Browsing by Subject "Diabetes mellitus"
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Item Acute effects of hyperglycemia in a chemical-genetic ablation model(2016) Howell, Julia; Biological SciencesDiabetes Mellitus (DM) is a debilitating disease characterized by elevated blood glucose levels, known as hyperglycemia. Glucose, the energy source for metabolism, is transported to the cells of the body by the hormone insulin. Without the proper formation and utilization of insulin, DM occurs in two forms; Type I DM is characterized by the loss B-cells which produce insulin, whereas, Type II DM is characterized by insulin resistance in which the body does not respond to the insulin that is produced. Regardless of DM subtype, 50% of patients suffer with mild to severe forms of nerve damage known as diabetic peripheral neuropathy (DPN). In the quest for therapeutic techniques, we are first trying to determine if zebrafish are an appropriate model organism for studying DPN as they are easier to observe than other animals such as mice, rats and humans. Their ability to serve as an appropriate model is dependent on them showing signs of peripheral nerve damage, as seen in humans, when rendered hyperglycemic. This was examined by exploiting a transgenic zebrafish line, Tg(ins;rifsB-mcherry). In this line, insulin producing B-cells of the pancreas are destroyed using the prodrug metronidazole (MTZ) and visualized by the fluorescent protein, mcherry, which was inserted into its genome. To assess possible peripheral nerve changes, we crossbred the transgenic lines, Tg(nkx2.2a;megfp) and Tg(nbt;dsred), into the Tg(ins;rifsB-mcherry) line to allow us to visualize the perineurial glia (GFP), the motor axons (DsRed) and the B-cells (mcherry) in the offspring. The offspring were raised for 5 days post fertilization (dpt) in egg water and then treated with MTZ for 48 hours. Using epiflourescent microscopy, peripheral nerve disruption was observed in two ways; (1) fewer motor nerves had perineurium (connective tissue that is important in maintaining the integrity of nerves) associated with them and (2) when the perineurium was present, it often appeared to improperly wrap the motor nerve. In addition, the motor axons of the MTZ-treated group also appear to be defasciculated and the neuromasts, mechanosensory hair cells, appear unhealthy compared to the control. This suggests that the sensory and motor systems of zebrafish are influenced by acute hyperglycemia. Future work will include a small molecule drug screen that may be able to provide insight on the molecular mechanisms underlying hyperglycemia induced degeneration of the peripheral nerve.Item Implementation of a Diabetes Education Initiative in a Privately-Owned Family Practice(2022-05) Ward, Howard III; Hart, Jennifer; Hofmann, Charles; Nursing; Doctor of Nursing PracticeOf the 34 million Americans living with diabetes mellitus (DM), approximately 95% have type-2 diabetes mellitus (T2DM), which is characterized by insulin resistance and gradual loss of insulin production (Centers for Disease Control and Prevention [CDC], 2019). Inefficient use of insulin causes excess glucose to build up in the bloodstream placing individuals at high risk for target organ damage (CDC, 2019). In rural and underserved areas of the country, the prevalence of T2DM among Americans continues to grow at an alarming rate (CDC, 2019). This office-based quality improvement project utilized a pre-test post-test design to assess patient self-care knowledge of T2DM before and after a standardized education session. The purpose of the education was to reinforce patient understanding of DM, as well as promote healthy lifestyle modifications to effectively manage the disease in patients residing in a rural, underserved area. This project aimed to answer the following question: “In adults 18 years of age and over recently diagnosed with T2DM, does early implementation of standardized disease-specific education increase patient Revised Diabetes Knowledge Test (RDKT) scores and compliance with T2DM management over standard care?” Participants were recruited from a privately-owned family practice located in a rural, underserved area, and those patients with a recent or new diagnosis of T2DM were eligible to participate. Descriptive and inferential statistics were used for quantitative data analysis. A one-sample t-test showed statistical significance in the difference in pre-test and post-test scores before and after the education, t (4.922), p < .05. Findings from this DNP project have potential to contribute to the lack of data and improve clinical practice in other rural, underserved areas.Item Implementing the Heikes Screening Tool for Prediabetes and Type 2 Diabetes for Adult Patients in a Rural Primary Care Clinic(2022-03) Bland, Laura; Keenan, Anastacia; Hardisty, Vicki; Nursing; Doctor of Nursing PracticeThe problem identified showed inconsistencies in screening for prediabetes and type 2 diabetes by primary care providers at a primary care office in rural Maryland. After a complete literature review, a standardized screening process for identifying those at risk for prediabetes and type 2 diabetes was the solution to this problem. The purpose of this project was to standardize a screening process for prediabetes and type 2 diabetes. A standardized screening process was created to assure all patients meeting criteria for the American Diabetes Association (ADA) screening guidelines were screened properly for risk while delivering the standard of care to all patients. The goal was to increase screening by practitioners. This will aid in early diagnosis of the disease, thus leading to a decrease in diabetic related complications. Heikes screening tool was implemented using a standardized process involving an inclusion and exclusion checklist created by the ADA to identify those needing further screening. If a patient met inclusion criteria, a Heikes screening tool was completed. The patient’s risk was then identified from the screening tool and discussed in real time with the patient. Heikes screening tool was evaluated and measured by how many additional patients could be captured for being at risk with the use of a standardized screening process. The Heikes screening tool and process created a more standardized approach to identifying patients at risk for prediabetes and type 2 diabetes. Descriptive and inferential statistics were used to analyze this screening process. There was a final sample of 40 participants using convenience sampling. The screening process was able to identify and screen 22.5% of participants that had not been previously screened as evidenced by a chart review or patient reporting. The data also revealed participants who had a waist circumference of 38.4in or more had a 6.65% higher risk of being in the high-risk category for diabetes development through the Heikes screening tool (p < 0.001).Item Promoting Use of Continuous Glucose Monitoring Devices at a Pediatric Clinic through Online Education and Peer Support(2022-05) Mbah, Glenise; Padgett, Stephen; Fiddler, Kathryn; Glasgow, Flora; Nursing; Doctor of Nursing PracticeType One Diabetes Mellitus (T1DM) poses social and health threats to the lives of many individuals. In the past, management of diabetes mellitus has revolved around the use of Self-Monitoring Blood Glucose devices such as fingersticks. Today, advancement in diabetes technology has led to the innovation of Continuous Glucose Monitoring (CGM) devices, which has drastically influenced how diabetes is treated. The leaders of this DNP project hoped to bring awareness of CGM to young people with diabetes and provide resources that would assist them in making informed decisions about how to manage this illness. Because CGM use continues to be lowest among young people (Tanenbaum et al., 2018), an educational program titled the Level-Up Workshop was developed to improve how this population perceives and uses CGM devices. The Level-Up Workshop was a virtual educational workshop designed to provide education on CGM use to youth with T1DM receiving diabetes-related care from a pediatric clinic. Workshop activities were geared towards improving problem-solving, trouble-shooting, and social support. Two workshop sessions were implemented and during each session, participants engaged in a series of activities led by a diabetic educator, a CGM device representative, and young people with T1DM. Recruitment to the workshops was challenging, and a total of 4 young people were eventually enrolled. Both patients and staff participants were positive about the experience. Despite the low number of participants, the format of this project shows promise as a means of educating young people with diabetes.Item The Systematic Utilization of a Depression Screening Tool for Patients with Type 2 Diabetes: A Quality Improvement Project(2021-05) Okeke, Sharon; Hall, Nicole; White, Barbara; Barnes, Annette; Nursing; Doctor of Nursing PracticeDepression seen in individuals with diabetes mellitus (DM) is associated with DM complications and increased healthcare costs. To mitigate these complications, the American Diabetes Association recommends that providers screen individuals with DM at least annually. However, routine depression screenings are not consistently performed for patients with type 2 diabetes (T2D). The purpose of this Doctor of Nursing Practice project was to implement a quality improvement (QI) project which focused on systematically screening adult patients with T2D in primary care for depression so that depressive symptoms could be identified, treated, and referred earlier. A retrospective chart review was conducted to explore the depression screening frequencies in the pre- and post-implementation periods. The Academic Center for Evidence-Based Practice Star Model was used to organize the implementation of the QI project. The Theory of Planned Behavior was used to assess the provider's willingness to adopt consistent depression screening practices which guided the implementation process. Patients who qualified were meant to be screened with the Beck Depression Inventory-2 tool during their annual wellness visit. The results revealed an increase in depression screenings for adult patients with T2D (n=41) from 15% to 61%. In addition, 30% of participants had positive depressive screening results compared to 0% in the pre-implementation group, and 14% were referred or began antidepressant treatment. These results suggest that the systematic utilization of a depression screening tool by providers in primary care does improve the frequency of depression screening and early identification of depression among individuals with T2D.