Used Tableau to created a Geo-map by zip codes, Bar chart by sex and race, and another Bar chart by age to display the dense of diabetes prevalence in 17 zip codes of North Texas. Literature Review is conducted to demonstrate the reduction of hyperglycemia events after the implementation of an inpatient multidisciplinary glucose control management program. Created Info-graphic to exhibit the ways to manage diabetes through education, counseling, meal/diet, and exercise and potential comorbidities in the diabetic patient that undergoes surgeries.

1. Running head: APPROACH TO SUPPORT DIABETES 1
NURS 4923 Capstone in Informatics
Approach to Improve Diabetes Through Education
Divya Bastola
Texas Woman’s University
Dallas, Texas
Author Note
Divya Bastola, Texas Woman’s University, Mathematics & Computer Science

2. Running head: APPROACH TO SUPPORT DIABETES 2
Table of Contents
Problem Identification 3
Literature Review 5
Search Process 5
Findings 6
Formulation of Innovative Approach for Clinical Problem 6
Outcomes and Associated Evaluation Criteria 7
Appendix A: Visual Analytic Dashboard for Support of Diabetes Type 2, Inpatient 10
Appendix B: Infographic 11
References 13

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Approach to Improve Diabetes Through Education
Problem Identification
According to the Center for Disease Control and Prevention (Centers for Disease Control and
Prevention, 2020), 34.2 million US adults have diabetes in which 1 out of 5 do not know they
have it. There are mainly 4 types of diabetes: Type 1, Type 2, Newly found diabetes, and
Gestational Diabetes. Diabetes is a chronic (long-lasting) health condition that affects how your
body turns food into energy (Centers for Disease Control and Prevention, 2020). The food that
we eat, especially carbohydrates, is broken down into a simpler form called glucose in the small
intestine and released in the bloodstream so that blood can take to the cells and tissue. Insulin
produced by the beta cells of pancreatic islets helps in absorbing the blood glucose level into the
cells and tissue to convert it into energy. However, sometimes there is not enough insulin
produced or sometimes cells in our body do not recognize the insulin therefore leaving too much
glucose level in the bloodstream which leads to Diabetes. The number of diabetes cases is
increasing every day. Diabetes is the 7th leading cause of death in the U.S. and the number one
cause of several other diseases like kidney failure, lower limb amputation, and adult blindness.
Type 1 Diabetes:
Type 1 diabetes occurs at every age, in people of every race, and every shape and size (American
Diabetes Association, 2020). According to the CDC, in the United States, there are nearly 1.6
million people that have Type 1 diabetes out of which 187,000 are children and adolescents. 5-
10% of diabetic patients fall under Type 1 diabetes (Centers for Disease Control and Prevention,
2020). In this type of diabetes, the body does not produce enough insulin. Different factors lead
to Type 1 diabetes. Type 1 diabetes can be inherited risk factors from parents. If a parent has
Type 1 diabetes, the odds for their child developing diabetes is 1 in 17. The chance of getting

4. Running head: APPROACH TO SUPPORT DIABETES 4
diabetes is 1 in 17 for a type 1 diabetic mother who gives birth to a child before the age of 25 and
1 in 100 if she gives birth after she turns 25 (American Diabetes Association, 2020). Food habits
might be another factor in developing diabetes. In experiments that followed relatives of people
with type 1 diabetes, researchers found that most of those who later got diabetes had certain
autoantibodies in their blood for years before developing diabetes (American Diabetes
Association, 2020). Type 1 diabetes can be managed with the help of insulin therapy, treatments,
a healthy diet, and enough exercise.
Type 2 Diabetes
According to the CDC, Type 2 diabetes is more common than Type 1. Unlike Type 1 diabetes,
the body does not use insulin properly as a result cannot control sugar and increases blood sugar
level (Centers for Disease Control and Prevention, 2020). The term insulin resistance is most
appropriate to describe this condition, about 90-95% of people who have diabetes are diagnosed
with Type 2 diabetes. Diabetes develops over many years and is usually diagnosed in adults, but
more and more in children, teens, and young adults (Centers for Disease Control and Prevention,
2020). Individuals should consider the risk factors of developing diabetes such as having
prediabetes, overweight, 45 years or older, having a parent, brother, or sister with type 2 diabetes
and physically active less than 3 times a week to be conscious ahead of time. Pregnant women
often develop gestational diabetes which may later develop into type 2 diabetes (Centers for
Disease Control and Prevention, 2020). Type 2 diabetes is highly linked to family history,
environmental factors, lifestyle, food habits, and obesity. Children who are introduced to an
unhealthy food diet from their parents are more likely to develop diabetes. Things like healthy
eating, exercising, compliance with prescribed insulin medication, injectable medications, and

5. Running head: APPROACH TO SUPPORT DIABETES 5
oral diabetes medicine can treat Type 2 diabetes (Centers for Disease Control and Prevention,
2020).
Newly Found Diabetes
According to the American Diabetes Association, 1.5 million people will be diagnosed with
diabetes this year. Diabetes can develop at any age. Although it may seem frightening and
stressful, there are always ways people can manage and control diabetes. Individuals with
diabetes can live longer than in the past, by practicing healthy measures. Individuals with type 1
or type 2 diabetes can manage this disease with diet and exercise (American Diabetes
Association, 2020). Eating foods that include a variety of whole grains, vegetables, fruits, non-
dairy products, lean meats, and healthy fats to acquire nutrients can help reduce the risks of
developing diabetes. Being physically active and decreasing stress levels can lower the risk of
developing diabetes (American Diabetes Association, 2020).
The purpose of this paper is to identify resources for individuals with diabetes to improve and
prevent diabetes with support and education.
Literature Review
A summary of the literature review to support the topic of Diabetes Mellitus is provided.
First, the literature review process will be described followed by the key literature review
findings. Details of the top sources for relevance are provided in Table 1.
Search Process
The university Library’s EBSCO database was used to search the articles related to
diabetes. Some important keywords like Medline, diabetes mellitus, prevention, control, and
inpatients were used to locate the 5 articles. The top 5 selected articles are presented in Table 1.

6. Running head: APPROACH TO SUPPORT DIABETES 6
Findings
Five articles are selected out of which all of the studies demonstrate positive outcomes.
From enhancing diabetes care to impact of glucose control management, outcomes following
certain surgeries in diabetic patients are topics of interest found in the article. The articles are
retrospective in nature and the glucose level is measured before glucose control management is
conducted and after and complication flowing the surgeries in diabetic and non-diabetic patients.
Formulation of Innovative Approach for Clinical Problem
The proposed approach for the topic of Diabetes II is to identify resources for individuals with
diabetes to improve and prevent diabetes with support and education (McLendon et al., 2019).
The specific components of this approach in order of sequence are:
1. Approach step/component #1 Literature Review – Literature Review is conducted and
finding were significant reduction in hyperglycemic events after the implementation
of an inpatient multidisciplinary glucose control management program (Momesso et
al., 2018) and potential for improving diabetes control after access to specialty care
through telemedicine and reduction of health care utilization costs (McLendon et al.,
2019). (See Table 1)
2. Approach step/component #2 Visual Analytic Dashboard – Created a Geomap by zip
codes, Bar chart by sex and race, and another Bar chart by age to display the dense of
diabetes prevalence in 17 zip codes of North Texas. (Data source is THCIC,
QlikView is the business intelligence tool to extract records, and Tableau is used to
create a visual analytic dashboard. (See Appendix A)
3. Approach step/component #3 Infographic – Created Infographic to exhibit the ways
to manage diabetes through education, counseling, meal/diet, and exercise and

7. Running head: APPROACH TO SUPPORT DIABETES 7
potential comorbidities in the diabetic patient that undergoes surgeries. (See
Appendix B)
Outcomes and Associated Evaluation Criteria
Diabetes prevalence in the patient that went through Total Hip Replacement (THR) and
Total Knee Replacement (TKR) was 11 percent. Health care facilities utilizing this approach can
be expected to find out the increase/decrease in pain, function, complication, and length of
hospital stay in patients with diabetes vs without diabetes and patients with poorly controlled
diabetes vs well-controlled diabetes (Lenguerrand et al., 2018). Several specific outcomes
relating to the approach were noted. For example, the median length of stay was 1 day longer in
a patient with diabetes (p = 0.004), but this attenuated after adjustments for BMI and
comorbidities (p = 0.3) (Lenguerrand et al., 2018). Weight loss program from the Veterans
Affairs Diabetes Prevention Program (VD-DPP) showed a change in weight and hemoglobin
A1c with a short period which attenuates the complications (Moin et al., 2017).
Another specific outcome was inpatient pain was greater for patients with diabetes but attenuated
some adjustments. Controlled blood glucose levels achieved from glucose control management
programs like inpatient multidisciplinary glucose control can be effective to reduce pain and
complications if done before surgeries (Momesso et al., 2018). The 12-month postoperative
subscales were similar by diabetes status following adjustment and there was little evidence of a
difference in outcomes according to glycemic control (Lenguerrand et al., 2018).

8. Running head: APPROACH TO SUPPORT DIABETES 8
Table 1
Literature Review Articles
1. Title
2. First Author
3. Date
4. Country
5. Patient
Population
6. Sample Size
7. Intervention of Interest
8. Design (Experiment,
observation, etc.)
9. Level of Evidence (I - VI)
10. Comparison of
Interest
11. Outcome of
Interest
12. Results of Study
13. Conclusion
14. Strengths
15. Limitations
A.
1. Enhancing
diabetes care
through care
coordination,
telemedicine, and
education:
Evaluation of rural
pilot program.
2. Susan
3. 2019
4. United States
5. Adult
patients.
6. 59
7. Provide a grant-funded
pilot diabetes care program
to control diabetes.
8. Experiment
9. Analysis
10. Pre and post
diabetes cases
through care
coordination,
telemedicine, and
education.
11. Improved
12. Statistically
reduction in A1C,
DSME (Diabetes
Self-Management
Education) test
score
improvement, and
reduced
hospitalization.
13. Rural models
show potential for
improving diabetes
control.
14. Not listed
15. Delay in
staffing and
credentialing,
Telemedicine: a
new model in
health care
system’s primary
care and broad
band internet
strength.
B.
1. Impact of an
inpatient
multidisciplinary
glucose control
management
program.
2. Denise
3. 2018
4. Brazil
5. Teenager
and adult
6. 389 patients
in May 2014,
545 patients in
June 2015, and
475 patients in
May 2017
7. Evaluate the impact of
implementation of an
inpatient multidisciplinary
glucose control
management program on
glucose control in
hospitalization patients.
8. Observation.
9. Analysis
10. Glucose
monitoring
obtained by
POCT (Point of-
Care Testing)
before the
implementation
of the MGCP
(Multidisciplinary
Glucose Control
Management
11. Improved
12. Significant
reduction in
hyperglycemic
events.
13. Implementation
of an inpatient
multidisciplinary
glucose
management
14. Not listed
15.
Nonrandomized
design, absence of
a concurrent
control group and
potential for type I
error (i.e. a false-
positive result).

9. Running head: APPROACH TO SUPPORT DIABETES 9
1. Title
2. First Author
3. Date
4. Country
5. Patient
Population
6. Sample Size
7. Intervention of Interest
8. Design (Experiment,
observation, etc.)
9. Level of Evidence (I - VI)
10. Comparison of
Interest
11. Outcome of
Interest
12. Results of Study
13. Conclusion
14. Strengths
15. Limitations
Program) in May
2014 and after its
implementation in
June 2015 and
May 2017.
program improved
clinical outcomes.
C.
1. Outcomes
following hip and
knee replacement in
diabetic versus
nondiabetic patients
and well versus
poorly controlled
diabetic patients: a
prospective cohort
study.
2. Eric
3. 2018
4. United States
5. Adults
6. Total Hip
Replacement
(THR) =300
Total Knee
Replacement
(TKR) = 287
7. Impact of diabetes and
glycemic control in
outcome of Total knee and
Hip replacement.
8. Observation
9. Analysis
10. Pain,
function,
complication, and
length of hospital
stay in diabetic
and nondiabetic
patients receiving
THR or TKR and
compared these
outcomes with
poorly controlled
versus well
controlled
diabetes.
11. Not listed
12. patients with
diabetes had longer
hospital stays,
more severe acute
postoperative pain
and worst
outcomes than
non-diabetic
patients.
13. Association
between diabetes
and worse
postoperative
outcomes were due
to obesity and
comorbidities.
14. Not listed
15. THR and TKR
patients were
analyzed together
to ensure a
sufficient sample in
which to
investigate
disparities in
outcome by
diabetes and
glycemic status
D.
1. Diabetes
Prevention Program
Translation in the
Veterans Health
Administration
2. Tannaz
5.Adults
6. 720
7. Effectiveness of the
Veterans Affairs Diabetes
Prevention Program with
care management program
in the Veterans Health
Administration health
system.
10. Compare the
VA-DPP to the
pre-program
MOVE diabetes
management.
11. Improved.
12. Weight loss
significant
13. VA-DPP
participants had
higher participation
and weight loss
14. Not listed
15. Trail may limit
generalizability,
19% of participant
did not complete
follow up HbA1c
testing,

10. Running head: APPROACH TO SUPPORT DIABETES 10
1. Title
2. First Author
3. Date
4. Country
5. Patient
Population
6. Sample Size
7. Intervention of Interest
8. Design (Experiment,
observation, etc.)
9. Level of Evidence (I - VI)
10. Comparison of
Interest
11. Outcome of
Interest
12. Results of Study
13. Conclusion
14. Strengths
15. Limitations
3. 2017
4. Unites States
8. Prospective, pragmatic,
and non-randomized study.
9. Analysis
rates, HbA1x, and
health expenditure
at 12 months
compared to
MOVE.
Participations were
not randomized,
etc.
E.
1. Determinants of
hemoglobin A1c
level in patients with
type 2 diabetes after
in-hospital diabetes
education: A study
based on continuous
glucose monitoring.
2. Keiichi
3. 2017
4. Japan
5.Adult
6. 54
7. Investigate the
relationship between blood
glucose profile and
hemoglobin A1c and 12
weeks after discharge of
type 2 diabetic inpatient.
8. Retrospective study
9. Analysis
10. Compare the
blood glucose
level of the
inpatient at
discharge and
HbA1c at 12
weeks of
discharge
11. HbA1c level at
12 weeks after
discharge
correlated with
MBG (Mean Blood
Glucose) level.
12. HbA1c
correlates with
MBG level.
13. Blood glucose
level profile at
discharge using
CGM (Continuous
Glucose
Monitoring) seems
useful to predict
HbA1c level.
14. Not listed
15. Treatment goal
differentiated from
patient to patient, it
was a retrospective
study carried out in
two hospitals and
the interindividual
variability in the
educational effect
was not included in
the analysis.
Note: Instructions are for each of the main articles (at least five) in support your proposed evidence-based practice approach, provide as many of these 15
characteristics as possible. Indicate N/A if not available.

11. Running head: APPROACH TO SUPPORT DIABETES 11
Appendix A: Visual Analytic Dashboard for Support of Diabetes Type 2, Inpatient

12. Running head: APPROACH TO SUPPORT DIABETES 12
Appendix B: Infographic

13. Running head: APPROACH TO SUPPORT DIABETES 13

14. Running head: APPROACH TO SUPPORT DIABETES 14
References
American Diabetes Association. (2020). The path to understanding diabetes starts here.
www.diabetes.org. https://diabetes.org/diabetes
Centers for Disease Control and Prevention. (2020). What is Diabetes? www.cdc.gov.
httpDepartment of State Health Services, (DSHS). (2020). Texas Health Care
Information Collection (THCIC). www.dshs.texas.gov.
https://dshs.texas.gov/thcic/s://www.cdc.gov/diabetes/basics/diabetes.html
Lenguerrand, E., Beswick, A. D., Whitehouse, M. R., Wylde, V., & Blom, A. W. (2018).
Outcomes following hip and knee replacement in diabetic versus nondiabetic patients and
well versus poorly controlled diabetic patients: a prospective cohort study. Acta
Orthopaedica, 89(4), 399-405. 10.1080/17453674.2018.1473327
McLendon, S. F., Wood, F. G., & Stanley, N. (2019). Enhancing diabetes care through care
coordination, telemedicine, and education: Evaluation of a rural pilot program. Public
Health Nursing (Boston, Mass.), 36(3), 310-320. 10.1111/phn.12601
Moin, T., Damschroder, L. J., AuYoung, M., Maciejewski, M. L., Datta, S. K., Weinreb, J. E.,
Steinle, N. I., Billington, C., Hughes, M., Makki, F., Holleman, R. G., Kim, H. M.,
Jeffreys, A. S., Kinsinger, L. S., Burns, J. A., & Richardson, C. R. (2017). Diabetes
Prevention Program Translation in the Veterans Health Administration. American
Journal of Preventive Medicine, 53(1), 70-77. 10.1016/j.amepre.2016.11.009
Momesso, D. P., Costa Filho, R. C., Costa, J. L. F., Saddy, F., Mesquita, A., Calomeni, M.,
Silva, C. D. S., Farret, J., Vasques, M. L., Santos, A. G., Cabral, A. P. V., Ribeiro, D.,
Reis, L., Muino, Maria de Fátima M., Vitorino, R. S., Monteiro, C. A., Tinoco, E., &
Volschan, A. (2018). Impact of an inpatient multidisciplinary glucose control

15. Running head: APPROACH TO SUPPORT DIABETES 15
management program. Archives of Endocrinology and Metabolism, 62(5), 514-522.
10.20945/2359-3997000000071
Torimoto, K., Okada, Y., Sugino, S., & Tanaka, Y. (2017). Determinants of hemoglobin A1c
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