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Risk of Undiagnosed Pre-Diabetes in AdolescentsAmy Badger, Kelly Geraghy, Kristen Litinjer, Sara Potes, Anita Riddle, Lisa SageFerris State UniversityAbstractDiabetes is fast approaching the number one disease in America. Due to excess weight, poor diet, and lack of physical activity people are becoming pre-diabetic and not even knowing it. Our group project centers on the need for screening adolescents in Kent County for pre-diabetes, then we as a community can help them with manage their modifiable risk factors and decrease the prevalence of adult Type 2 diabetes. Education is the number one tool to assist in modifying these risk factors. Since uncontrolled diabetes can lead to neuropathy, retinopathy, poor circulation, and other conditions it is extremely important to try and prevent the disease. By providing education in the school systems and changing the menus for lunch, we can help to decrease the number amount of individuals who have pre-diabetes. Additionally we as a community can provide further education for parents so that they can assist with increasing physical activity and changing the way the teens eat.Risk of Undiagnosed Pre-Diabetes in AdolescentsEach year new data is released discussing the current health problems within different communities. These health problems can range from the number of teen pregnancies to individuals with heart disease. In Kent County there are many health problems that are on the rise. Our group has chosen to focus on the risk of undiagnosed pre-diabetes in the adolescent population and how this increases their chances of developing Type 2 diabetes.AnalysisLocal DataWhen evaluating different health problems in a community, it is important to look at the local data from the community and compare it the current benchmarks. Unfortunately the state of Michigan does no surveillance of diabetes in children so it is nearly impossible to compare and contrast current benchmarks. It is also difficult to pin point any contributing factors when a difference in benchmarks cannot be seen from the data sets. Below is a national table on the detection of diabetes in children (Table 1). This study shows the need for interventions to begin in the five to nine year age group as this is when diabetes begins to steadily increase. The table also shows that there is not much of a difference between gender and ethnicity. Table 1. Demographic Characteristics of the Study Population in 2001 and Prevalence of Total Diabetes MellitusAge Group0-4 0.31 (0.27-0.35)5-91.25 (1.18-1.32)10-142.29 (2.20-2.39)15-193.35 (3.23-3.47)GenderMale1.77 (1.71-1.83)Female1.88 (1.82-1.95)Race/EthnicityWhite, Non-Hispanic 2.16 (2.10-2.23)Black, Non-Hispanic1.93 (1.79-2.08)Hispanic1.29 (1.21-1.38)Asian/Pacific Islander0.83 (0.74-0.94)American Indian1.29 (1.12-1.50)(Cases per 1,000 youth)The Burden of Diabetes Among U.S. YouthCurrently the rate of pre-diabetes is increasing among all age groups. The age most affected are the twelve to seventeen (16.2%), eighteen to forty-four (28.9%), and forty-five and over (36.6%). Educating adolescents and adults about the risks of developing pre-diabetes is more important than ever. With simple lifestyle changes in early Adolescents, the risk of adolescents developing Type 2 diabetes as adults could decrease by 58% (Michigan Department of Community Health, 2010).Model to Explain DifferencesDiabetes is currently the seventh leading cause of death in the United States and in the state of Michigan it is ranked sixth (Michigan Diabetes Action Plan, 2011). With the number of adults being diagnosed with diabetes, it has become important to screen adolescents for possible signs of pre-diabetes. By screening, we may be able to modify some lifestyle factors and change the current progression of diabetes. In June, July, and November of 2010 a planning process was conducted to create models/theories on the ever growing disease process of diabetes. According to the Michigan Diabetes Action Plan two models helped to guide the planning process: chronic Care Model and the Social Ecological Model (Michigan Diabetes Action Plan, 2011). The concept from these meetings that seemed to have the most impact on our group was the Evidence-Based Programs. These programs help to expand and promote successful self-management programs, prevention programs, and support innovation to improve the programs efficacy with more culturally diverse populations (Michigan Diabetes Action Plan, 2011).Many small and short-term studies have demonstrated an association between lifestyle modifications. Some of these modifications include increased physical activity, reduced sugar intake, and an increase in fiber intake (Shub, 2011). To promote long term success in lifestyle change it is important to perform screenings and follow-up education on nutrition, exercise, and weight control. For adolescents, non-invasive screenings in schools such as blood pressure and weight is an effective way to detect risk factors for early onset of Type 2 diabetes.Groups AffectedPre-diabetes and diabetes can affect anyone. It affects people of all ages, races, and cultures. It can be developing in people without then knowing it. The way our bodies are treated and what we teach our children is going to have a direct effect on our health in the future. The focus group for our community assessment is adolescents that are at an increased risk for pre-diabetes leading to Type 2 diabetes as adults. The increase of pediatric obesity has increased the incidence of Type 2 diabetes in children worldwide (Cruz, et al., 2005). Adolescents diagnosed with Type 2 diabetes usually are obese, have a family history of diabetes, or have reached puberty. Type 2 diabetes is more noteworthy in minority populations which also have the highest rates of obesity. Reports have shown that there is a high incidence of pre-diabetes in overweight children. In a clinical trial 21% of obese children ages eleven to eighteen were shown to have an impaired glucose tolerance when tested, 4% of those were positive for Type 2 diabetes (Cruz, et al., 2005).About 186,000 adolescents are affected by Type 1 and 2 diabetes. Approximately 15,000 new cases of Type 1 diabetes are diagnosed in adolescents annually. Type 2 diabetes is common in minority adolescents (Galivan, et al., 2009). It is estimated that 16-17% of all adolescents have a body mass index (BMI) greater than 95% of their age and sex specific BMI (Galivan, et al., 2009). Existing ResourcesWith pre-diabetes on the rise it is even more important to identify effective interventions to help slow this progression. Disease prevention must be culturally sensitive including modifiable risk factors including obesity, physical activity, and dietary factors (Bazzano, et al., 2005). Obesity counts for 60-90% of the risk which makes it the strongest risk factors for the development of diabetes (Bazzano, et al., 2005). Interventions need to include weight loss and increasing physical activity. The American Diabetes Association has programs listed on their web site that can help get people involved in weight loss. There are many support groups available in the Grand Rapids area for people with diabetes and pre-diabetes. Books are also available to offer support and education about ways to reduce the risk of pre-diabetes and Type 2 diabetes. Many of these publications that are available offer the same advice including increased physical activity for a minimum of thirty minutes per day and a diet low in fat with a reduced calorie intake (National Diabetes Education Program, 2008).Diabetes is still on the rise despite all the educational materials available. This can be in turn because people are not willing or are unable to spend money on the resources or take the time to find them. There are many resources out there that I found although it did take a lot of time. Most of the resources were books that needed to be purchased unfortunately. The American Diabetes Association has a very helpful website but again it takes time to look through all the material.If people are not willing to make a change in their lifestyle to help prevent diabetes then all the information available is not going to do them any good. Individuals need to be willing to make a change in order to decrease the likelihood of developing diabetes. Adolescents need the help of their families to make changes. Parents need to be willing to buy different food, items that are not processed, to help promote a healthy lifestyle. Parents also need to be willing to help find educational materials for their kids and be an encouragement to them. Pre-diabetes can serious, and may lead to even more serious problems. It is important to encourage all children and adolescents to exercise and eat a healthy diet to help prevent pre-diabetes.Evidence of a ProblemCommunity nursing focuses on the needs of a population. Community/Public health nursing is the care provided by educated nurses in a particular place and time and directed towards promoting, restoring, and preserving the health of a total population or community (Maurer & Smith, 2009). The problem of undiagnosed pre-diabetes in Kent County is focusing on the adolescent population. Kent County is home to 26 school districts, with 22.3% of its total population between the ages of five and nineteen (MDCH, 2009). There are factors within our control to decrease risk factors and help prevent diabetes. Some of these factors include weight loss, physical activity, and good nutrition. Most people with pre-diabetes will develop Type 2 diabetes within the next ten years unless they make changes in their current lifestyles (MDCH, 2009). Among the adolescent population, boys are more likely than girls to have pre-diabetes, which follows suit, as more adult men are more likely than women to have pre-diabetes (MDCH, 2009).With the above risks and population identified, the problem will focus on early diagnosis of pre-diabetes in the adolescent population of Kent County. Since we have identified a need within a population, we can address the health status of a community as a whole with interventions that will benefit all of its members (Muecke, 1984). For example, although the focus is on the adolescent populations, adults will also reap the benefits through early detection, improved diabetic education, and access to services. It will take a multi-disciplinary team and close management to adequately address this current health problem. The risk factors identified for our community assessment are obesity, lack of physical activity, and poor nutrition. With this in mind the disciplines working together on this assessment need to include a diabetic educator, dietician, school nurses, teachers, nurse practitioners, and physicians. It will also be vital to include parents and the community as a whole in the assessment. By working as a team, people with diabetes, their health care providers, and their support system can lessen and perhaps even avoid diabetes complication by making positive lifestyle changes and following preventive care practices in a timely manner (The Impact, 2011).Community GroupsThe escalating prevalence of Type 2 diabetes has serious consequences for the quality of life of those affected and their families as well as the communities (Satterfield, et al., 2003). Therefore it is of great importance to get the communities and families involved with high risk children prior to developing diabetes. African Americans are disproportionately burdened by diabetes, so education at the elementary and junior high school levels are imperative in order to decrease their risk. Grand Rapids has a high percentage of African Americans in the public schools. There are several community based groups that would be a good resource in addressing the issue of education regarding diabetes in adolescents.Many communities are breaking ground by implementing culturally relevant prevention programs in settings where many socioeconomic and environmental challenges exist. Federal agencies, volunteer organizations, and others aid to reduce the burden of diabetes by translating research findings into practice at multiple levels (Satterfield, et. Al., 2003). A couple of the most important federal resources are the Department of Public Health and the Centers for Disease control and Prevention. Local public health nurses along with a pediatric endocrinologist could help to develop for adolescents and pass it on to teachers within the community. Extensive discussions with the community members on diabetes and roles of diet and exercise in treatment and prevention would be compiled for further education. Work groups of community members and representatives of local organizations could aid in the teaching the materials presented. It would also be helpful to include any and all volunteers from the school and the neighborhoods to help with the education. Creating a community advisory board would also help to incorporate cultural practices into the diet and exercise programs necessary for decreasing pre-diabetes in adolescents.Other community resources that are available are the YMCA and grocery stores. The YMCA has various exercise programs available, and may be able to offer them to members of the community at a discounted rate. Grocery stores could aid by allowing a dietician to come in with groups from the community and showing them proper items to purchase when shopping. This would help families in making healthy meal choices.Problem StatementWhen performing a community assessment it is important to analyze the community as a whole. Our group researched data from the Kent County Health Department as well as the Michigan Department of Community Health websites. After obtaining data related to pre-diabetes and adolescents, we as a group were able to create a problem statement. This statement provides a nursing diagnosis with data that is related to the cause of the diagnosis and research to support the statement. Here is the problem statement that was created by our group:The risk of undiagnosed pre-diabetes in the adolescent population directly influences the prevalence of Type 2 diabetes in their adult life as related to an increase in obesity, lack of physical activity, and poor nutritional intake as evidenced by the Kent County Health Department Behavioral Risk Factor Survey and the Michigan Department of Community Health’s Diabetes Surveillance Tables. By developing this problem statement our group was able to look further into various ways to change this current statistic and create healthier adolescents who will grow and become healthy adults. ReferencesBazzano, L., Serdula, M., Liu, S. (2005). Prevention of type 2 diabetes by diet and lifestyle modifications. Journal of the American College of Nutrition, 24(5), 310-319. Cruz, M.L., Shaibi, G.Q., Weigensberg, M.J., Spruijt-Metz, D., Ball, G.D.C., & Goran, M.I. (2005). Pediatric obesity and insulin resistance: Chronic disease risk and implications for treatment and prevention beyond body weight modification. Annual Review of Nutrition, 25, 435-468.Gallivan, J.M., Kaufman, F.R., & Warren-Boulton, E. (2009). Overview of diabetes in children and teens. American Journal of Health, 40(5), 250-263. Retrieved from URL: cgi-bin/refsvc?jid=1908&accno=2010433597.Liese, A.D., D’Agostino, R.B., Hamman, R.F., Lawrence, J.M., Kilgo, P.D., Liu, L.L., … Williams, D.E. (2006). The burden of diabetes among U.S. youth: Prevalence estimates from the search for diabetes in youth study [Abstract]. Pediatrics, 118, 1510-1518.Maurer, F. & Smith, C. (2009) community/public health nursing practice: Health for families and populations. St. Louis, MO: Saunders/Elsevier.MDCH-Diabetes Prevalence in Children. (n.d.) SOM – State of Michigan. Retrieved October 13, 2011, from Department of Community Health (MDCH). (2009). Pre-diabetes in Michigan. Retrieved from Diabetes Action Plan. (2011-2014). The impact of diabetes in Michigan. Retrieved from , M. (1984). Community health diagnosis in nursing. Public Health Nursing, 1(1), p. 23-35.National Diabetes Education Program. (2008). Diabetes is preventable. Retrieved October 5, 2011 from , D.W., Volansky, M., Caspersen, C.J., Engelgau, M.M, Bowman, B.A., Gregg, E.W., … Vinicor, F. (2003). Communtiy-based lifestyle interventions to prevent type 2 diabetes. Diabets Care, 26(9), 2643-2652. Doi:10.2337/diacare.26.9.2643Schub, T., &Caple, C. (2011). Diabetes mellitus, type 2: Prevention in children and adolescents. Retrieved from Impact of diabetes in Michigan. (2011). Retrieved from Analysis of Data and Problem StatementSectionThis is a group scholarly paper. Possible PointsPoints EarnedAnalysisHow does the local data compare/contrast to benchmarks? What factors contribute to the identified difference? What concept, model or theory might explain the difference? What groups are particularly affected by this problem? What existing resources are available to address this problem? Are they adequate? If so, why is there still a problem? What evidence indicates that this problem is appropriate for community nursing intervention? What other disciplines would be involved in addressing this problem? What community groups could be resources in addressing the issue? Key data clearly summarized. Data is there but not always sourced nor is relevance of data always clear.All resources correctly sourcedAppropriate model/theory used You mention a model but no indication of how used.What are strengths of community indicating likelihood of successfully addressing problem? No sense of what community brings What existing agencies are likely partners? very general statementsWhat possible barriers are there? Not addressedDoes the analysis focus on a population? Very general focus—no specific group could actually identify.6050Problem StatementProblem statement: Refer to the Meuke article on a model for community nursing diagnoses for the format of the problem statement. Who is at risk of what related to what changeable factors as evidenced by what measurable indicators? Remember you may need to look at indirect indicators. All data is clearly and correctly cited.Population is clearly defined (who) No closest is adolescents in GR or Kent County What specific population based health risk has been identified? (risk of what) YesWhat are the possible causative factors that can be measured and changed to decrease the incidence of the indentified problem? (the related to factors) partialWhat indicators should change if the intervention is successfully carried out? (Think of both direct and indirect measures). Not clearly spelled out4030WritingUp to 30% of grade may be deducted for writing and format errors. Casual writing style, multiple areas are unsourced, at least one key reference not on reference page. -30-5Grade10075As you keep going for part 2, be sure to address the lacks identified in the summary of your data—pick a specific group to target the intervention. Make the intervention population focused—not individually focused. Identify a key agency that could be the lead group in tackling this. ................
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