Tag: Diabetes

This document presents guidelines on the use of smartphones and supportive mobile technology tools in the self-management of Diabetes in children and teenagers. Supportive mobile technologies are a set of gear that enhance the patient’s ability to monitor their state of health using their mobile phone (Klasnja & Pratt, 2012). Hence, the first step in this plan will be to acquire a mobile phone and a specific set of compatible technology tools comprising Telcare’s Blood Glucose Monitor, Glooko’s MeterSync Cable, and WellDoc’s DiabetesManager. This combination of gadgets will serve as a medium for collecting and logging blood glucose readings, providing real-time alerts and reminders, and translating and interpreting data over time. In particular, the smartphone will provide an interface for sharing data with the physicians and caregivers as well as make educational materials available based on the available trends.

Read also Pathophysiology of Type 2 Diabetes Mellitus

             Glooko’s MeterSync Cable is a universal cable that enables the patient to download glucose readings from a glucose meter. It will be used along with the Telcare’s Blood Glucose Monitor to keep track of all glucose readings, transmit data wirelessly, and provide real-time feedback. Telcare’s Blood Glucose Monitor can also be used individually without the need of logging readings to a smartphone as it is an enhanced type of monitor (Telcare, 2018). Nevertheless, this plan incorporates smartphones for purposes of integrating data into a management system and educating the patient. Glooko’s MeterSync Cable will therefore be used as a mere data transmission device for transferring data to the smartphone or a personal computer if need be (Baldridge, 2017). Lastly, the WellDoc’s DiabetesManager will serves as a diabetes management platform. It will be installed in the patient’s phone and used to interpret the data collected by Telcare’s Blood Glucose monitor. The platform will also send real-time alerts, educational materials, and actionable messages to patients based on their clinical information.

Read also Role of Physical Activity in Management of Diabetes – Initial Steps for an Evidence-Based Project

            WellDoc DiabetesManager is clinically tested and FDA-cleared to provide automated and real-time behavioral coaching and clinical decision support for the patient (Quinn et al., 2008). As a software-based system, it supports patients and empowers healthcare professionals to design certain parameters and extend care beyond traditional hospital visits through utilization of the internet and smartphones. Among its capabilities is the capture, storage, and transmission of self-management data to the physician and medication adherence. The transmitted data is analyzed by an Automated Expert Analytics System that identifies trends and delivers applicable behavioral and educational lessons to enable the patient achieve medication adjustments and effective lifestyle. The captured data will be used purposely to assess the patient’s state of health and detection of symptom changes.        

Read also Type 2 Diabetes and Childhood Obesity    

Altogether, this plan will require input from parents or guardians of the patients in form of assistance and adherence. It is important for the patient’s family to monitor the fulfillment of the requirements of this plan as children may forget or obscure the procedures. A significant advantage with this self-management strategy is that it applies throughout the teenage years and does not necessarily need to be changed unless a physician advises otherwise. This plan was successfully submitted to my healthcare setting and reviewed. My supervisors appraised it as valuable and applicable self-management model for diabetes patients. They claimed that the combination of smartphones and other technology tools has clear epidemiological value as it allows patient data to be collected over time. However, its implementation would depend on the center’s reimbursement model.

Introduction

• Type 2 diabetes mellitus is the most common form of diabetes.
• The condition is a worldwide pandemic, and affects about 10 percent of the population.
• About a quarter of the population above 65 years have type 2 diabetes mellitus
• Diabetes mellitus type 2 is characterized by chronic impairment of carbohydrate metabolism and chronic hyperglycemia
• It is non-insulin-dependent
• Usually results from interaction of environmental and genetic factors.

Read also Type 2 Diabetes and Childhood Obesity

Epidemiology

• Type 2 diabetes mellitus is a worldwide public health issue.
• The rate of increase in the number of those affected continue to rise steadily in developed countries such Japan and USA.
• As of 2015, close to 420 million people had diabetes type 2 worldwide (Forouhi & Wareham, 2019).

Read also Diabetes Among Citizens In Los Angles – Community Health Assessment

Risk Factors

• Chronic hypertension
• Advancing age
• Poor lifestyle and diet
• Family History of diabetes

Read also Healthy People 2020 Diabetes Objective

Anatomy

• Pancreas is an organ that lies below the stomach
• The pancreas produces integral homes, insulin and glucagon, that are at the center of carbohydrate metabolism.
• The beta cells are specifically crucial as they produce insulin that directly helps in utilization of glucose by peripheral organs

Read also Community Health Assessment – Diabetes Associated Deaths – Wayne County

Physiology

• The dysfunction of beta cells leads to insulin resistance in peripheral tissues.
• Insulin resistance leads to storage of excess glucose in form of fat
• Compensatory insulin production leads to hyperglycemia, which also leads to further destruction of beta cells

Read also Pathophysiology of Type 2 Diabetes Mellitus

Signs and Symptoms

• Increased thirst and Increased urination
• Delayed wound healing
• Recurrent infections
• Hyperglycemia and increased incidences of ketoacidosis

Treatment

• Lifestyle changes such as increased exercising.
• Diet changes which focus on reducing carbohydrates and increasing proteins
• Medications such as metformin, inulin, and thiazolidinediones, among others.

Read also Role of Physical Activity in Management of Diabetes – Initial Steps for an Evidence-Based Project

Patient and Family Needs

• A diabetes type 2 patient needs constant care to aid in compliance with drugs and recommended lifestyle changes.
• Management of a diabetes patient may affect a family’s finances and lifestyle as well.
• However, there should be a greater investment in family support in order to improve a patient’s condition (Ahmed & Yeasmeen, 2016)

Read also Digital Health Communication – Diabetes Centers – UCSF Medical Center

Conclusion

• Type 2 diabetes mellitus is a chronic condition characterized by hyperglycemia
• It is a common condition worldwide
• The management of the condition relies on lifestyle changes and medications

Provide an in depth discussion on the pathophysiology of Type 2 Diabetes as it occurs over time. Include signs and symptoms, diagnostic studies and the underlying pathophysiologic process causing the signs and symptoms. 

Type 2 diabetes mellitus is a chronic health condition characterized by an alteration in how it metabolizes glucose. Individuals with type 2 diabetes either fail to produce insulin or maintain healthy levels of glucose in their blood (Kasper et al., 2018). Marginal insulin resistance characterizes the condition’s pathophysiology, which eventually results in the deterioration of β-cell function functionality (Andrew Kagan, 2015, p. 43). It is also critical to acknowledge that there is a direct correlation between insulin resistance and obesity in populations globally.

Read also Pathophysiology of Pneumonia

As explained in the portal hypothesis, the adipose tissues containing heightened fatty acids that are non-esterified results in an increase in ectopic fat causing β-cell dysfunction. Type 2 diabetes has, over the past five decades, been on a steady rise among young children and now childhood obesity. The result is insulin resistance signaling an early onset of the condition. Common symptoms of type 2 diabetes are an increased regularity in feeling thirsty, intermittent urination and blurred vision. The Glycated hemoglobin test, random blood sugar test and oral glucose tolerance are typical diagnostic studies utilized by doctors to establish whether an individual might have diabetes. The Glycated hemoglobin test provides an average reading of glucose levels in the blood within a two month period.

Read also Type 2 Diabetes and Childhood Obesity

On the other hand, the random blood sugar test reveals the presence of type 2 diabetes in readings that are above 100 mg/dl. The oral glucose tolerance test also probes glucose levels by requiring patients to fast overnight, sip a sugar drink the next morning then take a blood sugar test. Surplus glucose in the blood is excreted as urine and the main reason why frequent urination is a symptom of affliction by the condition. Excessive thirst is a common sign of type 2 diabetes and as a result of dehydration. Moreover, high glucose levels cause the eye’s lenses to swell, resulting in blurry vision.

Introduction

Diabetes is one of the most significant health problems that affect the general population.  This project focuses on establishing the impact that physical activity has on the prevention and management of diabetes. A greater understanding of the relationship that exists between exercise and diabetes can help improve how diabetes is managed.

Overview of the Problem

Diabetes is a significant health problem due to its chronic tendency and difficulty to manage. The prevention of diabetes plays an important in the management of the condition worldwide. However, considering that there has been an increase in the number of people diagnosed with the health condition, it is important to explore alternative means of prevention and management of d. Physical activity has been shown to play an essential element in the management of this condition and thus forms the basis of this paper.

Read also Evidence Based Practice Project – Interventions for Type 1 Diabetes

Purpose Statement

The purpose of this paper is to establish the link between exercise and diabetes. This is significant in shedding more light on how best the condition can be prevented, especially for those in high risk of developing diabetes. The second significance is in establishing whether exercise can be effectively employed in the management of diabetes. 

Background and Significance

There has been an increase in the number of people who have diabetes. Lifestyle changes have been a significant contributor to this fact. One of the considerable factors in lifestyle has been diet and physical activity. A big part of management has been on nutrition and medication aimed at either preventing or managing acute symptoms and complication. Exercise has been shown to have a high potential in contributing to a better outcome in the management of the condition. Because increased activity improves the utilization of glucose, it has a huge potential in contributing to the management of diabetes.

Read also Evidence Based Practice – Hourly Rounding

PICOt Clinical Question

To be able to carry out impactful research on a given topic, it is of considerable significance to develop a relevant question that correctly captures the aims and the objectives of the study. This helps to guide a researcher in its mission to establish credible findings that can be adequately applied to develop a solution. The PICOt structure is an essential element that is widely used in the formulation of a relevant clinical question while researching a given subject.

Read also Searchable Question In PICOT Format – Sample Paper

The PICOt question for this paper is: Does increased physical activity improve health outcomes in patients who have diabetes type 2? The following table illustrates the breakdown of this question into various parts of the PICOt.

PICOt element	Part of the Question
P= Population	Patients with diabetes type 2
I= Intervention	Increased physical activity
C= Comparison	Those leading sedentary lifestyles
O= Outcome	Improved management of diabetes
t= Time	Not applicable in this question

The population of the study must be captured in the question when it is of interest to the researcher. In this case, the population of interest is the patients that are suffering from diabetes type 2. In some instances, the population is not indicated, especially when the intervention under study is expected to apply to a wide range of the population. An intervention is defined as the element that is introduced and its effectiveness is to be tested. It is included in all questions where the intervention is the principal element under study. It is what is expected to give an outcome that can be compared with previously used interventions. Time is an essential element when a given study is to be restricted. However, there is no need for time restriction in this study, and, therefore, the aspect of time is not included.

Literature Review

A literature review is an essential element in any research project, and especially one that seeks to establish and highlight the existing knowledge regarding a given topic of interest. For this evidence-based project paper, a search was conducted on Google Scholar, PubMed, NCBI, and PsychINFO. These resources were used because they contain peer-reviewed and scholarly articles and research materials that are essential in forming the basis for sound evidence-based project paper. The terms and phrases used in the search process include: “diabetes type 2”, “role of exercise in diabetes”, “how exercise affect insulin function”, and “impact of exercise on health outcomes diabetics”. From the extensive search process, the following research studies were found to be most relevant for this paper.

Read also Obesity and Physical Activity – Annotated Bibliography

Way et al. (2016) assess the effect that regular exercise has on a patient’s body tissues sensitivity to insulin. The study focused on randomized controlled trials that demonstrated that exercise played a big part in the control of type 2 diabetes. The authors explained that when established exercise regimes were stopped, the patients’ diabetes control went down. The authors conclude that this clearly shows the link between exercise and control of diabetes.

According to Colbert et al. (2017), physical activity has a central role in the prevention of type 2 diabetes. The study establishes that regular physical activity is needed if the patient is to realize any meaningful outcomes. Participation in daily physical activities helps the body’s tissues to utilize glucose better. In the process, responsiveness to insulin is scaled up, and this is found to be necessary for long-term management of diabetes. Kharroubi and Darwish (2015) establish the standard regulatory mechanisms employed by the body in the usage of glucose and the control of the excess levels. Although the authors focus on the distribution and the epidemiology of the condition in terms of different regions across the world, the link between exercise and diabetes is made. The authors establish the areas where people are more sedentary face poor outcomes as regards diabetes.

Read also Type 2 Diabetes and Childhood Obesity

Resistance training has a significant impact on how muscles work and utilize energy (Pesta et al., 2017). The skeletal muscles are the one that takes part in the usage of the majority of the glucose that gets into the body for energy production. The researchers found that resistance training increased the use of glucose by muscles, and therefore, led to improved diabetes management. Increased physical activity improves the sensitivity of the tissues to the effects of insulin (Bird & Hawley). The writers expound that insulin acts to reduce the amount of circulating glucose by either increasing its usage by body tissues or converting the excess into storage forms. Physical activity is shown in this study to improve the management of diabetes type 2.

Critical Appraisal

The research study by Pesta et al. (2017) focuses on the role of resistance training on management of diabetes type 2. The evidence provided is reliable as it directly studies a group of people who have diabetes and how their participation in endurance training helps them manage their diabetes. The research has the weakness of not having considered whether the same findings can be found in the general population. One gap in the study is that there is no way of establishing alternative means of taking part in resistance training for those with disabilities.

Read also Digital Health Communication – Diabetes Centers – UCSF Medical Center

The research by Way et al. (2016) is well structured and follows the correct order. The research takes the form of a literature review which focuses on analyzing existing studies on the topic. In selecting the proper research studies to review, the authors employ a very rigorous process in searching. The articles are derived from credible sources like PubMed. To increase the relevance, the materials reviewed are the most recent, which helps to capture the most updated information on the subject.

Colbert et al. (2017) focus on principles established by the American College of Sports Medicine and the American Diabetes Association. The research study focuses on highlighting the link between exercise and control of glucose levels in people with diabetes. The authors analyze the daily lives of those who have diabetes and finds that those who exercise daily have better control of diabetes. By doing this, the research establishes its relevance as there is the employment of follow-up of people in their daily lives.

Read also Health People 2020 Diabetes Objective

Kharroubi and Darwish (2015) is a research that looks at the global perspective of the distribution of diabetes among different population sets. The study is relevant to this paper’s subject as it focuses on the influence of sedentary lifestyle on the management of diabetes. There is also a focus on the effect of exercise on insulin function and control of glucose levels. By taking this approach, the study can credibly conclude that a sedentary lifestyle is linked to poor control of sugar levels and, therefore, leading to poor health outcomes, especially concerning diabetes. The apparent gap in this research by Kharroubi and Darwish (2015) is whether a sedentary lifestyle contributes to the development of diabetes.

Bird and Hawley (2017) is a credible research study that focuses on the analysis of the available knowledge on the topic. The researchers assembled a wide range of researches that focuses on the subject. Through this, the authors can conclude that exercise increases sensitivity to insulin, and therefore, improve the control of glucose in the body. The central gap in the research is the fact that there is no independent of the extent to which exercise on its own contributes to the management of diabetes without the addition of anti-diabetic drugs.

Evidence-Based Practice (EBP) Standard

Based on the knowledge established above, it is possible to develop a direction on how patients can be advised further on how to prevent or manage diabetes. The table below illustrates a model that can be applied:

Patient history	Recommendations
Patient has no diabetes, but has there is a history of diabetes in family	Advise patient to undertake daily exercises and to be keen the kind of diet they take.
The patient is diagnosed with diabetes	Advise the patient to adhere to medications in addition to daily exercises.

Read also Evidence-Based Practice (EBP) Summary

The patient’s preferences in terms of the exercises that they might prefer should be considered. Some patients may prefer light exercises, in which case the healthcare professional should advise the patient to do them for a longer duration and more frequently to match the results that would have been achieved from rigorous exercises.

Implications

The discussion above provides many opportunities for learning and application in the management of patients with diabetes. Considering that diabetes is a chronic illness that requires long-term management, there is the need for a concerted effort to provide patients with a wide array of alternatives with which they can put to use in the management of diabetes. On research, it is clear from the works of literature reviewed above that many areas still need to be worked on. There is the need for research to be conducted on alternative ways of achieving the same resistance as that of resistance training, and especially for people with diabetes who are physically challenged and thus cannot engage fully in physical activities. There are also areas of this topic that can be used for educational purposes to improve literacy on the subject and management of diabetes. Medical professionals should be well informed of the significant contribution that exercise plays in improving the health outcomes of patients with diabetes. The general public should also be informed, frequently, of the importance of engaging in daily exercises to prevent developing diabetes. This is an essential tool for public health and can be conveyed in schools and public gatherings. In practice, it is clear that medical professionals need to seriously consider integrating the aspect of physical activity in the management of diabetic patients. It is a regular practice to rely on medications heavily. However, this paper has established that physical activity contributes to the increase of sensitivity to insulin by body tissues. This is important as it helps to increase the amount of glucose that is utilized by body tissues and therefore leads to improved control of blood sugar levels.

This paper elaborates in detail the significance of health promotion and maintenance of desirable health by embracing healthy lifestyles so as to avert the occurrence of both childhood obesity and Type 2 diabetes. In the past, reported diabetes cases among children were that of immune mediated type 1a. However, with increasing cases of childhood obesity there has been a dramatic increase in Type 2diabeties among the children. Obesity is associated with resistances to insulin; Type 2 diabetes is developed when the condition is coupled with insulin deficiencies in the body. Children who develop this type of diabetes have higher chances of experiencing micro vascular as well as macro vascular complications of the ailment during young ages compared to individuals who become affected by the condition in adulthood (Wilmot & Idris, 2014).

Read also Diabetes Among Citizens In Los Angles – Community Health Assessment

These complications include atherosclerotic cardiovascular illnesses, myocardial infarction, stroke, renal inefficiency and failures, retinopathy that can lead to blindness, neuropathy and even sudden death in chronic cases. Since both cases, Type two diabetes and childhood obesity have raised a lot of concern in the recent past, healthcare professionals are advised to take more measures in reducing the impacts of the diseases. This can be done by researching on the root cause of both diseases and mitigating further incidences.

Importance of health promotion

Increasing rates of both childhood obesity and Type Diabetes among children have detrimental effects and substantial long term repercussions to the affected persons, the society and the public health system at large. It is therefore necessary that all health care providers reduce the effects at the early age, prevent and control further occurrences. Since Type 2 diabetes can be avoided by practicing good health measures, healthy habits and lifestyles have to be instilled in populations at high risk of developing the conditions (Segel, 2011). In the event that measures meant for stopping the rise of childhood obesity and Type 2 diabetes are ignored, more harm will be seen in both the children and the society. Early onset of Type 2 Diabetes automatically leads to early development of chronic complications like renal failures, neuropathy or even blindness due to retinopathy, which affects the physical wellness of the children. Tagging to that, the economic, psychological and social impacts of these conditions are too significant.

Read also Childhood Obesity – Review Of The Literature

Patient population

For the past thirty years, the number of children diagnosed with obesity has kept on increasing at a very high rate. It is documented that 22.6% of children between the age of 2 to 5, and 31% between the ages of 6 to 19 years have higher risks of being overweight in United States of America. The other fact is that the condition disproportionately affects children who descend from minority groups. The occurrence of obesity among non-Hispanic white children was 8.6%, 8.8% for non-Hispanic black children, and 13.1% for the case of Mexican American children. The children suffering from obesity have higher chances of becoming obese adults as well if the recommended health measures are not taken seriously. They are also likely to develop serious medical, psychological, and social problems all through their life span (Koukourikos et al, 2013). The growing prevalence of childhood obesity corresponds to the rise of Type of diabetes among the children. In the pediatric population, Type 2 diabetes accounts for a significant fraction of number of newly diagnosed diabetes. The figure rises to a high of 50% incidences in some clinics. Children at puberty stage have higher chances of developing Type diabetes even though they are not obese. This is because of the fact that puberty is closely related to the enhanced secretion of growth hormones by the body, a factor that promotes the body’s ability to develop insulin resistance. Therefore, when this factor is coupled with genetic and environmental factors, the individual has higher chances of developing Type 2 diabetes.

Proposed solution

Health care professionals and care givers including parents and guardians should assume the active role of identifying cases of obesity, reduced glucose tolerance and diabetes in children. This can be done through various ways. The first one is through identification of environmental and genetic risk factors like gestational diabetes, maternal obesity and lack of physical activities by the populations at risks at an early age. This will help in reducing the impacts caused by the risk factors and avert the development of chronic conditions. Counseling programs should also be provided in all learning institutions that promote the importance of weight loss through modifications of lifestyles (Hurtado-lopez & Marcias-Rosales, 2013). The other solution is screening of persons at risks of getting Type 2 Diabetes, this is because the disease is asymptomatic and signs might show up at later stages upon development of chronic complications. It is, therefore, essential to monitor the risk factors and use screening methods to identify the presence of the condition among the population at risk.

Read also Evidence Based Practice Project – Interventions for Type 1 Diabetes

The American Diabetes Association (ADA) endorses screening for diabetes among children who have a BMI of 85th percentile for age and gender, alongside two risk factors for Type 2 Diabetes. Screening is more important because it helps in early detection of the disease and early treatment and management provided to those affected (Ortega-Cortes, 2013). It is evident that diabetes related complications begin even before the onset of its signs and symptoms. Aggressive treatment on the other hand slows the occurrence of complications, therefore early identification and treatment of children with Type 2 Diabetes presents the promise of prevention of occurrences of serious complications.

Goals

One of the goals is to reduce the occurrences of childhood obesity among the populations. This will not only promote better and healthy lifestyles but also reduce the occurrences and spread of Type 2 diabetes. All government entities and communities should ensure that children are encouraged to choose healthy lifestyle choices. Teachers should take the roles of eliminating junk foodstuffs like candy and sodas in school cafeterias and mandate regular physical activities. Governments should ensure that policies are formulated that protect the right of children to access good healthy foods whether in their homes or school environment, should also ensure that all schools provide the recommended environments for children to play and exercise (Farsani et al, 2013). This goal will be measured using the BMI method, the BMI should be plotted annually on the BMI growth charts. This can be done by the providers of healthcare in all Centers for Disease Control and Prevention (CDCP), and determine if the level of childhood obesity is increasing or decreasing.

Read also Health People 2020 Diabetes Objective

The other goal is ensuring that Type 2 diabetes in children is prevented by all means. The disease can be prevented or delayed from occurring for many years. With thorough investigation, identification, treatment and management of the condition, it can be prevented from occurring at an early age. It is paramount to note that even small changes can make big differences in a person’s body, which can lead to prevention of the disease. This includes daily eating of healthy foods, having enough physical exercises, and being active on a daily basis. Parents and guardians should also be aware of Type 2 diabetes warning signs since the condition is asymptomatic. The warning signs include having blurred visions, abnormal fatigue, increased thirst, and frequent nighttime urination. Upon identification of the signs, the parents and guardians are supposed to take their children for Type 2 diabetes screening (Karnik & Kanekar, 2015). So as to ensure that this goal is achieved, all relevant institutions, including government and learning institutions are expected to come up with effective policies that promote healthy living conditions and lifestyles. These policies have to be followed to the latter end, and form of punishments enforced to those who violate the provided laws. Health audits can be conducted in the relevant institutions so as to ascertain that the measures are adhered to, and any corrective measures undertaken in case of incompliances.

Barriers

The first barrier to effective prevention of childhood diabetes and Type 2 diabetes is financial challenges. All the programs that lead to interventions of the diseases based both in schools and community levels need subsequent monitoring of improvement and sustainability for longer periods of time. Therefore with insufficient funds, the program facilitators may end up using ineffective methods or discontinue the programs, which will end up negating the whole process. School based intervention programs need more funds since it involves training of teachers, provision of enough facilities and promotion of policies that encourage healthy lifestyles. It is also the most essential and preferred intervention mechanism since children longer in schools than they stay in their homes or community (Segel, 2011).

Read also Fast Foods and Obesity Research Paper

Communities on the other hand will find it difficult to provide safe neighborhood for the children to play and exercise with insufficient funds. In order to avert this barrier, all the relevant institutions should practice transparency when explaining the impacts of the disease in society. This will help in raising funds especially form the private sector and other non-governmental organizations to help in mitigating the impacts. The federal and state governments on the other hand should allocate funds that can help in preventing occurrences in populations at high risks of getting both conditions.

Read also Community Health Assessment – Diabetes Associated Deaths – Wayne County

The other barrier is that stigmatizing obese children has become a common occurrence. Obese children are often face discrimination because of their body appearance, this reduces their chances of coming out for healthy programs and any other essential assistances.  This mostly happens in learning institutions and community settings, where interventions are mostly conducted. This act of stigmatization, especially by their peers, is seen as mental barrier and leads to undesirable body image and the avoidance of certain foods. This makes the condition worse because it can lead to other detrimental effects like malnutrition (Ortega-Cortes, 2013). This can be eliminated by implementing policies that support healthy living while at the same time discouraging any forms of discriminations of all persons. These policies should be supported by all levels of government, starting from national, regional to local.

Benefits

The reduction of childhood obesity and Type 2 diabetes has more benefits to the patient population, the key ones being that it reduces the psychological and social health issues that can affect the well-being of the children throughout their lifespan. Obese children have negative body image which ends up lowering their self-esteem in the long run. This may also affect their academic and social lives which are more essential in a child’s growth (Koukourikos et al, 2013). With early detection and treatment, the children are able to live normal lives and achieve their desired potentials in future. With regard to the nursing profession; health promotion activities reduce the chances of disease occurrences hence increasing the rate of healthy populations. This promotes the roles of nurses in the society, which is creating and maintaining healthy environments. Reduced disease occurrence and spread will consequently lead to reduced roles and responsibilities on the part of health care providers and care givers.

Participants and Interdisciplinary Approach

For successful implementation of this plan, many stakeholders have to be involved. This is because the determinants of childhood obesity are varied and no single intervention is likely to eliminate it. With respect to that, varied stakeholders have to be incorporated in the plan as well. Sustained interventions have to be undertaken at different levels, individual levels especially in schools and communities with the aim of effecting changes in behaviors. The other important sectors are the agricultural departments, food manufacturing companies, learning institutions, transportation and urban planning departments (Segel, 2011). The other important people are the public health officers who can assist in diseases surveillances and epidemiology. Medical officers are needed to provide treatment and management of the diseases among the populations already affected by the chronic complications of both childhood obesity and Type 2 Diabetes.

Read also Morbid Obesity Research Paper

The education sector will assist in incorporating healthy living programs in schools calendars.  Urban planning departments will take the important role of ensuring that children have the right environments for playing and physical exercise activities (Karnik & Kanekar, 2015). Agricultural and food manufacturing companies will ensure healthy and nutritious foods are marketed and sold to the public. Parents and guardians have to take the role of instilling good healthy practices among the children while in home, while teachers are mandated to provide the same roles while the children are in schools. The federal and state governments are mandated to protect the rights of children to access good health services and live healthy lives.

Conclusion

Obesity among children has become a public health concern not only in the United States of America but the entire world. This is because it has led to the development of conditions that were prevalent in adults to the children population. This includes the sudden increase of Type 2 Diabetes among the children, which is strongly associated with childhood obesity. It is important to note that continuous increase in childhood obesity will lead to corresponding increase in Type 2 Diabetes (Segel, 2011). This will have negative impacts not only to the affected individuals but also the entire society. It will negatively impact the economy of the affected states and nations because more time and available resources will be used in solving challenges that are caused by the diseases. Therefore sustainable interventions have to effected by all the stakeholders so as to ensure that all children live healthy and have brighter future.

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Introduction

The paper focuses on assessing diabetes among citizens living in Los Angles. Diabetes mellitus is protracted condition typified by high blood sugar level. There has been outrageous growth on cases of diabetes in world and is currently regarded as an international pandemic. About 17.9 million of people in the US had this disease based on 2007 statistics and about 5.7 million more individuals had the disease though undiagnosed. Los Angeles County documented diabetes as the 6^th primary causes of death from 1997. It also identified as an essential reason for premature death in the county from 1999. The disease attributed to 25 deaths in every 100000 individuals in 2006 and was documented as the 9^th primary attribute of premature death (Public Health, 2010). This paper designs community health assessment of Los Angeles people focusing more on diabetes.

Read also Community Health Assessment: Depressive Disorders in Los Angeles County

Diabetes in Los Angeles – The Public problem: Diabetes

Diabetes is a disease that is caused by abnormal blood sugar level. There are two types of diabetes which include type I or diabetes insipidus and type II diabetes or diabetes mellitus. Diabetes type I is normally caused by inability to effectively produce, release or store a primary hormone or when kidneys are not able to properly respond to the said hormone. It is a rare form of diabetes and it is mostly genetic. Diabetes type II happens when the body fails to utilize insulin or make insulin according. Diabetes type two is very common and can easily be found among elderly in the society. This happens to be the main cause of diabetes in Los Angeles County and in the entire American region.

Read also Role of Physical Activity in Management of Diabetes – Initial Steps for an Evidence-Based Project

Who are Affected?

Diabetes is a common problem among adults aged from 50 years onwards. Although it can affect all in the society based on different risk factors, it is highly recorded among the gaining population. The rate of diabetes has been increasing gradually for all ages from 1997 to 2011 with individuals aged from 18 to 29 increasing from 0.8% in 1997 to 1.7% in 2011. Individuals aged from 30 to 39 increased from 2.8% in 1997 to 3.7in 2011. Individuals aged from 40 to 49 increased from 5.1% in 1997 to 7.9% in 2011, individuals aged from 50-64 increased from 11.6% to 14.9% and for individuals aged from 65 and above increased from 14.3% to 24.1%. Based on this data, it is also evident that the rate of diabetes increases with increase in age and thus, it is highly found among the elderly population (Public Health, 2012).

Read also Community Health Assessment – Diabetes Associated Deaths – Wayne County

Diabetes is also found to affect men at a higher rate that women though the difference is very minimal. In 2007, the percentage of female with diabetes was 8.8% while that of male was 9.4% and in 2011 the percentage of male with diabetes was 10.8% while that of female was only 9.1%. This is a clear indication that more men were affected by this disease in the county than women. Cases of diabetes in the country are more common among minority communities that include African American, Latino and Asians as compared to whites. However, Latinos are recording the highest number of affected people at 13.5%, followed by African American at 12.4%, the Asians and 9.9%, and then whites at 6.7% based on 2011 statistics. The most affected regions include East at 16.2%, Antelope Valley at 11.9%, and South at 11.7%, with the least affected region being west at 5.2%. Other regions include South Bay at 9.8%, Metro at 8.5, San Gabriel at 7.5%, and finally, San Fernando at 9.6%. Diabetes is also common among pregnant women though the condition may not be permanent. In this cases, cases of younger mother aged from 25 years and above may be common. However, the rate of the affected individuals also increases with age and thus, more cases are reported to older pregnant mothers than younger ones (Public Health, 2012).

Read also Healthy People 2020 Diabetes Objective

Main Risk Factor

Diabetes type two has been related with age since more elderly people are diagnosed with the disease as compared to younger ones as statistically demonstrated above. Another major aspect contributing to the spread is obesity. Increase in the level of obesity contribute equally to increase in diabetes type II among adults aged from 18 years and above.

Public Intervention

Information related to the affected individuals in the population and the risk factors can be used to create intervention to the individuals in the community. Based on the above analysis, the government should consider enhancing early diabetes diagnoses from the age of 40. In this case, free regular diabetes diagnoses should be encourage after one reaches 40 years, and yearly testing done to ensure that this population is free from the disease and those that are affected are treated. Shorter testing intervals should be encouraged among individuals from minority communities especially Latinos and African American (Satterfield et al., 2003). Prenatal testing of diabetes should also be encouraged. Another intervention measure is treatment and management of obesity. People should be taught more about physical fitness and its advantage and be encouraged to take part in physical fitness and good feeding behaviors. This is anticipated to handle obesity and diabetes at large (Tuomilehto et al., 2011).

Read also Evidence Based Practice Project – Interventions for Type 1 Diabetes

Public Policy

Information regarding the age, gender, region and ethnic group of the most affected individual would assist in making public policies. Information on risk factor would also assist in developing policies that will enhance a high rate of diabetes prevention. Public policy should focus on early and regular testing, embracing of physical fitness, change of lifestyle at older age to eliminate drugs and other unhealthy products, definition of the best diet at old age, medical insurance policy among other policies that would better the situation.

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Diabetes centers are the primary focus for this research because of diabetes; caused by hormonal issues and also by lifestyle choices, continues to be life threatening due to severe complications associated with it (North Raleigh Clinic, 2017). The presence of a digital platform that specializes in the diagnosis, prevention, and management of diabetes is vital in early detection and also the management of diabetes before serious complications arise. Two Diabetes centers are the central focus; North Raleigh Endocrinology and Diabetes Center and Diabetes Center University of California, San Francisco (UCSF).

North Raleigh Center targets not only diabetics but also other hormone related conditions like thyroid disorders, pituitary and adrenal, calcium and bone and sex-hormone related conditions. The facility has two physical locations and a website (North Raleigh Clinic, 2017). A fax and phone numbers are available on the website, and no other social media platform links have been displayed (North Raleigh Clinic, 2017).

The entire website has only three pictures that are not diabetes related. The mission and history of the organization are not listed on the website (North Raleigh Clinic, 2017). A link on the website provides downloadable patient forms such as registration forms, physician referral forms, and billing information; credit cards they accept and other payment means acceptable. There is the provision of external links that give more information about research, support groups and easy to read topics among other information about the mentioned conditions manageable by North Raleigh Center (North Raleigh Clinic, 2017). Maps for the two physical locations are present alongside the written physical addresses.

Strengths	Weaknesses
v  Billing information present. v  Maps and physical location provided. v  Downloadable patient forms giving patient history to the doctor prior to consultation.	v  Poor pictorial choices on the website. v  No social media platform available to access information about the clinic. v  Lacks history, mission and general clinic information.
Opportunities	Threats
v  More pictorial description of diseases treatable v  Links to social media v  Indication of their victories in management of diabetes	v  Information release authorization that is downloadable, patient signature can be faked enabling a third party to acquire confidential information

Table 1

Diabetes Center UCSF has a sophisticated website. The home page displays a pictorial slide show of doctors appearing to consult each other and other photos of doctors who seem to be to be having conversations with patients; a grown-up and a child, the doctors with smiles on their faces. The first impression from opening this website is that; the facility has professional and friendly doctors (UCSF Medical Center, 2017). A link ‘About Us’ has pictures of the team on what looks like a team building adventure with other sub-links such as history and mission; a vision for a cure drives their leadership in Diabetes. A listed evidence of their successes from 1960’s is listed; from developing a way to measure insulin levels among other great achievements in the 1960’s to create the pioneering functioning human thymus tissue obtained from the embryonic stem cells in the 2010’s (UCSF Medical Center, 2017). A black and white photo that appears to be of scientists from mid 19 century is present.

A link focusing on their research is present; type 1 and type 2 diabetes, obesity and clinical trials. A photo is present showing a scientist handling samples (UCSF Medical Center, 2017). Links about patient care and patient education are available giving information concerning pediatric patients, adults and diabetes clinics. It also has a link for donations and news link that enables one connect with them to receive e-news updates and also online newsletters through the email. A search place is available that uses key words to find answers to different questions by those accessing the website (UCSF Medical Center, 2017). A video gallery, a link that connects directly to Twitter and a ‘game’ to make gifts in the form of online donation is present.

Strengths	Weaknesses
v  Relevant and well-situated pictures v  Sufficient information about clinic activities; newsletters v  Gives impression that they believe in teamwork v  Patient education that involves both pediatrics and adults. v  Social media link available; twitter v  Documentation about their research achievements over the years.	v  Mention of donations to the clinic; can be a turn- off v  Focuses on diabetes only leaving out other hormone related conditions.
Opportunities	Threats
v  Provide online platform for appointment booking v  Provide mobile apps that provide answers to inquiries and appointment booking	v  Too many features on the website that can be confusing.

The rationale of equipping healthcare organizations with digital platform ranges from the benefits of early booking, inquiries that can be answered over the phones (UCSF Medical Center, 2017). It enables elimination of the hustle that comes from traveling all the way to the clinic and patient education on what symptoms to watch out for, how dieting can be vital in living a healthy lifestyle to bolster saving of lives (North Raleigh Clinic, 2017).

The digital platform brings the patient closer to the doctor. Availability of articles on diabetes that are mentored by actual doctors hence giving out accurate information is key to prevention, management, and diagnosis of diabetes (UCSF Medical Center, 2017).

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This paper discusses a research conducted by various scientists with the purpose of stemming cell cure for type 1 diabetes that often affects children. Type 1 diabetes is regarded as an autoimmune metabolic condition that results in the body killing all insulin producing pancreatic ß-cells needed to regulate the glucose level in human body. According to the researchers, significant steps have been made in reversing an equivalent type 1 diabetes in mice by using transplants from the stem cells. This research implies that scientists are moving closer in finding the best cure for diabetes in children that often leads to an unending injections. The California researchers have recently reported that the above experiments were capable of replacing the damaged pancreatic cells by the disease, and are incapable of making insulin (Boseley, 2014).

The researchers also noted that lack of insulin in children reduces the body’s power to absorb sugars including the glucose from the bloodstream. The killer disease was first observed in children or young adults. However, recent research indicates that insulin injections can be used in regulating and monitoring blood sugar levels. This stem cell experiment research was also meant in finding out whether it could be possible to replace the damaged insulin producing ß-cells. However, this has always proved difficult because there is a partial regeneration of the mature ß-cells (Harvard Stem Cell Institute, 2014).

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This research also incorporated the Gladstone Institute researchers who placed much effort in collecting fibroblasts/skin cells from various laboratories mice. They then used a unique molecule ‘‘cocktail’’ in addition to reprogramming factors in transforming the cells to look like the endoderm cells. Endoderm cells are a true representation of the early embryonic cells that matures to the major organs of the body such as the pancreas. The researchers also used a different chemical cocktail in transforming the endoderm-like cells into cells that closely resembled the early pancreatic cells known as PPLCs. The primary objective of this experiment was to determine whether the PPLCs could be coaxed into mature cells, which could have a similar functionality to ß-cells capable of responding to the right chemical signals, and significantly-secretion of insulin. Furthermore, the researchers’ first experiment on the petri-dish proved that they indeed responded to the correct chemical signals (Boseley, 2014).

Read also Type 2 Diabetes and Childhood Obesity

The stem cells were then injected by the researchers inside mice, which were modified genetically. As a result, the amount of glucose level in animals began decreasing gradually to a point of reaching normal levels. There was an instant glucose spike when the transplanted cells were removed, implying that the hyperglycemia and the PPLCs transplantation were having a direct linkage. After the first eight weeks of transplantation, these researchers discovered that the pancreas-like cells were transformed into real thing (Boseley, 2014). It now had a full functioning ß-cells capable of secreting insulin, which developed inside the mice.

The researchers also noted that this study was among the important advances in history and was a great achievement. This is because several decades have passed without generating the human pancreatic ß-cells regardless of the much effort and time used. However, these researchers overcame this hurdle by opening the door for discovering more drugs that can be helpful in treating type 1 diabetes as well as diabetic transplantation therapy. Through this research, scientists are hopeful that they will also develop an implantation device for protecting the cells. Therefore, the ultimate pre-clinical step in developing a type 1 diabetic treatment involves the protection of immune system attack that could possibly destroy the 150 million cells, which must again be transplanted to every patient being treated (Harvard Stem Cell Institute, 2014).

Scientists also noted that using the process of cell transplantation to treat type 1 diabetes was an essential experiment because it also used cadavers cells, and needed the use of a more powerful immunosuppressive drugs that have been available to a limited number of patients. However, with experiment research, scientists are now assuring patients that the same treatment will now be available to most patients, especially if the project is successfully completed. In addition, this advancement gives hope to type 1 diabetic children since it could lead to an essential unlimited tissue supply for these patients especially those awaiting to undergo cell therapy (Harvard Stem Cell Institute, 2014).

The researchers noted that this scientific principled proof was a major success since it could one day be used in treating type 1 diabetes that often affect children. This research also marked the prospect of translating these new findings to the human system. This modern technology concerning human cells is capable of enhancing understanding on how diabetes is caused by the ß-cells inherent defects, thus bringing a much closer need for curing diabetes in children. In addition, these scientists also postulate that human embryonic stem cells has assisted for the first time in producing massive quantities of insulin that is needed for the pharmaceutical purposes as well as transplantation purposes (Boseley, 2014).

Introduction

The selected healthy people 2020 objective is to reduce diabetes mellitus as well as the economic burden related with it. This is aimed at improving the life quality of individuals who are at the risk of or suffering from diabetes mellitus. Diabetes mellitus is a medical condition that develops when the body fails to produce enough or to react suitably to insulin. Insulin in this case is a hormone used to regulate the level of glucose in the body. Without insulin motioning system proper functionality, the level of blood glucose increases. This results to other body metabolic abnormalities an aspect that contributes to severe disabling difficulties (Healthy People, 2014). This paper focuses on identifying behavioral, environmental, and biological risks contribute to diabetes health risks of a family.

Read also Identified Disparities to Health Within the Healthy People 2020 – Questions and Sample Answers

Diabetes Risk Factor

The development of diabetes type II is highly determined by the individuals’ behaviors, environment and biological aspects. Diabetes mellitus is highly associated with obesity which is contributed by individual eating habits and the lifestyle.  Individuals who are fond of eating carbohydrates and junk food are at high risk of developing diabetes type II irrespective of their age. Thus, even obese children have a high risk of developing diabetes. In addition, physical exercises are very important in burning extra fats in the body. Therefore, families who develop the habit of participating in physical exercises reduces their risk of developing diabetes type II, while those that do not take part in physical exercise regularly increases their risk of developing this condition ( Pletcher et al., 2002).

Read also Cancer Prevention – Healthy People 2020 Objectives

There are genetic factors that contribute to the development of the diabetes mellitus. Moreover, race is also regarded as the risk factor for diabetes mellitus. In addition, individuals with close family members suffering from diabetes are at a higher risk of developing the same. This indicates there is a biological factor influencing the development of diabetes type II. The main environmental risk factors for diabetes type II include a sedentary lifestyle and obesity. In this regard, increase in the rate of diabetes has highly contributed to the increase in the cases of diabetes mellitus. The intrauterine environment is an essential type II diabetes risk factor. Studies have demonstrated that low birth weight which is a sign of fetal malnutrition is related with type 2 diabetes in later life (Pletcher et al., 2002).

Read also Role of Physical Activity in Management of Diabetes – Initial Steps for an Evidence-Based Project

Phoenix Arizona Public Health

Phoenix Arizona is facing a number of public health challenges. Some of the major, public health problems in Phoenix Arizona include cancer, diabetes, heart disease and stroke among others. These, health issues have cause a number of problems in the society one of them being economic challenges. Some of these health issues such as cancer, diabetes and heart disease may survive for a lifetime. In addition, they are quite expensive to manage since they may also require a change of lifestyle among other expenses (Arizona Department of Health Services, 2013).

Read also Type 2 Diabetes and Childhood Obesity

For instance, diabetes requires a change of diet and employing more effort in physical exercise among other things. It also requires regular medical check-ups and purchase of medicine to ensure that the patient is stable. This highly cost the family members a great deal of their earning. This changes their lifestyle negatively due to expenses involved in the management of the disease. This also increases the level of stress in a family as people struggle to fit an endless medical condition. Some of conditions particularly stroke may increase patient’s level of dependency and thus denying the families an opportunity to learn their businesses as normal. This increases the level of stress and poverty in the family.

Community Health

Introduction

Community health assessment helps a country’s Public Health Department to understand the health needs of a local population and to come up with ways on how to improve them. Through community health assessment, a country can distinguish the needs of the community from those of individuals, which is crucial in better planning and health care provision (Wright, Williams and Wilkinson, 1998).

Community

The community that will be used for analysis in this paper is Wayne County, New York. Wayne County is one of the counties in New York that has recorded high rates of adult deaths in the recent past. The Public Health Department of Wayne County is charged with the responsibility of identifying the health priorities in the community.

Demographic and epidemiological data

Wayne County, New York is located on the Southern Shore of Lake Ontario. According to United States 2015 census, Wayne County has a population of 92,685. The county has been experiencing rising number of deaths resulting from chronic diseases. In the year 2015, 28.5 percent of adults died as a result of diabetes in Wayne County (Centers for Disease Control and Prevention, 2015).

Windshield survey

From the demographic and epidemiological data provided above, it is clear that many deaths in Wayne County are caused by diabetes and diabetes-associated problems. The main factor contributing to this problem is poor access to health care services. Due to lack of proper guidance, many people suffering from diabetes have difficulties managing the problem.

Problem

The priority health concern for Wayne County in New York is poor access to health care. This is a priority concern because it is the main contributing factor to high death rates that are observed in Wayne County. One of the actions that the Public Health Department of Wayne County should take to reduce the number of diabetes-associated deaths is increasing access to health care as one of the Healthy People 2020 objectives.

Summary

High percentage of deaths in Wayne County, New York occurs from diabetes. Both female and male adults are at risk with the main contributing factor being lack of access to medical care. The best way to address this is to increase access to medical care in order to fulfill one of the most crucial Healthy 2020 objectives.