study. The Lancet Diabetes & Endocrinology, 6(10), 798-808.

Gittelsohn, J., & Trude, A. (2017). Diabetes and obesity prevention: Changing the food environment in low-income settings. Nutrition Reviews, 75(Suppl. 1), 6269.

Hustead, E. (2018). Team Science and Transformational Leadership in the Healthcare Field. Leadership in Healthcare and Public Health. Web.

Mandal, J., Ponnambath, D. K., & Parija, S. C. (2016). Utilitarian and deontological ethics in medicine. Tropical parasitology, 6(1), 5.

Introduction

As the leading cause of disability and death in the U.S. and the entire world, chronic conditions can be considered a significant public health problem in modern society. In fact, they are usually associated with constant pain, fatigue, and mood disorders, which worsen the overall quality of life. At the same time, the majority of chronic illnesses, such as diabetes and heart disease, are preventable if appropriate measures are taken. In contrast, poor diet choices, bad habits, and a lack of physical activity considerably increase the likelihood of facing some chronic health issues. Therefore, it is tremendously essential to take into consideration positive lifestyle choices, such as eating a balanced diet and getting adequate sleep. However, some forms of chronic conditions are unpreventable, as they develop on a genetic level. In this case, people are advised to manage a certain condition with the help of medications and the transformation of lifestyle strategies.

For instance, diabetes is a life-changing condition that cannot always be prevented. On the one hand, some forms of this health issue can be prevented by cutting sugar and refined carbohydrates from the diet, eating fiber, and quitting smoking. On the other hand, there are cases when the body is unable to process glucose naturally. This form of diabetes cannot be prevented with the help of lifestyle changes, although it can be successfully managed if noticed on time. There is a variety of treatment programs that have been used by patients with this diagnosis for numerous decades, which is why diabetes is not perceived as a life-threatening disease anymore. Simultaneously, if the symptoms of this health issue are ignored, the person is likely to face multiple health complications, including heart attack, kidney damage, eye problems, or neuropathy.

Accordingly, in order to minimize the potential negative impact of any chronic diseases, including diabetes, it is crucial to go for general medical checkups regularly. As a result, patients will get the opportunity to detect health issues at the earliest stages of their development. When it comes to diabetes, this health disorder can only be diagnosed by specialist diabetes healthcare professionals. Subsequently, the process of understanding this condition should start with making a regular appointment with a doctor. The inability of the body to store and use the sugar and fat from the food can result in the development of diabetes, which means that lifestyle changes and diabetes medication should become an integral part of the patients life.

Overview of the Problem

Currently, diabetes is widely known as a metabolic disease that causes high blood sugar. Most frequently, this health issue develops due to the inability of the body to produce insulin or use it properly. Moreover, there are cases when the body exhibits a combination of both. In other words, the cells do not receive appropriate amounts of sugar from the blood, which is why blood sugar levels increase.

When the person consumes food, it transforms into a simple sugar called glucose. This monosaccharide serves the function of providing energy that a body needs for daily activities. In turn, the amount of glucose significantly depends on insulin, as this hormone promotes glucose uptake. For instance, the increase in glucose is interrelated with the process of releasing more insulin to push more glucose into the cells (Punthakee et al.). As a result, to increase blood glucose levels, the body contributes to the development of the need to consume food. From the perspective of people who are diagnosed with diabetes, their bodies do not make insulin or their cells are resistant to this hormone. Hence, it results in a considerable increase in sugar levels in the blood.

At the present time, clinicians identify four main types of diabetes, such as type 1 diabetes, type 2 diabetes, as well as prediabetes, and gestational diabetes. Type 1 diabetes is a chronic health issue that develops when the bodys immune system attacks and destroys the cells of an individual which produce insulin. Scientists and clinicians still debate regarding the main cause of these attacks, although it is assumed that the bodys own immune system functions inappropriately due to genetic factors (Punthakee et al.). In terms type 2 diabetes, this form of health condition is extremely common in the whole world. In contrast to type 1 diabetes, this form of metabolic disease is characterized by the inability of cells to respond to insulin in the appropriate manner. In addition, this form of diabetes is usually associated with obesity. Thus, the majority of patients are diagnosed with either type 1 or type 2 diabetes, although cases of prediabetes and gestational diabetes also take place.

Prediabetes is a health condition when the body produces a higher than normal blood sugar level. In fact, it can be considered a sign that lifestyle changes are required to avoid the potential development of this condition into type 2 diabetes. By entering high-quality prevention programs, people are predicted to decrease blood sugar levels and avoid health complications. In turn, gestational diabetes usually occurs among pregnant women who were not diagnosed with any form of diabetes before pregnancy. In this case, females are required to eat healthy foods, exercise and, if necessary, take medication. Ignoring these recommendations can contribute to the development of type 2 diabetes and obesity in the life of the newborn. Furthermore, some babies can die either before or shortly after birth. Therefore, in order to reduce the impact of this chronic disease on the life of adults and newborns, it is essential to go for regular medical checkups.

Statistics

The prevalence and morbidity of diabetes and prediabetes change annually, even though there are some trends that repeat each year. In 2018, a total of twenty-four million Americans were diagnosed with this chronic disease, which is approximately ten percent of the overall population in the U.S (CDC). Presently, it is the number one cause of kidney failure, lower-limb amputations, and adult blindness in the country. Most frequently, such a considerable number of people diagnosed with this health issue is considered to be the result of a sedentary lifestyle. Out of all people suffering from diabetes, nearly one and half million individuals are diagnosed with type 1 diabetes (CDC). In other words, this form of a metabolic disorder accounts for around five percent of all diabetes cases. Consequently, over ninety percent of individuals with diabetes struggle with the second type of this disease. It can be explained by the inability of bodies to use insulin efficiently.

In the context of the demographic structure of people diagnosed with diabetes, it is crucial to take into account age, gender, and race. For example, approximately fourteen percent of Americans aged over sixty suffer from diabetes (CDC). It is assumed that the chances of facing this chronic disease increase with age because of increasing insulin resistance and impaired pancreatic islet function. When it comes to youth, over 200,000 individuals struggle with the consequences of this type of metabolic disorder (CDC). From the perspective of race, African Americans, Hispanics, and American Indians are at the highest risk of facing diabetes, whereas representatives of the white race are least likely to be diagnosed with this health issue. It can be explained by the fact that white people have the lowest rates of obesity which can result in insulin resistance.

As the seventh leading cause of death in the U.S., diabetes is considered one of the most considerable health issues in the country. A total of one and half million Americans died due to diabetes complications in 2019 (CDC). At the same time, it is predicted that the majority of cases of diabetes are underreported. Nearly one-third of Americans with diabetes who died had this chronic disease listed on their death certificate (CDC). As a result, thousands of people live in the U.S. without having a proper understanding of their health status. As to the cost of diabetes, around $320 billion are spent on cases of diagnosed diabetes in the U.S. annually (CDC). Accordingly, medical expenditures among people without diabetes are two times lower than expenditures among individuals suffering from any form of diabetes. It is another reason why diabetes should be taken into consideration by the American population and the local government.

Symptoms

Diabetes symptoms depend on a variety of factors, including the exact level of blood sugar, age of the person, and the presence of other chronic issues. Usually, general symptoms of this disease are increased hunger, frequent urination, extreme fatigue, and weight loss. However, symptoms can also vary based on the type of diabetes (Bettencourt-Silva et al.). For instance, individuals suffering from type 1 diabetes are likely to experience hunger, tiredness, and unintentional weight loss. At the same time, people diagnosed with type 2 diabetes are predicted to experience increased hunger, blurry vision, as well as sores that are slow to heal. Also, it is essential to note that high levels of sugar circulating in the blood contribute to the development of recurring infections, as it is difficult for the body to heal. Hence, symptoms of diabetes significantly vary, although it is important to make an appointment with a doctor in case some of the symptoms listed above are noticed.

Furthermore, gender plays an important role in terms of diabetes symptoms. In fact, females struggling with this chronic disease are more likely to face urinary tract infections and yeast infections than males (Bettencourt-Silva et al.). Simultaneously, men have a higher likelihood of suffering from a decreased sex drive and poor muscle strength. A vast amount of attention should also be dedicated to symptoms of gestational diabetes. On the one hand, this type of diabetes is not associated with noticeable signs or symptoms. On the other hand, females diagnosed with this disease are likely to experience unusual thirst, frequent urination in large amounts, and fatigue. Taking into account that gestational diabetes can result in an increased risk of premature birth, pregnant women are recommended to go for routine practitioner visits on a regular basis.

Causes

Each type of diabetes is caused by different factors that should be taken into consideration equally. For example, as an autoimmune disease, type 1 diabetes has been studied for several decades. Nevertheless, clinicians are still not aware of the main cause of this disorder. The only thing that is known to scientists is that the bodys immune system mistakenly attacks insulin-producing beta cells (CDC). In spite of the fact that this topic still needs to be studied from different perspectives, scientists assume that type 1 diabetes might develop due to a combination of genetic and environmental factors. Most frequently, children and adolescents are diagnosed with this form of a metabolic disorder, which is why it is believed that genes are involved in the process of type 1 diabetes development. However, this chronic disease is considered a rare form of diabetes.

In turn, type 2 diabetes is regarded as the most common form of this health issue despite the fact that it is preventable in the majority of cases. In the context of causes, the bodys cells become resistant to insulin, which is why this hormone cannot be used efficiently. As a result, the level of blood sugar increases, whereas insulin production significantly declines. The main factors contributing to the development of this type of diabetes are obesity, genes, and the lack of physical activity. Finally, gestational diabetes is a disease that only occurs during pregnancy. It is assumed that this form of diabetes is caused by the process when insulin-blocking hormones are produced.

Risk Factors

There are different risk factors for each type of diabetes, which is why the process of diabetes prevention should be mainly based on eliminating these factors from life. In the case of type 1 diabetes, the primary risk factors include family history and age. Currently, the majority of individuals diagnosed with this chronic disease have a family member suffering from the same health issue. Therefore, genes are believed to play an essential role when it comes to type 1 diabetes. In addition, children and adolescents are most likely to struggle with this problem, which is the reason why age is considered a considerable risk factor for this form of diabetes. Simultaneously, in the U.S., representatives of the white race are diagnosed with this chronic disease way more frequently than members of other ethnic groups.

As for type 2 diabetes, its risk factors are clearer and understood better. For example, people are considered to be at risk of facing this health issue if they are diagnosed with obesity and prediabetes (Bellou et al.). Moreover, women suffering from gestational diabetes at some point in their lives are likely to be diagnosed with type 2 diabetes in the future as well. Similar to type 1 diabetes, both age and family history belongs to the list of risk factors for type 2 diabetes. However, in this case, people aged forty-five and older are at risk of facing this health issue. A vast amount of attention should be paid to the physical activity of the person. In fact, physically active people are more sensitive to insulin. By the way, physical activity can be attributed to effective preventative measures in terms of heart disease and nerve damage.

In the context of prediabetes and gestational diabetes, risk factors are similar, although there are some differences. For instance, there is a high chance to face prediabetes if the person belongs to the groups of African Americans, Latinos, or American Indians. Besides, being overweight and aged over forty-five contribute to the development of both prediabetes and gestational diabetes. Females delivering babies who weigh over nine pounds are likely to suffer from diabetes as well. Additionally, it is tremendously common practice when the woman affected by polycystic ovary syndrome develops the symptoms of diabetes. In spite of the fact that gestational diabetes usually lasts no more than nine months during pregnancy, it is a significant risk factor for the potential development of type 2 diabetes. Therefore, it is essential to approach the issue of pregnancy in advance to prevent the negative impact on the health of a newborn and future mother.

Prevention

Scientists and clinicians have been taking appropriate measures in order to manage the condition and improve glucose absorption for numerous decades. Subsequently, evidence-based information has been successfully transformed into effective preventative programs reducing the number of potential diabetes cases throughout the whole country. Currently, it is predicted that around twenty-five million Americans could have prevented the development of type 2 diabetes (Punthakee et al.). This number includes people who are not aware that their health is affected by diabetes. Considering that approximately ninety percent of diabetes cases are potentially preventable, the goal of decreasing the number of patients suffering from this form of metabolic disorder can be successfully achieved (Punthakee et al.). Consequently, diabetes prevention is considered one of the most researched areas of healthcare at the moment.

The majority of recommendations regarding the prevention of diabetes are based on a modification of lifestyle choices. Therefore, the patients should take responsibility for their health, whereas health providers are required to inform people at risk of facing diabetes about the importance of maintaining a positive lifestyle. One of the main strategies to prevent this chronic disease is losing weight. As an integral part of any diabetes prevention program, weight control is also important for preventing other health issues, such as heart disease, arthritis, and some types of cancer.

Usually, doctors recommend patients lose around ten percent of their overall weight in order to reduce the chances of facing diabetes (Punthakee et al.). However, the main issue associated with this prevention strategy is that numerous individuals are not able to keep their weight. In other words, the person can lose twenty pounds, although they gain this weight back in a short time. To avoid these problems, doctors are required to develop comprehensive weight loss plans that involve easy-to-follow recommendations in order to avoid weight gain.

Furthermore, healthy nutrition plays an important role in the process of diabetes prevention among all individuals regardless of their age, gender, or ethnic background. Taking into account that weight loss and the quality of nutrition are interrelated, healthcare providers consider food as an essential tool for the prevention of chronic diseases. In the case of diabetes, doctors recommend reducing the number of calories by including vegetables, whole grains, fruits, and healthy protein in daily nutrition. Also, it is vital to replace sugary drinks with water, coffee, or tea. A healthy diet should be low in fat and salt, which is why it is usually recommended to limit red meat and processed meats. For example, to prevent diabetes of any type, people can eat hard-boiled eggs, avocado, beef sticks, yogurt with berries, as well as veggies, and hummus.

Physical activity is another essential element of each diabetes prevention plan. Physically inactive individuals are two times more likely to suffer from diabetes than people who are doing sports regularly (CDC). In case the person has poor understanding regarding the types of exercises that are the best for them, it is recommended to consult with the health care professional. On average, clinicians highlight that thirty minutes of physical activity five days a week are beneficial for reducing the risk of suffering from diabetes in the future (Punthakee et al.). For instance, walking, cycling, swimming, and dancing are tremendously effective for decreasing insulin resistance.

The lack of sleep and stress also increase the risk of experiencing diabetes. In order to prevent diabetes, people are recommended to get adequate sleep of at least seven hours per day (Punthakee et al.). In the context of stress reduction, patients can take into consideration yoga, leisure activities, and improvement of the work-life balance. At the same time, it is important to quit smoking and alcohol consumption, as these habits increase the chances of developing type 2 diabetes by thirty percent (CDC). In fact, these activities cause inflammation and oxidative stress, which results in the development of diabetes. In addition to common preventative measures, some people should be served with individual recommendations. Accordingly, the process of diabetes prevention should always begin by making an appointment with a healthcare professional. In turn, this person will take appropriate measures to perform tests and prescribe medication in order to manage the disease.

Diagnosis

Diagnosis of diabetes is a complex process that is based on several crucial steps. The American Diabetes Association provides recommendations regarding people that should be screened for this chronic disease. At present time, these people are the ones with a body mass index higher than twenty-five and aged over forty-five (Chatterjee and Davies). Furthermore, individuals who have been diagnosed with prediabetes and gestational diabetes are considered for screenings.

To determine if the health of a person is affected by diabetes, the glycated hemoglobin (A1C) test is used in the first place. The main benefit of this test is the opportunity to identify the average blood sugar level for the past several months. The results are usually interpreted by the healthcare specialist in clinical settings. The person is diagnosed with diabetes if an A1C level is higher than six and a half percent on two separate tests (Chatterjee and Davies). In turn, the test level between 5.7 and 6.4% can be interpreted as prediabetes, whereas other results are considered normal.

If this test cannot be performed due to certain reasons, healthcare specialists have the opportunity to use a mix of other diagnostic tools. For instance, random blood sugar tests or fasting blood sugar tests can be used to determine sugar levels in the blood. Moreover, healthcare providers frequently use the oral glucose tolerance test to determine the bodys response to sugar. In this case, the patient is not allowed to drink and consume food eight hours before the test (Chatterjee and Davies). To diagnose a woman with gestational diabetes, the doctor is likely to use an initial glucose challenge test that is usually followed by glucose tolerance testing. Once the person is diagnosed with any type of diabetes, the healthcare specialists will develop an appropriate treatment plan to manage the symptoms of this health issue.

Treatment and Possible Complications

In the present circumstances, healthcare specialists are offered the opportunity to use a variety of medical therapies and approaches to treat diabetes. Considering that each person is affected by this chronic disease differently, treatment options also vary. All individuals suffering from type 1 diabetes are required to take insulin regularly. It can be done with the help of injections or by using a pump. Lifelong insulin therapy can be based on either short-acting insulin or long-acting insulin, which depends on each specific case. Additionally, patients who struggle with type 1 diabetes are frequently prescribed to take high blood pressure medications, aspirin, and cholesterol-lowering drugs (Tan et al.). At the same time, the therapy includes frequent blood sugar monitoring, healthy nutrition, as well as regular physical activity. If at least one element of the therapy is ignored, the disease is predicted to progress with time.

Type 2 diabetes differs from other types of this disease when it comes to causes, which is why treatment options for this form of metabolic disorder are also different. Some patients diagnosed with type 2 diabetes require medication to manage blood sugar levels, whereas others can enjoy high-quality life by only making some lifestyle changes. In case the person still needs insulin, healthcare specialists are likely to prescribe metformin (Tan et al.). However, there are other options that can be used to treat certain symptoms of diabetes. In order to put this disease into remission, healthcare providers can offer patients the opportunity to use obesity surgery procedures. Lastly, a healthy diet and physical activity are usually included in the treatment plan of individuals suffering from this health issue.

The main purpose of all treatment therapies is to lower glucose levels in the blood of patients. However, if the person ignores signs of this disease or healthcare specialists use inappropriate treatment options, diabetes can lead to severe health complications. For example, long-term problems include retinopathy, foot problems, heart disease, nephropathy, nerve damage, and some types of cancer. One of the most common complications experienced by patients suffering from diabetes is blood vessel damage. In fact, high glucose levels affect them, which is why the blood cannot be transported to some parts of the body. As a result, the person can lose feelings in some body parts, such as legs or hands. In some cases, untreated diabetes can lead to death. Hence, this chronic disease should be diagnosed and treated on time.

Conclusion

Presently, chronic issues are considered a major health threat to the entire planet. Nevertheless, the healthcare industry develops rapidly, thereby offering people the opportunity to minimize the effect of severe disease on the overall well-being of patients. Therefore, chronic health issues, such as diabetes, can be successfully treated if they are diagnosed punctually. Today, diabetes is still regarded as the seventh leading cause of death in the U.S., although appropriate measures are taken to address this problem. For example, numerous diagnostic tools and treatment therapies have been developed in the past several decades. Currently, clinicians have a deep understanding of different types of diabetes, causes, risk factors, symptoms, and complications associated with this disease. Thus, it is predicted that the rates of deaths caused by this condition will significantly decrease in the nearest future throughout the whole world.

Millions of people are estimated to be affected by diabetes in spite of their age, gender, and ethnic background. In turn, obesity, bad habits, poor nutrition, and the lack of physical activity considerably increase the chances of being diagnosed with diabetes. The person can live with this disease for a long time without experiencing severe symptoms. Nevertheless, the majority of people still face increased hunger, frequent urination, extreme fatigue, and weight loss. Once any of these symptoms are noticed, it is tremendously essential to make an appointment with a doctor. The healthcare specialist will perform appropriate tests to determine if the person should be diagnosed with diabetes. If the person is diagnosed with this chronic health issue, the best treatment options will be offered. If the recommendations are followed, the patient is expected to live a long and healthy life.

The percentage of people suffering from diabetes has increased lately due to the sedentary lifestyle that is selected by many individuals. With the advancement of innovative technologies, the global population has replaced physical activities and adequate sleep with the use of gadgets. As a result, the overall health status of people has worsened. These trends in the area of healthcare have encouraged clinicians to promote healthy lifestyles through different communication channels. It has helped to increase the levels of awareness in terms of diabetes prevention across the globe. First, in order to prevent any type of diabetes, it is important to improve nutrition by adding vegetables, whole grains, fruits, and healthy protein to the diet. Second, it is recommended to increase physical activity. For instance, thirty minutes of physical activity five days a week is extremely beneficial for preventing a variety of health issues. Stress reduction also plays a vital role in the context of diabetes prevention.

References

Bellou, Vanesa et al. Risk Factors for Type 2 Diabetes Mellitus: An Exposure-Wide Umbrella Review of Meta-Analyses. Plos One, vol 13, no. 3, 2018, p. e0194127. Public Library of Science (Plos). Web.

Bettencourt-Silva, Rita et al. Diabetes-Related Symptoms, Acute Complications and Management of Diabetes Mellitus of Patients Who Are Receiving Palliative Care: A Protocol for A Systematic Review. BMJ Open, vol 9, no. 6, 2019, p. e028604. BMJ. Web.

Chatterjee, Sudesna, and Melanie J. Davies. Accurate Diagnosis of Diabetes Mellitus and New Paradigms of Classification. Nature Reviews Endocrinology, vol 14, no. 7, 2018, pp. 386-387. Springer Science and Business Media LLC. Web.

CDC. National Diabetes Statistics Report. 2020. Web.

Punthakee, Zubin et al. Definition, Classification and Diagnosis of Diabetes, Prediabetes and Metabolic Syndrome. Canadian Journal of Diabetes, vol 42, no. 2, 2018, pp. 10-15. Elsevier BV. Web.

Tan, Sin Yee et al. Type 1 And 2 Diabetes Mellitus: A Review on Current Treatment Approach and Gene Therapy as Potential Intervention. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, vol 13, no. 1, 2019, pp. 364-372. Elsevier BV. Web.

Diabetes mellitus refers to a group of endocrine diseases that develop due to a relative or absolute lack of the hormone insulin or a violation of its interaction with the cells of the body. Since this is a very common disease, there are several important nursing policies regulating the management of patients with diabetes. In my opinion, the policy that should be supported is the main measure for diabetes mellitus, which is aimed at creating an adequate ratio between absorbed carbohydrates, physical activity and the amount of injected insulin or hypoglycemic tablets. This is the lifestyle nursing policy which includes diet therapy, physical activity and insulin replacement therapy.

This particular policy has been chosen because nurses should treat patients with diabetes with special responsibility and attention. First of all, nurses need to help them adapt to the current situation. This can be done by changing the diet, and including light walks and medications prescribed by the doctor. The selected lifestyle nursing policy best helps the patient to adapt to life with diabetes. It is important for patients to observe the correct daily routine, and monitor body weight (Hartmann-Boyce et al., 2020). This is what contributes to the production of the necessary amount of hormone.

The selected lifestyle nursing policy when working with patients with diabetes will best help to stabilize their condition. I believe it is the best choice for nurses because it allows them to perform high-quality work that meets professional standards. In the modern medical activity of a nurse, there are their own technologies and models that should be guided by during daily work. All this places high demands on the knowledge and practical skills of a nurse. The selected policies allow nurses to best fulfill the direct responsibility of the nursing staff. Compliance with chosen policies will ensure high-quality fulfillment of doctors appointments, patient care, and many manipulations with patients with diabetes at a high level.

The popularity of the disease can be considered the selling point that would establish nursing policies for patients with diabetes as a priority issue for nursing advocacy and health policy development. According to statistics, 20 million people die from this disease every year and 40 million become disabled due to vision loss, complications with the cardiovascular system and amputation of limbs (Hartmann-Boyce et al., 2020). 1.5 million people die every year from complications caused by diabetes (Hartmann-Boyce et al., 2020). Of the 100% of cases identified, 56% are women and only 44% are men (Standl et al., 2019). Standl reports that now 7% of the worlds population has diabetes, which is about 285 million people (Standl et al., 2019). Forecasts for the future are disappointing, according to experts, the number of patients will steadily grow, and by 2030 there will be 439 millions of them (Standl et al., 2019). It is the beginning of active nursing work according to policies that will prevent serious complications caused by the disease.

The rules of the masters prepared nurse and of other key players in this health policy are extremely important. It allows to improve the quality of life of the patient and help to find both existing problems and those that may arise in the future. The masters prepared nurse and of other key players in this health policy should determine the range of problems that can make difficulties in the patients life. Further, the quality of life of patients with a serious chronic disease will be improved with the help of scientifically and medically sound technology of patient care through compliance with chosen nursing policies.

References

Hartmann-Boyce, J., Morris, E., Goyder, C., Kinton, j., Perring, J., Nunan, D., Mahtani, K., Buse, J. B., Del Prato, S., Ji, L., Khunti, K. (2020). Diabetes and COVID-19: Risks, management, and learnings from other national disasters. Diabetes Care, 43(8), 16951703. Web.

Standl, E., Khunti, K., Hansen, T. B., & Schnell, O. (2019). The global epidemics of diabetes in the 21st century: Current situation and perspectives. European Journal of Preventive Cardiology, 26(2), 714. Web.

Introduction

Professional nurses collect data, prepare reports and conduct monitoring. This information forms the basis of benchmark data that compares the quality of patient safety services. This paper will explore data on the issue of diabetes self-management, which I discussed earlier in other assessments. The 61-year-old female patient was diagnosed with type 2 diabetes five years ago at age 56. She tried to cope with the disease with a home approach, but the treatment was not enough effective. She currently has suffered from several hyperglycemic episodes over the past year. At the time of the interview, her weight was 77.7 kg. The patient is a friend of the family that cares for her.

Type 2 diabetes mellitus (T2DM) is one of the most common metabolic disorders worldwide. According to Galicia-Garcia et al. (2020), patients with T2DM have a 15% increased risk of all-cause mortality compared with people without diabetes. Although T2DM has a strong genetic basis, many cases of T2DM can be prevented by improving major modifiable risk factors such as obesity, physical inactivity, and unhealthy diet. This paper aims to find diabetes self-management solutions. This issue also applies to my clinical practice because it emphasizes using evidence-based approaches to treat T2DM effectively.

Assessment of the Patient, Family, or Population Problem

Diabetes is one of the ten leading causes of death in the world. It caused 1.6 million deaths in 2015, indicating a 60% increase over 15 years from less than 1 million in 2000 (Adu et al., 2019). International audits have shown that treatment adherence in patients with type 1 and type 2 diabetes is less than optimal. Consequently, most of these patients are at risk of severe life-threatening health complications and place a heavy economic burden on affected individuals and the health care system.

In contrast, uninterrupted involvement in self-management of type 2 diabetes is correlated with health outcomes in terms of good blood glucose control, fewer complications, improved quality of life and, decreased diabetes-related risk, reduced risk of death (Adu et al., 2019). The term self-management refers to the day-to-day activities a person must take to control or reduce the impact of illness on their health and well-being in order to prevent further illness. Diabetes self-management activities include engaging in recommended behavioral activities such as healthy eating, medication adherence, activity, monitoring, risk reduction, problem-solving, and healthy coping, which are essential to successfully managing the disease.

Effective communication between the health care provider and the patient is one of the factors that favorably influence a patients decision to self-manage. Such collaboration is characterized by trust, respect, and shared decision-making in planning health goals (Adu et al., 2019). According to Tuohy (2019), intelligent communication in nursing is essential to ensure optimal patient care. The manager is empowered to ensure the proper exchange of information between the stakeholders involved in managing the patients condition. Leadership and change management significantly affected the development of the proposed medical interventions for my patient.

In the treatment of diabetes, the level of self-efficacy of patients depends on the level of their self-management skills. Consequently, patients with adequate skills and performance are more likely to adhere to the prescribed behavioral regimen needed to achieve optimal health (Powers et. Al, 2020). Acquiring skills in diabetes self-management and its effectiveness is a continuous learning process. One method of education could be patient support using medical technology interventions such as mobile phone applications to monitor treatment and diet and educate patients with diabetes.

Thus, during practical hours, I determined that the problem of Diabetes Self-management has a positive effect on Patient Safety, as the risks of developing complications and adverse outcomes are reduced. The Quality of Care improves as a trusting and reliable relationship is established between the medical provider and the doctor. In addition, the cost of medical care is reduced, as regular self-management prevents crises, complications, and the number of hospitalizations.

The features listed above defined my communication with the patient and facilitated consultation meetings with a family that intended to provide patient-centered care. During these meetings, I learned that the patient was not on a diet, skipped medication, and sometimes added sugar to her meals. I required the patient to follow a diet, exercise regularly, and reduce her sugar intake to controlling weight. I recommended constant monitoring of blood sugar and medication. In addition, I advised installing a smartphone app to monitor adherence to the recommendations and keep a diary of food and changes in blood sugar readings. My leadership strategy allowed the patient to accept the set of standard medical interventions that I suggested to her.

For studying nursing practice standards and strategies, I reviewed several evidence-based practice documents:

• The report of the American Diabetes Association, the Association of Diabetes Care, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Association of Nurse Practitioners, and the American Pharmacists (Powers et al.,2020).
• The cross-sectional study about the role of transformational leadership, work environment and patient safety culture (Ree, 2020).
• The research ethics and scientific integrity (West, 2020).

From the review I learned the standards of communication and collaboration with patients and their families for successful treatment. These standards include providing honest and complete information about the disease in a way that the patient can understand. Based on the review, the patient should have a choice that can be made on the basis of complete information. In addition, nursing practice standards include technology-based approaches to rapidly operate communication models in which the nurse, clinician, pharmacologist, and patient play their roles.

The knowledge gained helped me to offer patient and her friends a variety of approaches and settings for diabetes self-management education and support, allowing them to choose the method that best suits their needs. Traditionally, diabetes education services have taken place in healthcare settings during hospitalization, registration, treatment failure, or changes in quality of life (Powers et al., 2020). Technical services, including web-based programs, telemedicine, and smartphone applications, contribute to increased access to medical care, continuous education, and support (Powers et al., 2020). Support groups have proved to be another effective method, where patients with diabetes or their relatives can receive both social and psychological support.

An important standard of nursing practice was the collaboration between the patient and the practitioner. Ree (2020) argued that patient-centered care in clinical practice improves patient outcomes at the expense of therapy effectiveness. According to this, my task has been to ensure that each stakeholder is held accountable for the role they should play in terms of intervention. For instance, my patient had to follow an established eating plan, engage in physical activity, avoid sugar, and take medication. In addition, I urged my patient to participate in the Diabetes self-management education and support (DSMES) program.

During the sessions, I encountered barriers that hindered effective diabetes self-management. The first barrier was stress due to lifestyle changes; the patients depressed state did not allow her to act, aiming for success. The second barrier was the financial costs of treatment. The patient believed that buying drugs and food for her diet would be too expensive in her current financial situation. However, the arguments I provided based on calculations and data have shown that the costs of treatment are much lower than the costs of the ambulance services she paid for after hyperglycemic episodes.

I sought to build trust and confidentiality between patient and myself. West (2020) has shown that establishing a solid relationship of trust between practitioner and patient improves outcomes. Patients must be bold in disclosing confidential information to nurses to provide relevant information about the course of the disease. A trusting relationship between the patient and me ultimately led to the acceptance of the proposed interventions. Patient and her friends agreed with me about the presence of the problem and its significance and relevance.

After the sessions, I changed my definition of the problem, emphasizing working more with family members. The role of the patients environment is often underestimated. However, my practice has shown that the positive attitude from family and friends helps set the patients up for success and encourages them to monitor their indicators and diet carefully for avoiding complications and crises. I could have had more control over the organization of a suitable home environment if the patient had relatives living with her. The family of her friends wanted to help with the treatment, but could not be with the patient every day.

Effects of Policies on Nursing Scope

Nursing standards aim to protect the patient from malicious and harmful activities. The government initiates health policies such as the Affordable Care Act, Medicaid, and Medicare to ensure that doctor meets the needs of the patient (Carey et al., 2020). One of the concepts I implemented to provide adequate medical care for my patient was DSMES.

Local, state, and federal legislation provides care quality and patient safety of DSMES programs. Such legislation include the National Standards for Diabetes Self-Management Education and Support, a Summary list of standards and ADCESs interpretation of the standards, and ADA Education Recognition Service Review Criteria and Indicators influence. These rules ensure constant patient care and safety across all medical organizations.

DSMES demonstrates effectiveness in terms of patient care and cost-effectiveness. People with diabetes who completed more than 10 hours of DSMES over 612 months significantly reduce mortality (Powers et al., 2020). Research shows that those involved in diabetes education are more likely to use best practices and incur lower healthcare costs (Powers et al., 2020). DSMES is cost-effective by reducing emergency room visits, hospitalizations, and readmissions.

Another problem that affects nursing policy and strategy is the cost of diabetes care. Healthcare costs for a person with diabetes are higher than for a person without diabetes. According to Powers et al. (2020), the cost of diabetes in the US in 2017 was $327 billion, including direct medical costs ($176 billion) and lost productivity ($69 billion). These data are confirmed by observation of my patient. She has suffered several hyperglycemic episodes over the past year, substantially increasing her and government healthcare costs.

To improve the quality of care, and reduce costs for the system and individuals, I suggest applying of technology tools more frequent. This approach simplifies diabetes self-management standards for patients and make learning more accessible and uninterrupted. In addition, this approach will reduce the costs of patients since they do not have to go to the hospital for every consultation.

The determination to prevent the development of complications is one of the main factors contributing to the self-management of diabetes. The study by Adu et al. (2019) confirms that medical technologies provide short-term and long-term health benefits for people with diabetes. The World Health Organization (WHO) has also confirmed that mobile technology can help deliver health outcomes that can transform healthcare systems worldwide.

Evidence-based therapies were developed to address the clinical problem of my type 2 diabetic patient. Relevant and available benchmark data sources were used such as administrative data, patient medical records, patient surveys, and standardized clinical data. I found and tried in practice strategies to ensure effective and collaborative communication between stakeholders. Government and the Nursing Council play their part in shaping nursing practice by setting specific requirements such as confidentiality and honesty.

Conclusion

Assessment show that diabetes self-management significantly effects the quality of care, patient safety, and costs for the state and patients. A patient with enough knowledge and skills to control this disease improves the quality of life and reduces the risk of complications and re-hospitalization. Ultimately, this decreases the cost of the state and patients on healthcare. A considerable role in the effective implementation of the Self-management program is played by the patients family and environment, which must have knowledge about diabetes and be able to create a safe environment for the patient. The standards and policies that the medical staff maintains significantly affect the quality of care.

References

Adu, M. D., Malabu, U. H., Malau-Aduli, A. E., & Malau-Aduli, B. S. (2019). Enablers and barriers to effective diabetes self-management: A multi-national investigation. PloS one, 14(6). Web.

Carey, C. M., Miller, S., & Wherry, L. R. (2020). The impact of insurance expansions on the already insured: the affordable care act and medicare. American Economic Journal: Applied Economics, 12(4), 288-318. Web.

Galicia-Garcia, U., Benito-Vicente, A., Jebari, S., Larrea-Sebal, A., Siddiqi, H., Uribe, K. B.,& Martín, C. (2020). Pathophysiology of type 2 diabetes mellitus. International journal of molecular sciences, 21(17), 6275. Web.

Powers, M. A., Bardsley, J. K., Cypress, M., Funnell, M. M., Harms, D., Hess-Fischl, A., & Uelmen, S. (2020). Diabetes self-management education and support in adults with type 2 diabetes: a consensus report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. Diabetes Care, 43(7), 1636-1649. Web.

Ree, E. (2020). What is the role of transformational leadership, work environment and patient safety culture for personcentred care? A crosssectional study in Norwegian nursing homes and home care services. Nursing Open, 7(6), 1988-1996. Web.

Tuohy, D. (2019). Effective intercultural communication in nursing. Nursing Standard, 34(2). Web.

West, E. (2020). Ethics and integrity in nursing research. Handbook of research ethics and scientific integrity, 1051-1069. Web.

Community-Based Teaching on Diabetes

Diabetes is a human disorder that is brought about by the miss-production of insulin that helps in the breakdown of blood sugars in the body. Diabetes is known to be very fatal. It can cause serious problems to the human body depending on the type and the stage. As stated by Billings & Halstead (2009) the common symptoms include fatigue excess hunger erectile dysfunction, loss of appetite, slow healing of wounds or no healing at all. Diabetes is broadly divided into two, Diabetes mellitus and diabetes insipidus. Diabetes mellitus is brought about by low production of insulin thus result to increase in blood sugar in the human body. Diabetes insipidus is brought about by excess production of insulin thus the high breakdown of blood sugars in the blood system. Diabetes can be caused by various factors, they include Heredity/genes, infection, food, overweight, lack of exercise, and high blood pressure. The paper will elaborate on the ways and means that had been used to try to minimize the infection of diabetes and also how to help the affected and the infected.

Area: The State of Mississippi

The paper tries to look at the state of Mississippi. It has one of the highest levels of poverty, obesity, and diabetes thus the need for medical attention. As stated by Bleich, et al (2008), the state of Mississippi Is mainly composed of black Americans who due to economic problems, few health personnel, and cultural barriers, are not well medically covered, unlike the whites who are well off and have full access to health services. Center for Medicare and Medicaid Services (CMS) in collaboration with Center Control and Prevention (CDC) has adversely tried to help the community to try to reduce the spread and infection of diabetes. This is through showing the need to stay healthy and have a routine checkup of their body.

Time Allotted

The time of each activity is very important, this helps to underlay strategy that will help to fully cover the much-needed activity. The activity includes having practitioners teach groups the way they can control diabetes which will need two hours to be exact. The next is having people treat the diabetic group. Also, randomizing and evaluating the independent and dependent variables. This will approximately take four hours.

Objectives

This activity is aimed to achieve various things, which include the control and the factors that contribute to the spread of diabetes. The main objective is to provide training to medical practitioners to be able to deal with diabetic conditions. With the best expertise, the community will thus be advised on how to control and avoid practices that hamper the infection of diabetes. The other main objective is to identify the factor that causes obesity. They may include heredity, where the disease could be inherited through the family. Also, food or bad dieting may cause diabetes. This may be seen when one eats a lot of food with a high amount of sugar content that exhausts the insulin in the body. The other factors include infection. The infection of the pancreas, leading to its malfunction. This hampers the correct release of insulin. The other objective is to provide the basic ways of living a healthy life. The basic ways, including eating a well-balanced food diet, eating with food less amount or even no cholesterol since it cause one to have a high blood pressure that causes diabetes. The other basic way to live a healthy life is to make sure you do some exercise now and then to help in the breakdown of some excess fat in the body (Billings & Halstead, 2009)

Content

The principles of proper nutritional dieting habits depend on the type of diabetes that one has. Those with diabetes insipid us require food with calories that range from 1500-1800 per day to maintain the body weight due to excessive loss. People with diabetes should eat a lot of different fruits regardless of the content of sugar. This is because they help to promote good health prevent the loss of weight. One should spread the eating through the day so that you reduce the sudden increase of the amount of glucose in the blood system. The most effective exercise of an obesity control program includes running or doing some exercise to reduce somebodys fats to fuel. According to Billings & Halstead (2009) of the American Heart Association recommends a minimum of 30 minutes of moderate exercise at least 5 days a week.

Several factors increase the risk of diabetes, they include; eating food with a high level of caloric acid and having minimal or low physical activity. Age has also been seen as a factor. It is seen that as one advances in age he or she has a high chance of being overweight. Pregnancy at a later age, insufficient sleep, and the use of drugs that increase weight are factors that also increase the risk of getting obese. Participation in physical education and progressive physical activity help in the conversion of the excess fat to fuel. The progression helps to keep up and maintain his body structure due to routine exercise (Flegal, et al, 2008).

Instructional Methods and Teaching Strategies

There are several methods of guiding the obese to reduce their weight, maintain their body shape, and thus reduce the high chances of becoming diabetic. The methods include using exercise programs and video channels that show the methods of doing practices. It also involves showing the correct method of lifting weights and stretching. Use of nutritional chats to show the basic food groups that are necessary for healthy growth. Presentation through overhead projectors to elaborate the best method to practice exercise is also encouraged. In the process, the participants are involved in physical activity like running and doing some exercise. The other method is introducing the participants into the gym which is simple, convenient, and convenient (De young, 2009)

Instructional Materials, Equipment, and Resources

Patients and family members are interviewed to realize the factors that might have contributed to obesity. This is through listing their day to chores, the food they eat, and the family medical history of anyone who has ever been diagnosed with diabetes. Afterward, obtaining information on the specific running a physical exercise facility which would help in the management. The last should be acquiring of materials which are printed showing the beast healthy foods and how they are cooked.

Evaluation Methods

The understanding of eating healthy and doing some physical exercise is important to control and reduce the chances of becoming obese thus reduction of chances of becoming diabetic. As stated by De Young (2009), the community, health care workers and providers have the obligation of following the guidelines underlaid to cube obesity in the community.

Outcome

The paper has provided a detailed discussion of the correct method to be used in the state of Mississippi on how to control and avoid becoming obese. This will reduce the chances of becoming diabetic. It has also detailed the best ways of maintaining ones health through eating right and healthy. Finally, the paper has outlined the procedure gone through which a physical exercise that helps in developing the best body structure.

References

Billings, D. M., & Halstead, J. A., (2009). Teaching in Nursing: A Guide for Faculty, St. Louis: Elsevier Sanders.

Bleich, S., et al., (2008). Why is the developed world obese? New Jersey: Annu Rev Public Health.

De Young, S., (2009). Teaching strategies for nurse educators. Upper Saddle River NJ: Prentice Hall.

Flegal, K. et al., (2002). Prevalence and trends in obesity among US adults, St. Louis: Elsevier Sanders.

Yang, W., Kelly, T. & He, J., (2007). Genetic epidemiology of obesity, New York: Lippincott Williams & Wilkins publishers.

Introduction

Type 2 diabetes mellitus (T2DM) is a prevalent illness affecting more than 16 million Americans. Its commonness among adults is on the rise, but more worrying is the recent recognition of this disease among children and adolescents. Researchers know little about the varying epidemiology, management and etiology of T2DM in pediatric inhabitants. Nevertheless, practitioners looking after the welfare of children and adolescents ought to consider the diagnosis of this disease in the children showing signs of hyperglycemia. The increase of T2DM among children and adolescents in the last five years has surfaced in parallel with a surprising rise in the number of young people who are obese. Along-with family weight, obesity emerges as a major risk factor for the increase of T2DM.

Literature Review

T2DM is one of the most rapidly increasing chronic illnesses in the US. In the last five years, health specialists have emphasized the need for its primary prevention (Fox; 2009). It has been repeatedly established that both asymptomatic and symptomatic patients of diabetes have an increased commonness of both macro-vascular and micro-vascular problems by the time the disease is first detected. The increased awareness concerning the aetiology, pathogenesis and the history of T2DM has brought about improved primary prevention measures of the disease. Even though a clearly accepted consensus concerning the early patho-genesis lacks, preventive strategies can be based-upon the current accessible knowledge. The increasing prevalence of T2DM, the seriousness of the disease, its numerous and harsh complications and the increasing socio-economic expenses, emphasize the significance of immediate preventive measures. Recently, a surprising increase in the occurrence of T2DM among children and adolescents in the US has been detected.

The young population in the US is becoming increasingly obese and inactive; researchers allege that T2DM will probably appear more often in younger generations than before. Puberty seems to play a significant role in the development of diabetes in young people. There is greater resistance to the insulin action during puberty that results in hyper-insulinaemia which brings about the manifestations of T2DM. One fundamental cause of this could be increased development of hormone secretion, and this outcome is modified by obesity. It is normally understood that diabetic patients with an early onset of T2DM may have a stronger genetic disposition compared to those whose onset period is older. Childhood and adolescence are life periods where peers lifestyles are adopted. This is the primary period where awareness and knowledge concerning T2DM and its risk factors ought to be distributed to the population.

Chiefly, the preventive message ought to entail factors related to practical advice about healthy eating habits and the support of physical activity; this should focus on the whole population, not just to high risk persons. The peer pressure amongst the young people is so rampant that benefits expected from such a population strategy to manage environmental risk factors for T2DM are likely to be extensive (Krentz; 2008). Efforts to prevent T2DM in children and adolescents should follow the same general pattern as that proposed for the prevention of T2DM in adults. Even though primary prevention attempts may be targeted for high-risk persons, the main approach must be based upon applying prevention measures at the population level. Prevention of T2MD in high-risk children and adolescents is predicated on the facility to categorize those at increased risk and offer them adequate service.

The population strategy is supposed to uphold the prevention of obesity and sufficient physical activity levels as desired standards for the whole community. These goals may not be easy to attain in the real world, but they are not irrational. In addition to general health support in the US, there is a need for healthcare experts to take part in developing and executing school and community based programmes to encourage better dietary and physical activity behaviors for all children and adolescents. Health specialists in USA say that, school programmes ought to encourage healthy eating habits, healthy food choices and adequate levels of physical activity. The commonness of T2DM in children and adolescents is greatly increasing in US. In the last five years, research studies show this disease has increased by 8% in children and adolescents. Health specialists in US fear that the disease will continue increasing among the young people if proper preventive measures are not implemented. 8-40% of young people recently diagnosed with diabetes in USA, is due to T2DM (Mazze; 2012). Reports show that the disease is affecting children who are as young as 8 years. These children are mostly in ethnic groups experiencing high risks of T2DM. Type 2 diabetes mellitus in children and adolescents is a serious illness with very poor results over ten to twenty years. The Internal Diabetes Federation proposes that supplies be made to provide the best medical care, prevent life-long problems and offer more studies so as to attain a better comprehension of the disease. Medical professionals in US state that in children and adolescents, T2DM is caused by an amalgamation of insensitivity to insulin and the failure to secrete beta-cell.

There are numerous environmental and hereditary risk factors for insensitivity to insulin and inadequate beta-cell secretion, for example obesity, inactive behaviors, family history T2DM, ethnicity, puberty, low weight of birth, contact to diabetes in the womb, and feminine gender. There is sufficient proof that some ethnic groups have higher vulnerability than others. Environmental factors also play a significant role in the growth of T2DM. Research studies show that Children and adolescents in US are inactive and have poor eating patterns thus causing obesity which is the main risk factor for T2DM (Bethel; 2008). Young people are unhealthy and unfit thus increasing the chances of acquiring type 2 diabetes mellitus.

The increase of type 2 diabetes among childhood and adolescence in US in the last few years is alarming, particularly when one considers the lasting public health and societal outcomes as these patients acquire persistent complications at a very tender age. The extensive treatment of young people with T2DM ought to focus on the metabolic derangements associated with the illness, for example obesity, resistance of insulin, insulin shortage, dyslipidemia, high blood pressure, and other early complications. Efforts ought to be marshaled to enhance the inadequate remedial armamentarium with newest drugs for adolescents with T2MD.GLP-1 receptor agonists are particularly optimistic and should be used in this population without obstruction (Krentz; 2008). Individualizing medications routines ought to be given consideration, taking into account the higher rates of T2MD in minority adolescents and children.

US medical experts claim that research study is required to create evidence-based proposals for glycemic goals and the preventive measures of micro-vascular and macro-vascular complications in adolescents with T2MD.Primary preventive measures of T2MD can be described as all measures intended to decrease the occurrence or commonness of the illness on the population level, by lessening its onset risks. This may be realized by adjusting the causal or fundamental risk factors for T2MD. Secondary prevention T2MD on the other hand, can be described as all approaches intended to decrease morbidity and mortality amongst patients diagnosed with T2MD. Since T2MD is a diverse and multi-factorial disease, prevention should be based upon amendment of numerous risk factors concurrently. If not, the potential for preventive measures will remain curtailed and inadequate.

The existing proof, however, shows that even one intervention, for instance increased physical activity in inactive children and adolescents or loss of weight in the obese, can bring about a noticeable decrease in the risk of T2MD (Codario; 2010).There are two constituents to the plan of a prevention measure: a population-based approach, for changing the way of life and those environmental risk factors which are the fundamental causes of T2MD among children and adolescents in US; and a high-risk measure for screening young people at high risk for T2MD and establishing preventive measures to this young generation on an individual basis.

Conclusion

According to current knowledge, the confirmed high risk persons are: those with a family history of T2DM; females who had gestational diabetes; individuals whose glucose level in their blood has been earlier found to be fairly increased; and individuals with hypertension. Additionally, obesity and sedentary children and adolescents have an increased risk for T2DM. In general, these high-risk young people are so many in US and these cases are continually increasing annually. As knowledge and preventive measures of the genetic predisposition for T2DM increases, ethnic groups with a higher genetic predisposition ought to be targeted.

References

Bethel, M. (2008).Type 2 Diabetes Mellitus: An Evidence-Based Approach to Practical Management, New York, NY: Humana Press.

Codario, R. (2010).Type 2 Diabetes, Pre-Diabetes, and the Metabolic Syndrome, New York, NY: Springer.

Fox, C. (2009).Type 2 Diabetes, New York, NY: Class Publishing Ltd.

Krentz, A. (2008).Type 2 Diabetes in Practice, New York, NY: Royal Society of Medicine Press.

Mazze, R. (2012).Staged Diabetes Management, New York, NY: John Wiley & Sons.

Introduction

Obesity among children in America has increasingly become a major public health concern. According to the America Obesity Association, approximately 15 percent of children between the ages 6  11 years and adolescents aged between 12  19 years are obese. The problem of obesity in children did not just happen by accident; fundamental changes in the society have contributed significantly to the increase in incidences. Obesity is the main predisposing factor to type II diabetes and other comorbidities like cardiovascular diseases. A number of intervention programs have been adopted in various settings to mitigate the problem of obesity with the overall goal of reducing type II diabetes

Brief description of the program

The New Jersey Diabetes Prevention and Control program has initiated a public health initiative that seeks to address the problem of obesity and by extension type II diabetes through a primary level intervention targeting mainly young people in 4^th to 6^th grade. The initiative was basically a primary level intervention program targeting a cohort of obese children in North West side of New Jersey. The area was chosen because of its apparent high-level obese population. The program involved lifestyle education sessions to address the health needs. A cohort of children and their families were systematically identified within the program area. An initial evaluation of basic indicators of obesity and type II diabetes were done; these included, body mass index (BMI), total cholesterol level, glucose, and insulin. Subsequently the identified subjects were then taken through education sessions delivered to them in groups. The education sessions addressed the following: nutrition, physical activity, behavioral change and obesity related morbidity. The sessions were repeated for a year at three monthly intervals. Measurements of the basic indicators were taken over time to assess the impact of the intervention.

Objective of the program

The overall objective of the program was to mitigate the high level of type II diabetes in the target population, through education on lifestyle. Specific objectives included:

• to enhance the level of knowledge and awareness of the risk factors associated with diabetes among children with obesity
• to highlight obesity related morbidity including type II diabetes
• to impact behavioral change in children for healthy living

Planning and implementation

This initiative involved health promotion programs designed using the guideline of intervention mapping protocol as illustrated by Bartholomew, L. Kay, et al, (2006). Six key steps were followed which involved: ( i) review of existing literature to assess the population dynamics, environmental factors and the health seeking behavior; (ii) exploring the specific objectives of the program; (iii) laying out the methods and strategies for intervention; (iv) developing the program; (v) adoption and implementation of the strategies; and (vi) evaluation of evidence gathered.

The implementation process involved an initial evaluation of basic indicators of obesity and type II diabetes; these included, body mass index (BMI), total cholesterol level, glucose, and insulin.

Role of community nurse

Though the program had a multidisciplinary approach, public health nurses played the most important role. They were involved in all aspects of the entire program, however, their main roles were in the implementation process. They recruited participants, undertook the initial clinical evaluation for indicators of obesity and type II diabetes, carried out follow ups as well as the final evaluation.

Outcomes

At the point of recruitment, there was generally a high prevalence of the risk factors for type II diabetes. The key indicators were all elevated: the Body Mass Index (BMI) of most of the participants was substantially high (average BMI 31.6 kilograms per square meter); approximately 46.3 percent had elevated total cholesterol; while about 56.8 percent exhibited hyperinsulinemia. By the end of the program there was a mean reduction of 18.6 percent in the all the key parameters among the participants who successfully completed the program.

Generally, success in a program of this nature is gauged by the percentage of reduction in the risk factors and continued evidence of the disease or lack of it thereof. This however, may not be optimal or may be completely incorrect. The evaluation stage is critical since it will determine if the correct guidelines were followed in each mapping stage.

Conclusion of the most important factor to consider

Minimal challenges were experienced in the development of the program. However, setbacks included funding. Identification and segmentation of the population was also a bit difficult. The other major problem experienced was arriving at a consensus on the best strategy to use to deliver the best result and the availability of staff. In the implementation/management stage, the main setback was compliance among the participants. A number of the participants missed education sessions and defaulted on their schedules for the checkups for body mass index (BMI), total cholesterol level, glucose, and insulin. Consistent follow-ups had to be carried out. These challenges provided a valuable lesson to be considered when planning for such an intervention program.

Comparison of this approach and other interventions

According to Torrance (1986), health intervention programs outcomes should be expressed in common units to enable clear comparison to be made. The analysis should begin with some units such as morbidity and health seeking behaviors. Kalz (2009) argues that there are persistent controversy regarding school based health intervention program. Kalz indicates that there is limited evidence to show reduction in obesity for school based programs. However, Carmina et al disagrees with Kalz assertions in their article School-based Obesity and Type 2 Diabetes

Prevention Programs: A Public Health Perspective, they suggest that school based programs yielded good results. They identified three key outcomes: reduced incidences of obesity, significant behavioral change in terms of nutritional intake and increase physical activity, and the feasibility of the program. Therefore, intervention programs should be integrated to have the maximum effects.

Reference

Bartholomew, L. Kay, et al, (2006) Planning health promotion programs: an intervention mapping approach, San Francisco : Jossey-Bass,

Carmina, N.et al, School-based Obesity and Type 2 Diabetes Prevention Programs: A Public Health Perspective,2. Web.

Katz, D.L. (2009) School-Based Interventions for Health Promotion and Weight Control: Not Just Waiting on the World to Change Annual Review of Public Health Vol. 30: 253-272

Torrance, GW. (1986) Measurement of health state utilities for economic appraisal: A review, Journal of Health Economics. Vol 5:1-30.

Project Completion

The patient and family engagement approach by Smith et al. (2017) was applied to a group of 30 people with diabetes. Upon their recruitment and the relevant ethical procedures, blood glucose was measured for them before the intervention; then, the intervention was carried out with the help of the Ottawa Model of Research Use (OMRU) (Graham & Logan, 2004; Logan & Graham, 1998). Eight weeks of the intervention were completed, after which the patients blood glucose was measured once again. The key findings are associated with the participants demographics and blood glucose.

Demographics

The demographics can be summarized as follows. All of the people recruited had diabetes. The slight majority of the participants were female (63%), 40-50 years old (60%) and with one comorbidity (specifically, hypertension  50% or obesity  10%). Additionally, 27% of the people involved had no reported comorbidities, and 13% had more than one additional condition. Figures 1-3 show the details of the demographics.

Blood glucose

Blood glucose was measured, fasting, for the participants before and after education based on Smith et al. (2017). Additionally, blood glucose was monitored by the participants as a part of their diabetes management; no peaks were recorded over the course of the project. All the participants demonstrated blood glucose between 105 and 125 mg/dl. Sixty percent of the participants (18 people) demonstrated a reduction in blood glucose after the intervention. Figures 4 and 5 present the histograms of the pre- and post-intervention blood glucose in the participants.

With the help of SPSS, the blood glucose data were explored and analyzed. First, the normality of the distribution of both datasets was checked with the help of the Kolmogorov-Smirnov and Shapiro-Wilk tests (see Table 1). Based on Shapiro-Wilk test, which is a more appropriate test for small sample sizes, the post-intervention dataset might be abnormally distributed. Looking at the scatterplot of the dataset (see Figure 6), this assumption appears reasonable. As a result, it is not helpful to use parametric tests for this project (Looney & Hagan, 2015; Polit & Beck, 2017).

Table 1. Tests of Normality.

It had been initially intended to use paired t-test for the task because of the specifics of the sample, which was supposed to be bigger, as well as the methodology (a pre- and post-test study). However, with the small sample, as well as the potentially abnormal distribution of the post-intervention data, it was more appropriate to use a non-parametric alternative. Polit and Beck (2017) recommend Wilcoxon signed ranks test as the suitable option since the project uses continuous data (see Table 2).

Table 2. Wilcoxon Signed Ranks Test.

As can be seen from Table 2, both the 2-tailed and 1-tailed tests return values that are greater than 0.05, which was the significance level set for the project. As a result, it is reasonable to state that the project cannot imply that the differences between the pre- and post-test datasets are statistically significant. Thus, the hypothesis about the effectiveness of the engagement method by Smith et al. (2017) in reducing blood glucose cannot be supported by the current project.

Discussion

Patient engagement in their care is a relatively new approach to healthcare (Bombard et al., 2018; Kim et al., 2018; Park & Giap, 2020). Diabetes, which is a very widespread condition with significant negative outcomes (National Center for Chronic Disease Prevention and Health Promotion, 2017; Zimmet, Alberti, Magliano, & Bennett, 2016), is among the conditions that require self-management, which makes various attempts to train and engage patients relevant for it (Quinn et al., 2018).

Furthermore, some evidence implies that the various methods of engagement, which include education and reconciliation, as well as consultations, may help to increase patient engagement levels, which are generally low, as well as possibly, with limited evidence, be associated with positive outcomes, including patient safety (Kim et al., 2018; Park & Giap, 2020).

These findings are applicable to diabetes as well; different interventions, including messages in a mobile-based patient engagement intervention (Quinn et al., 2018), helped to bring down blood glucose (Freeman, Hanlon, Denslow, & Hooper, 2018; Lee, Lee, Yoo, & Park, 2017). In the end, it is suggested that patient engagement is associated with blood glucose levels, and specific interventions were shown to result in improved engagement (Glenn, Nichols, Enriquez, & Jenkins, 2019). Thus, there exists some recent literature which implies that patient engagement measures might have an impact on blood glucose.

The findings of the present research cannot support the existing data about statistically significant improvements in blood glucose in patients. Here, it should be pointed out that the cited studies investigated the effects over prolonged periods of time (usually, half a year) while the current project only had several weeks (Freeman et al., 2018; Lee et al., 2017; Quinn et al., 2018).

Furthermore, the current project does suggest that over time, the blood glucose in the majority of engaged patients reduces; it is just that the results were not statistically significant, which may be attributable to the specific intervention used, the limited time of monitoring and, possibly, the small sample, which forced the project to employ a non-parametric test (Looney & Hagan, 2015; Polit & Beck, 2017). As a result, it should be highlighted that the research does not necessarily disprove the prior studies; rather, it cannot support them based on the currently available data.

The limitations of the project should be discussed in detail. First of all, the project is not a randomized controlled trial; it is a pre-test post-test study, which means that it does not guarantee the control of all extraneous variables (Polit & Beck, 2017). Furthermore, the sample of the project was relatively small, and the data distribution prevented the project from employing a parametric test, which are generally considered to be more accurate than non-parametric ones (Looney & Hagan, 2015; Polit & Beck, 2017).

Both these features mean that the findings might not be very generalizable. In line with that, it should also be mentioned that only the participants of one healthcare institution were involved; as a result, bringing the findings outside of those or very similar settings would not be appropriate.

As a result of these limitations, additional research may be recommended. It is noteworthy that the guide by Smith et al. (2017) has not been empirically studied before, which means that for the people who might consider implementing it, additional inquiry into its effectiveness might be helpful.

It is notable that the current research suggests a statistically insignificant drop in blood glucose of the participants; also, other research in the field implies that diabetic patient engagement is a promising endeavor which can improve blood glucose (Freeman et al., 2018; Lee et al., 2017; Quinn et al., 2018). Therefore, an additional test of the materials by Smith et al. (2017) that would involve a bigger (and, possibly, more diverse) sample over a longer period of time could produce more conclusive findings.

The value of the project can be described as follows. Aside from researching an intervention that was not studied before (that is, the specific Smith et al. (2017) intervention), it has a well-justified methodology that employs well-established methods, for example, the OMRU (Graham & Logan, 2004; Logan & Graham, 1998).

All the choices, including those that led to limitations, were explained by the needs of the project and feasibility considerations (especially as related to time and access to patients). It should also be pointed out that while nonparametric tests are not as accurate as parametric ones, they are extremely helpful for the cases of using abnormally distributed data (Polit & Beck, 2017).

Since the assumptions of the initially planned t-test could not be applied to the data, the decision to use a non-parametric test is very well-justified, and it can be claimed that the selected test is recommended by the relevant literature for similar cases (Looney & Hagan, 2015; Polit & Beck, 2017).

In summary, the presented research is not exactly in line with the existing literature since it does not demonstrate a statistically significant effect of the selected method by Smith et al. (2017). However, that could be explained by the projects limitations, as well as the fact that the patient engagement approach by Smith et al. (2017) has not been studied before. The project contributes new evidence to the methods of engaging patients with diabetes in their own care, which is a very promising field. With a greater sample and longer timeframe, an additional inquiry into the topic could be very helpful.

References

Bombard, Y., Baker, R., Elaina, O., Bhatia, P., Casalino, S., Onate, K.,& Pomey, M. (2018). Engaging patients to improve quality of care: A systematic review. Implementation Science, 13(1), 1-22. Web.

Freeman, K., Hanlon, M., Denslow, S., & Hooper, V. (2018). Patient engagement in type 2 diabetes: a collaborative community health initiative. The Diabetes Educator, 44(4), 395-404. Web.

Glenn, L. E., Nichols, M., Enriquez, M., & Jenkins, C. (2020). Impact of a communitybased approach to patient engagement in rural, lowincome adults with type 2 diabetes. Public Health Nursing, 37(2), 178-187. Web.

Graham, I. D., & Logan, J. (2004). Translating research-innovations in knowledge transfer and continuity of care. Canadian Journal of Nursing Research Archive, 36(2), 89-103.

Kim, J. M., Suarez-Cuervo, C., Berger, Z., Lee, J., Gayleard, J., Rosenberg, C.,& Dy, S. (2018). Evaluation of patient and family engagement strategies to improve medication safety. The Patient  Patient-Centered Outcomes Research, 11(2), 193-206. Web.

Lee, M. K., Lee, K. H., Yoo, S. H., & Park, C. Y. (2017). Impact of initial active engagement in self-monitoring with a telemonitoring device on glycemic control among patients with type 2 diabetes. Scientific reports, 7(1), 1-7. Web.

Logan, J., & Graham, I. D. (1998). Toward a comprehensive interdisciplinary model of health care research use. Science Communication, 20(2), 227246.

Looney, W. S., & Hagan, L. J. (2015). Analysis of biomarker data: A practical guide. Hoboken, NJ: John Wiley & Sons.

National Center for Chronic Disease Prevention and Health Promotion. (2017). National Diabetes Statistics Report, 2017. Web.

Park, M., & Giap, T. (2020). Patient and family engagement as a potential approach for improving patient safety: A systematic review. Journal of Advanced Nursing, 76(1), 62-80. Web.

Polit, D.F., & Beck, C.T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

Quinn, C. C., Butler, E. C., Swasey, K. K., Shardell, M. D., Terrin, M. D., Barr, E. A., & Gruber-Baldini, A. L. (2018). Mobile diabetes intervention study of patient engagement and impact on blood glucose: mixed methods analysis. JMIR mHealth and uHealth, 6(2), e31. Web.

Smith, K., Baker, K., Wesley, D., Zipperer, L., Clark, M. D., Hanneke, C. R.,& Goeschel, C. A. (2017). Guide to improving patient safety in primary care settings by engaging patients and families. Web.

Zimmet, P., Alberti, K., Magliano, D., & Bennett, P. (2016). Diabetes mellitus statistics on prevalence and mortality: Facts and fallacies. Nature Reviews Endocrinology, 12(10), 616-622. Web.