The World Health Organization has estimated that by 2030, approximately 350 million people will be diagnosed with Type 2 diabetes mellitus (T2DM). Currently, 18.8 million people are diagnosed with T2DM. An additional 7 million people have high blood sugar but have yet to have an official diagnosis of diabetes. The literature supports early identification and prevention are key to reducing the severity of T2DM its complications. The Health Belief Model, the Chronic Care Model and Orem's Theory of Self-Care guided the current proposal, whose purpose was to develop and validate a new T2DM DSME module. A validation of the DSME module was completed by 5 local diabetic clinical experts. Each expert reviewed the DSME modules then completed a 10-question Likert-type scale survey. The survey was used to measure the content amount, ease of use, and visual presentation. Descriptive analysis was employed to analyze these data. Results revealed that all strongly agreed that the education module was easy to read and follow. They also strongly agreed that there was an adequate amount of educational information within the module. Additional comments from the experts resulted in minor revision to the new DSME. A future pilot study comparing current education to the newly validated DSME module will be implemented post-graduation. Changing the diabetic teaching culture into an improved patient focus role has the potential to reduce the economic healthcare impact and empower patients to bring about positive social change. Social change will also improve trust and confidence among patients within the healthcare organization.

The primary purpose of this research study was to provide an in-depth analysis of a pre-diabetes self-management education program located in a Midwest health care center and to evaluate the effectiveness of the program. The study was designed to answer the following research questions: (1) How was the DSME program developed and how is it being implemented? (2) To what extent do the program's elements align with the National Standards for Diabetes Self-Management Education? (3) What factors affect completion of the entire program by participants? (4) What factors affect non-completion of the entire program by participants? (5) How do participants perceive their experience in the program? (6) What are the immediate effects of the program in terms of weight loss and exercise adoption? (7) What are the long-term effects of the program in terms of maintenance of weight loss, maintenance of physical activity, and prevention of T2D? (8) To what extent are the AADE Standards for Outcome Measurement of DSME being met? Effective DSME programs are typically those that meet nationally recognized guidelines and outcomes measures. Data were collected to determine the effectiveness of this program using the following methods: interviews, document reviews, observations, and a survey. Descriptive statistics in the form of frequencies and percentages were used to describe the results. Analysis of the qualitative data was conducted and themes emerged. Recommendations were provided as to how the program can be improved upon to make it more effective.

Type 1 diabetes is a long-term diagnosis, the prognosis of which is directly related to the patient's ability to self-manage the disorder. Adolescents are not currently taught how to manage diabetes; instead, parents and educators expect self-management to be more of a learned behavior from their parents. The purpose of this project was to create a quality improvement plan which the regional pediatric diabetes center study site could implement to improve adolescent glycemic control. Orem's self-care theory was used as theoretical framework for the design and evaluation of the project. The practice-focused question for this doctoral project was: Can a quality improvement plan focused on diabetes self-management education support better control of the glycemic ranges of Type 1 diabetes in adolescents during the transition of self-management from parent to child? The design of the project included creation of curriculum for classes as well as streamlining blood glucose reporting within the center. The quality improvement plan outcomes provided an improvement on hemoglobin A1c of 0.3% for those utilizing the reporting systems and an improvement of 0.4% for those who had attended the education classes. Of the 11 patients who routinely sent in blood glucose over the 4-month time period, 10 met the goal of checking glucose as directed. These outcomes indicate the potential need for more concise direction within nursing practice to provide individual ages within the pediatric population with specific education plans to improve health outcomes. Improving the glycemic control of adolescents living with diabetes allows for a better transition into adulthood with a decreased risk of long-term complications, significantly contributing to positive social change.

Type 2 diabetes mellitus affects patients' health across the globe and is costly to manage. The chronic high blood sugar of diabetes is linked to cardiovascular and kidney damage, impaired functional status, and multiple organ failure. To lessen the complications associated with diabetes and promote self-care in those with the disease, health care professionals must be vigilant in offering diabetes education to patients with each clinic or primary care visit. Lack of diabetic educators in the clinic that provided the setting for this study indicated a need to increase clinical staff competency in teaching self-care and diabetes management to patients. The resulting project, guided by Bandura's theory of social learning, involved the creation of an educational curriculum, which was evaluated by 5 content experts with 5 or more years of experience caring for adult patients with Type 2 diabetes mellitus who provided narrative feedback. The content experts indicated satisfaction with the program and offered the following recommendations: (a) implementation of staff coaching on motivational interviewing, (b) additional help in securing medications and blood glucose testing supplies for noninsured patients, (c) translation of patient tools into Spanish at a Grade 3 or 4 reading level for better patient understanding, and (d) proceeding with full implementation after the recommendations are carried out. Improved self-care among diabetes patients could promote positive social change through the prevention of acute, long-term complications and disability.

Diabetes is the 7th leading cause of death in the United States. Uncontrolled diabetes and lack of self-care knowledge leads to increased emergency department (ED) visits, utilizing limited health care resources. The practice-focused question asked whether a patient-focused diabetic self-care toolkit could decrease the number of diabetes-related ED visits. The purpose of this project was to reduce the number of diabetes-related ED visits and was supported by the social cognitive theory. The sources of evidence included the facility's ED Information System (EDIS) data and a patient survey developed by the project lead. There were 149 participants (135 males and 14 females). Before program implementation there were 3240 total ED visits with 124 diabetes-related disposition diagnoses. Post-project there were 3362 total ED visits, with 126 diabetes-related disposition diagnoses. Data collected revealed no meaningful difference between the pre-project and post-project ED diabetes related visits. However, of the 124 pre-project diabetes-related visits, 59 had a triage complaint or disposition diagnosis of medication refill, and of the 126 post-project diabetes-related visits, 33 were medication refills. Although implementation of the diabetes resource toolkit did not help to decrease diabetes related emergency department visits, it did identify that 47.58% of pre-project visits and 26.19% of post-project visits were related to medication refills, showing a 21.39% post-project decrease in medication refill visits. This identifies one potential positive impact of the toolkit implementation. The implications for positive social change from this project is the recognition that medication refills are an impacting contributor to diabetes-related ED visits and from that, nursing practice can gain new knowledge in the fight against diabetes.

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