Awareness and Knowledge Among Prediabetes Introduction Chapter

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Running head: EARLY AWARENESS24EARLY AWARENESSMetabolic Syndrome/Pre-diabetes Early Awareness Education and Its Effects on BMISubmitted by:Nancy L. GeeDirect Practice Improvement Project ProposalDoctor of Nursing PracticeGrand Canyon UniversityPhoenix, Arizona1/13/18Chapter One: Introduction to ProjectIntroductionIn society today, obesity is really a recurrenthas become a widespread co-morbidity related toleading to excessive rise in bodyweight. Additionally, it is considered as one of the most essential and changeable risk factors within the pathogenesis of health problems like type-1 and type-2 diabetes, which has beendocumented in most biochemical studies as well as cross-sectional research (Piven, 2014). In current times, there are many crucial biochemical studies in the inter-relationship amid body mass index (BMI) and its connection with advancement of diabetic issues (Innocent, Oweh, Sandra & Josiah, 2013). The Center for Disease Control (CDC) anticipates that one-in-threenearly 33% adults may have diabetes by the year 2050 (CDC, 2010; Robert Wood Johnson Foundation, 2016); as presently, more than twenty-nine million adults in America has been diagnosed with diabetic issues and an additional eighty-six million have pre-diabetes (Statistics about Diabetes, n.d; Robert Wood Johnson Foundation, 2016).Pre-diabetes is a condition where blood sugar levels are elevated, however lesser than the established inception of diabetes level related to diabetes (Kowall et al., 2012). Kowall, et al (2012) writes “pre-diabetes is a result of Impaired Fasting Glucose (IFG), Impaired Glucose Tolerance (IGT), or perhaps a mixture of IFG and IGT (p. 828). Further, diabetes has numerous effects which might consist of several health disorders and, in a few instances, failure of bodily organs (Tabák, Herder, Rathmann, Brunner, & Kivimäki, 2012; Brown, 2017). Thus, Type-2 diabetes (T2D) puts individuals at risk for a variety of ailments like cardiac condition, amputations, renal malfunction, vision loss, as well as obesity. Weight reduction has been seen to stop the triggering of T2D and morbid obesity in individuals having pre-diabetes (Brown & Kuk, 2015). As a result, “early diagnosis and management of pre-diabetes can avoid its crossover to complete onset diabetes and thus reduce the related problems” (Brown & Kuk, 2015, p. 79).Given that diabetes educational interventions have been a successLittle is known about how patients respond to Diabetes Self-Management Education (DSME), the goal of this study will be to measure the awareness and knowledge of metabolic syndrome/pre-diabetes risk factors among obese patients (BMI >30) in an internal medicine/family practice clinic with a BMI >30. Th. The study makes use of a adopts a quantitative approach using a descriptive method and pre-post test research structure to determine subjects\' understanding and knowledge of metabolic syndrome/prediabetes, and T2D. The pretests will establish current knowledge and gaps about diabetes awareness and post-test will determine the information they gained from the intervention (DSME) and how they plan to use that information in their life. The results, will state the help in the advancement and improvement of the pre-diabetes and diabetes informative and knowledge-based self-management intervention programs.Thereafter, tThis chapter places the research within the much larger framework of the scholarly materials and after that reaches up to a particular target audience while describing the idiosyncrasies of this DPI project such as background of the study, problem statement, purpose of the study, clinical question(s), advancing scientific knowledge, significance of the study, rationale for methodology, nature of the study, definition of terms, assumptions, limitations and delimitations and lastly, summary and organization of the remaining chapters.CriterionLearner Score(0, 1, 2, or 3) Comment by Segovia, Julie H: Learner scores have not been completed – these table need to be completed as a self-assessmentChairperson Score(0, 1, 2, or 3)Comments or FeedbackIntroductionThis section briefly overviews the project focus or practice problem, why this project is worth conducting, and how this project will be completed. (3-4 paragraphs or approximately 1 page)1Not clear what the project intervention is or what the project design isPractice improvement project topic is introduced.1Not clear what the improvement isDiscussion provides an overview of what is contained in the chapter.2Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.1Review sentence structure, grammar and choice of words for scholarly writingNOTE: Once the document has been approved by your Chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.Score 0 (not present); 1(unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready).Background to the ProjectThe frequency of identified diabetic issues amid U.S. adults has gone up twofold within the past four decades and seventy five percent in the past twenty-five years (NCD Risk factor Collaboration, 2016; Gregg et al, 2004; Centers for Disease Control and Prevention, 2006). The life-time danger of acquiring diabetes within the U.S. in 2000 had been 33% for males and 39% for females and this had been even greater amid U.S. minority communities (Narayan et al, 2003). Since 2000 research related to the life-time danger of acquiring diabetes could not be found in the literature.BMI is a highly effective strongand flexible, yet controllable, risk element for diabetes (ADA, 2017; Ford, Williamson and Liu, 1997; Diabetes Prevention Program Research Group, 2002). Nevertheless, the outcome link between of prediabetes knowledge on and BMI hasn\'t been extensively examined (Arayan, James, Theodore et al, 2007). Medical experts use the Body Mass Index to determine whether a person is overweight, obese, normal or underweight. It’s a determination of the ratio between a person’s weight and their height (Lo, Wong, Khalechelvam and Tam, 2016).The following are details of the findings from research, with regard to the relationship between the BMI ratio and diabetes. Relationship between BMI and Diabetes: Iit was found by Narayan et al (2007) that one’s risk of developing diabetes in their lifetime is one in three, at the point of birth. He further noted that the risks of developing the condition across the categories of BMI over a lifetime are still unclear. The study sought to demonstrate the specific lifetime risks for the various BMIs for people in the US, based on sex, ethnicity and age subgroups (Narayan et al., 2007).The survey data for the National Health Interview n=780, 694, from 1997 to 2004 was the basis for indicating race, sex, age, ethnicity and the prevalence of BMI-linked occurrence of diabetes in the US in 2004 (Narayan et al., 2007). The data from the US Census Bureau including age, sex-specific mortality, population rate projections and race were used along with two earlier studies relating to mortality, to project the mortality rates related to BMI ratios (Narayan et al., 2007).The findings and estimates informed the Markov Model projection of the lifetime risks of diabetes diagnosed by race, sex baseline age and BMI. According to the results, the lifetime risk of developing diabetes at the age of 18 for underweight people was shot from 7.6 to and those who were obese was 70.3% between underweight people and those who were significantly obese. The figures also increased from 12.2 to 74.4 for women in the same weight categories. The difference in lifetime risk was lower at advanced ages. For example, at age 65, normal weight males had their lifetime risk difference rise from 3.7 to 23.9 points in percentages between overweight people and the ones regarded as very obese. The figure increased by 8.7 percentage points to 26.7 for women (Narayan et al., 2007a). It was also noted that the effect of BMI on the duration of diabetes compounded with an increase in one’s age (Narayan et al., 2007b).The risk of developing diabetes type II diabetes was investigated in a case control research by Ganz et al (2014) by studying its incidence versus BMI ratios. The rising effect of BMI, basing on BMI categories was also assessed. Those who recorded weights between 25 and 29.9 were labelled as overweight. And then there was the Obesity Class I who measured between 30 and 34.9. Class II Obesity group registered BMI index from 35 to 39.9. Obesity Class III on its part recorded figures equal to or over 40 (Ganz et al., 2014).Relative risks and ratios regarding the odds were calculated from a range of logistic regression outcomes. Age, cardiac history, sex and hyper-inflammatory identified by erythrocyte sedimentation and C- reactive protein states and use of psychiatric medications were used to select group, memberssubjects. (Ganz et al., 2014). Measures of BMI were taken a year preceding the first diagnosis of type II diabetes. BMI was obtained from dates that were randomly assigned for those that were in the control. The relationship between BMI and the incidence of diabetes was not only found to be strong but that the risk increased with large higher levels of BMI figures (Ganz et al., 2014).There is a significant correlation between diabetes and being overweight. A number of studies have established a strong link between the two factors. In one study, for instance, Akbari et al (2017) found that patient education regarding type II diabetes can help reduce barriers. The core aim of the study was to establish the impact of an education program intervention, using the model BASNEF on awareness barriers, adaptation, lifestyle and support for patients living with type-II diabete (Akbari, 2017). It has been noted that removing the barriers associated with the diabetes condition is a reasonable step towards empowering patients of diabetes to manage their lives with the condition, and to recognize what really affects the barriers. The findings indicated that there was a clear difference between a score derived from living barriers such as lifestyle, awareness, protection and adaptation components, and the BASNEF model variable, i.e. enabling factors, attitude, subjective norm, knowledge, and behavioral intention.CriterionLearner Score (0, 1, 2, or 3) Comment by Segovia, Julie H: As above, self-assessment is not completedChairperson Score (0, 1, 2, or 3)Comments or FeedbackBackground of the ProjectThe background section explains both the history of and the present state of the problem and project focus. This section summarizes the Background section from Chapter 2. (2-3 paragraphs)1Unclear that the problem/project focus is. Pre-diabetes is not discussed. Education for pre-diabetes not discusses. In other words, tie the project focus in within this section.Provides an overview of the history of and present state of the problem and project focus.1See comments aboveSection is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.2Check grammar and sentence structureNOTE: Once the document has been approved by your Chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.Score 0 (not present); 1(unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready).Problem statementType II diabetes, previously referred to as non-insulin-dependent diabetes (NIDDM), makes up most cases associated with type II diabetesof diabetes mellitus globally. It\'s approximated that in 2000 there had been roughly a hundred and fifty million people with the illness and that this quantity is most likely to increase twofold by the year 2025 (Kaveeshawar &Cornwall, 2014; King, Aubert, & Herman, 1998). Type II diabetes will be the fourth or perhaps fifth prominent cause of demise in many developed nations and there\'s expanding proof that this has attained epidemic dimensions in quite a few developing and recently industrialized nations (Amos, McCarty, & Zimmet, 1997). All-time low levels of type II diabetes are generally noticed in places where individuals retain traditional life-style (Gray, 2015; Bennett, 1999). Dramatic modifications in the frequency or occurrence of type II diabetes happen to be noticed in places where there have already been significant modifications in the kind of foods utilized, from the conventional native diet plan to a common “western” diet plan (Hu, 2011; Bennett, 1999; Lako and Nguyen, 2001; Hetzel and Michael, 1987). Changing illness levels are revealed by modifications in a number of dietary elements along with modifications in other life-style associated elements, notably a decrease in physical exercise (Sami, Ansari, Butt, Rashid, & Hamid, 2017; Steyn et al, 2004).Because of these facts, the objective of this study is to assess the awareness and knowledge of diabetes amongst patients with prediabetes in an internal medicine/family practice clinic. After carrying out DSME pre-intervention assessments on patients with prediabetes, gaps are going to be recognized in awareness and understanding of diabetes amongst the subjects. The pre-assessment outcomes will be utilized to enhance and modify the educational plan to satisfy the individual requirements of patients with prediabetes.Absent from the literature is information on how patients respond to self-management methods that should be adopted to attain the preferred benefits; and precisely what they will do with the understanding knowledge they develop gain from DSME educational interventions. There\'s an expanding demand for interventions that enhance patients’ understanding and knowledge of diabetes (Islam et al., 2014). The “substantial population at an increased risk for or with diabetes is actually within the age bracket of 25 - 65 years. Insufficient steps to decrease occurrence of pre-diabetes might result in a consequential boost in health investment, morbidity, as well as other associated health circumstance” (National Diabetes Statistics Report, 2014, para 8).To manage an increased incidence of diabetes diagnoses, health interventions will be essential to avoid diabetic issues or postpone their development (Islam et al., 2014). Such endeavors can consist of complete life-style change for all those at an increased risk for metabolic syndrome/pre-diabetic issues and timely treatment for patients suffering from the disorder. An aAmbitious self-management methods focusing on individuals at an increased risk of diabetes is definitely an important public health strategy targeted at reducing the threat elements for diabetes (International Diabetes Federation, 2013).CriterionLearner Score(0, 1, 2, or 3)Chairperson Score(0, 1, 2, or 3)Comments or FeedbackProblem StatementThis section includes the problem statement, the population affected, and how the project will contribute to solving the problem. (2-3 paragraphs)2States the specific problem proposed for research by presenting a clear declarative statement that begins with “It is not known if and to what degree/extent...,” or “It is not known how/why and…”.1Unclear – please see aboveIdentifies the need for the project.2Not clear as yet what the intervention isIdentifies the broad population affected by the problem.

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2Suggests how the project may contribute to solving the problem.1Unclear what the patient or practice outcome isSection is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.2NOTE: Once the document has been approved by your Chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.Score 0 (not present); 1(unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready).Purpose of the ProjectThe objective of this study is to evaluate awareness and understanding concerning metabolic syndrome and diabetes in pre-diabetic individuals and the effects on BMI. To determine if the patients qualify for prediabetes stage, the researcher will utilized patients’ healthcare records to choose individuals with an increased fasting glucose (IFG), and hypertension in the healthcare facility Copperview Medical Center. In addition, the individuals will be recognized as obese if they have a body mass index (BMI) of more than 30kg/m2. The independent variables will be the DSME intervention plan and the dependent variable will be patients’ awareness level about the threat of acquiring T2D and awareness concerning risk lowering habits and treatments; and these factors will be assessed utilizing adopting a a qualitative surveyquantitative method and using a descriptive design. The Other dependent variables will be BMI assessment. The BMI will be measured by weighing the patient before awareness education and eight weeks after receiving the intervention. Additional independent variables are how awareness and understanding levels amongst individuals differ based on education level and lastly the health belief model will be utilized as the theoretical foundation of this study.This project will make use of diabetes associated queries in the pre-assessment to evaluate and classify individuals according to their understanding and knowledge of diabetic issues. Dedication of a towards increasing patients’ their understanding and awareness of diabetes as well as their risk of acquiring type II diabetes might encourage them to alter their life-style and embrace new treatments to decrease the threat of diabetes. This project will target inclusion criteria for this study will be adults of both sexes with a BMI of more than 30kg/m2. Furthermore, the results might be helpful in the advancement of future interventions towards decreasing diabetes risk in communities with higher risk of acquiring type II diabetes.CriterionLearner Score(0, 1, 2, or 3)Chairperson Score (0, 1, 2, or 3)Comments or FeedbackPurpose OF THE PROJECTThe purpose statement section provides a reflection of the problem statement and identifies how the project will be accomplished. It explains how the proposed project will contribute to the field. (2-3 paragraphs)1Not clear what the intervention is therefore it’s missing as to how the project will be accomplished. With the way it’s worded it’s currently understood that the project is to measure awareness of a pre-condition and if that awareness impacts BMI? The intervention appears to be missing.Presents a declarative statement: \"The purpose of this project is....\" that identifies the research design, population, variables…

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…connection being investigated is amid awareness concerning diabetic issues in prediabetic individuals and the way it impacts diabetes managementtheir willingness to self-manage diabetes. After awareness-level and knowledge-level assessment of diabetes amongst the subjects utilizing a quantitative descriptive methods, the researcher will make use of an educational intervention program for patients with prediabetes. This can be carried out to enhance clinical results amongst individuals, as well as, progression of more efficient educational intervention models (Funnel et al., 2010).CriterionLearner Score(0, 1, 2, or 3)Chairperson Score (0, 1, 2, or 3)Comments or FeedbackNature of the PROJECTThis section describes the specific research design to answer the clinical questions and why this approach was selected. It describes the research sample being studied as well as the process that will be used to collect the data on the sample.1 Project design needs to be identifiedDescribes the selected design for the project.0 not clearDiscusses why the selected design is the best design to address the problem statement and clinical questions as compared to other designs.1 not discussed – new variable introducedBriefly describes the specific sample being studied and the data collection procedure to collect information on the sample.0 – data collection procedures unclearSection is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.1 Flow of thought not clearNOTE: Once the document has been approved by your Chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.Score 0 (not present); 1(unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready).Definition of termsDiabetes Knowledge: For this project we the researcher will use the definition employed by Fonseca et al (2012) who state that diabetes knowledge represents having abilities, data, and details concerning diabetic issues that is obtained via experience or education.Pre -diabetes: For this project the researcher will we assume the definition put forward by ADA, (2011) which classifies prediabetes as a medical problem in which the degree of blood sugar is greater than the normal degree, although not enough to be classified as type two diabetes.Type II diabetes: For this project, once again, the researcher will we assume the definition put forward by ADA, (2011) which classifies Type 2 diabetes as a disorder in which the body doesn\'t take advantage of the insulin released through the pancreas, resulting in higher blood sugar levels (ADA, 2011).Obesity: The researcher will We will use the definition put forward by Haas and his colleagues (2013) who state that this is a health disorder where there\'s excessive unwanted fat that may be established when BMI, calculated by dividing a person’s weight from the height, which is powered square, exceeds 30 kg/m2.CriterionLearner Score(0, 1, 2, or 3)Chairperson Score(0, 1, 2, or 3)Comments or FeedbackDefinitions of TermsThis section defines the project constructs and provides a common understanding of the technical terms, exclusive jargon, variables, phenomena, concepts, and sundry terminology used within the scope of the project. Terms are defined in lay terms and in the context in which they are used within the project. (Each definition may be a few sentences to a paragraph in length.)2Defines any words that may be unknown to a lay person (words with unusual or ambiguous means or technical terms) from the research or literature.2Defines the variables for a quantitative project or the phenomena for a qualitative project from the research or literature.2Definitions are supported with citations from scholarly sources.2Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.2Additional terms throughout will need definitionsNOTE: Once the document has been approved by your Chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.Score 0 (not present); 1(unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready).Assumptions, limitations and delimitationsThis project will be centered on the belief that individuals with prediabetes might have less understanding and knowledge of diabetes, consequently, the educational DSME intervention program will certainly enhance the patients’ understanding of diabetic issues. Additionally, it is presumed that growing awareness concerning diabetic issues as well as its associated challenges might lead to enhanced benefits when managing the health disorder. The sample for this study will be restricted to patients inside an internal medicine/family practice clinic. Consequently, the opportunity to make use of the results to the general populace at an increased risk of acquiring type II diabetes is restricted (Stommel and Wills, 2004).Results generalization is reasonably limited because of the small volume of subjects and also the absence of a control group. Because the target populace, the obstacles to registering more subjects will include individuals travelling, working, or experiencing other scheduling restrictions, along with issues in reaching out to a few subjects. The limitations to acquiring all after-intervention information may include lapses in subject\'s insurance coverage, and absence of insurance coverage to get a 3 2 month BMI measurement. The project impact might be understated because of the timing involved in the awareness education intervention that will take place during the February-March after winter months sedentary activity related to determents of winter weather and participating in holiday season festivities and parities where people might be much more likely to drink alcoholic beverages and avoid eating healthy foods. The subjects may well improve their clinical health indicators indications much more if this DSME intervention takes place in another period of time.The independent variables will be the DSME intervention plan and the dependent variable will be patients’ awareness level about the threat of acquiring T2D and awareness concerning risk lowering habits and treatments; and these factors will be assessed utilizing a closed-ended questionnaire and a quantitative descriptive design. Other dependent variables will be BMI assessment. The BMI will be measured by weighing the patient before pre-assessment and awareness education and eight weeks after receiving the intervention. This project will make use of diabetes associated queries in the pre-assessment to evaluate and classify individuals according to their understanding and knowledge of diabetic issues. Dedication towards increasing their understanding and awareness of diabetes as well as their risk of acquiring type II diabetes might encourage them to alter their life-style and embrace new treatments to decrease the threat of diabetes.CriterionLearner Score(0, 1, 2, or 3)Chairperson Score (0, 1, 2, or 3)Comments or FeedbackAssumptions, Limitations and DelimitationsThis section identifies the assumptions and specifies the limitations, as well as the delimitations, of the project. (3-4 paragraphs)1States the assumptions being accepted for the project (methodological, theoretical, topic-specific)1Missing details on methodology, theory, etc…Provides rationale for each assumption, incorporating multiple perspectives, when appropriate.1Identifies limitations, and delimitations of the project design.1Discusses the potential generalizability of the project findings.1Not clear what the independent variable is and how it is anticipated to impact BMIThe Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.2NOTE: Once the document has been approved by your Chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.Score 0 (not present); 1(unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready).Summary and organization of the remainder of the studyIncreasingly, diabetes is becoming a health problem which is more likely to overload the existing medical care program. Additionally, diabetes can be the cause of various other health problems making it a very complicated disease. There is certainly a need for efficient initiatives such as early awareness to assist with prevention or slowing down the incidences of the disease focused on slowing the progression (Brown, 2017). The achievements of a health intervention programs are partially affected by the people’s degree of understanding concerning the health disorder. Understanding and knowledge lead to obesity and diabetes cognizance, and as a result, therapy and control of this disorder (ADA, 2017). This project will examine knowledge and understanding of metabolic syndrome/pre-diabetes in prediabetic subjects. The results of this project could possibly assist lawmakers and medical service providers who will include them in creating and applying obesity and diabetes programs (Brown, 2017).The rest of the study which will be performed and completed within an eight-week time period is going to be split up around 4 additional chapters. The literature review will likely makes up chapter two and will consist of the theoretical fundamentals. The methodology will make….....

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Awareness and Knowledge Among Prediabetes Introduction Chapter

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