EARLY AWARENESS

Metabolic Syndrome/Pre-diabetes Early Awareness Education and Its Effects on BMI

Submitted by:

Nancy L. Gee

Direct Practice Improvement Project Proposal

Doctor of Nursing Practice

Grand Canyon University

Phoenix, Arizona

1/13/18

Chapter One: Introduction to Project

Introduction

In society today, obesity is really a recurrenthas become a widespread co-morbidity related toleading to excessive rise in bodyweight. Additionally, it is considered as one of the most essential and changeable risk factors within the pathogenesis of health problems like type-1 and type-2 diabetes, which has been

documented in most biochemical studies as well as cross-sectional research (Piven, 2014). In current times, there are many crucial biochemical studies in the inter-relationship amid body mass index (BMI) and its connection with advancement of diabetic issues (Innocent, Oweh, Sandra & Josiah, 2013). The Center for Disease Control (CDC) anticipates that one-in-threenearly 33% adults may have diabetes by the year 2050 (CDC, 2010; Robert Wood Johnson Foundation, 2016); as presently, more than twenty-nine million adults in America has been diagnosed with diabetic issues and an additional eighty-six million have pre-diabetes (Statistics about Diabetes, n.d; Robert Wood Johnson Foundation, 2016).

Pre-diabetes is a condition where blood sugar levels are elevated, however lesser than the established inception of diabetes level related to diabetes (Kowall et al., 2012). Kowall, et al (2012) writes pre-diabetes is a result of Impaired Fasting Glucose (IFG), Impaired Glucose Tolerance (IGT), or perhaps a mixture of IFG and IGT (p. 828). Further, diabetes has numerous effects which might consist of several health disorders and, in a few instances, failure of bodily organs (Tabk, Herder, Rathmann, Brunner, & Kivimki, 2012; Brown, 2017). Thus, Type-2 diabetes (T2D) puts individuals at risk for a variety of ailments like cardiac condition, amputations, renal malfunction, vision loss, as well as obesity. Weight reduction has been seen to stop the triggering of T2D and morbid obesity in individuals having pre-diabetes (Brown & Kuk, 2015). As a result, early diagnosis and management of pre-diabetes can avoid its crossover to complete onset diabetes and thus reduce the related problems (Brown & Kuk, 2015, p. 79).

Given that diabetes educational interventions have been a successLittle is known about how patients respond to Diabetes Self-Management Education (DSME), the goal of this study will be to measure the awareness and knowledge of metabolic syndrome/pre-diabetes risk factors among obese patients (BMI >30) in an internal medicine/family practice clinic with a BMI >30. Th. The study makes use of a adopts a quantitative approach using a descriptive method and pre-post test research structure to determine subjects' understanding and knowledge of metabolic syndrome/prediabetes, and T2D. The pretests will establish current knowledge and gaps about diabetes awareness and post-test will determine the information they gained from the intervention (DSME) and how they plan to use that information in their life. The results, will state the help in the advancement and improvement of the pre-diabetes and diabetes informative and knowledge-based self-management intervention programs.

Thereafter, tThis chapter places the research within the much larger framework of the scholarly materials and after that reaches up to a particular target audience while describing the idiosyncrasies of this DPI project such as background of the study, problem statement, purpose of the study, clinical question(s), advancing scientific knowledge, significance of the study, rationale for methodology, nature of the study, definition of terms, assumptions, limitations and delimitations and lastly, summary and organization of the remaining chapters.

Criterion

Learner Score

(0, 1, 2, or 3) Comment by Segovia, Julie H: Learner scores have not been completed these table need to be completed as a self-assessment

Chairperson Score

(0, 1, 2, or 3)

Comments or Feedback

Introduction

This section briefly overviews the project focus or practice problem, why this project is worth conducting, and how this project will be completed. (3-4 paragraphs or approximately 1 page)

1

Not clear what the project intervention is or what the project design is

Practice improvement project topic is introduced.

1

Not clear what the improvement is

Discussion provides an overview of what is contained in the chapter.

2

Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.

1

Review sentence structure, grammar and choice of words for scholarly writing

NOTE: Once the document has been approved by your Chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.

Score 0 (not present); 1(unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready).

Background to the Project

The frequency of identified diabetic issues amid U.S. adults has gone up twofold within the past four decades and seventy five percent in the past twenty-five years (NCD Risk factor Collaboration, 2016; Gregg et al, 2004; Centers for Disease Control and Prevention, 2006). The life-time danger of acquiring diabetes within the U.S. in 2000 had been 33% for males and 39% for females and this had been even greater amid U.S. minority communities (Narayan et al, 2003). Since 2000 research related to the life-time danger of acquiring diabetes could not be found in the literature.

BMI is a highly effective strongand flexible, yet controllable, risk element for diabetes (ADA, 2017; Ford, Williamson and Liu, 1997; Diabetes Prevention Program Research Group, 2002). Nevertheless, the outcome link between of prediabetes knowledge on and BMI hasn't been extensively examined (Arayan, James, Theodore et al, 2007). Medical experts use the Body Mass Index to determine whether a person is overweight, obese, normal or underweight. Its a determination of the ratio between a persons weight and their height (Lo, Wong, Khalechelvam and Tam, 2016).

The following are details of the findings from research, with regard to the relationship between the BMI ratio and diabetes. Relationship between BMI and Diabetes: Iit was found by Narayan et al (2007) that ones risk of developing diabetes in their lifetime is one in three, at the point of birth. He further noted that the risks of developing the condition across the categories of BMI over a lifetime are still unclear. The study sought to demonstrate the specific lifetime risks for the various BMIs for people in the US, based on sex, ethnicity and age subgroups (Narayan et al., 2007).

The survey data for the National Health Interview n=780, 694, from 1997 to 2004 was the basis for indicating race, sex, age, ethnicity and the prevalence of BMI-linked occurrence of diabetes in the US in 2004 (Narayan et al., 2007). The data from the US Census Bureau including age, sex-specific mortality, population rate projections and race were used along with two earlier studies relating to mortality, to project the mortality rates related to BMI ratios (Narayan et al., 2007).

The findings and estimates informed the Markov Model proection of the lifetime risks of diabetes diagnosed by race, sex baseline age and BMI. According to the results, the lifetime risk of developing diabetes at the age of 18 for underweight people was shot from 7.6 to and those who were obese was 70.3% between underweight people and those who were significantly obese. The figures also increased from 12.2 to 74.4 for women in the same weight categories. The difference in lifetime risk was lower at advanced ages. For example, at age 65, normal weight males had their lifetime risk difference rise from 3.7 to 23.9 points in percentages between overweight people and the ones regarded as very obese. The figure increased by 8.7 percentage points to 26.7 for women (Narayan et al., 2007a). It was also noted that the effect of BMI on the duration of diabetes compounded with an increase in ones age (Narayan et al., 2007b).

The risk of developing diabetes type II diabetes was investigated in a case control research by Ganz et al (2014) by studying its incidence versus BMI ratios. The rising effect of BMI, basing on BMI categories was also assessed. Those who recorded weights between 25 and 29.9 were labelled as overweight. And then there was the Obesity Class I who measured between 30 and 34.9. Class II Obesity group registered BMI index from 35 to 39.9. Obesity Class III on its part recorded figures equal to or over 40 (Ganz et al., 2014).

Relative risks and ratios regarding the odds were calculated from a range of logistic regression outcomes. Age, cardiac history, sex and hyper-inflammatory identified by erythrocyte sedimentation and C- reactive protein states and use of psychiatric medications were used to select group, memberssubjects. (Ganz et al., 2014). Measures of BMI were taken a year preceding the first diagnosis of type II diabetes. BMI was obtained from dates that were randomly assigned for those that were in the control. The relationship between BMI and the incidence of diabetes was not only found to be strong but that the risk increased with large higher levels of BMI figures (Ganz et al., 2014).

There is a significant correlation between diabetes and being overweight. A number of studies have established a strong link between the two factors. In one study, for instance, Akbari et al (2017) found that patient education regarding type II diabetes can help reduce barriers. The core aim of the study was to establish the impact of an education program intervention, using the model BASNEF on awareness barriers, adaptation, lifestyle and support for patients living with type-II diabete (Akbari, 2017). It has been noted that removing the barriers associated with the diabetes condition is a reasonable step towards empowering patients of diabetes to manage their lives with the condition, and to recognize what really affects the barriers. The findings indicated that there was a clear difference between a score derived from living barriers such as lifestyle, awareness, protection and adaptation components, and the BASNEF model variable, i.e. enabling factors, attitude, subjective norm, knowledge, and behavioral intention.

Criterion

Learner Score (0, 1, 2, or 3) Comment by Segovia, Julie H: As above, self-assessment is not completed

Chairperson Score (0, 1, 2, or 3)

Comments or Feedback

Background of the Project

The background section explains both the history of and the present state of the problem and project focus. This section summarizes the Background section from Chapter 2. (2-3 paragraphs)

1

Unclear that the problem/project focus is. Pre-diabetes is not discussed. Education for pre-diabetes not discusses. In other words, tie the project focus in within this section.

Provides an overview of the history of and present state of the problem and project focus.

1

See comments above

Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.

2

Check grammar and sentence structure

NOTE: Once the document has been approved by your Chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.

Score 0 (not present); 1(unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready).

Problem statement

Type II diabetes, previously referred to as non-insulin-dependent diabetes (NIDDM), makes up most cases associated with type II diabetesof diabetes mellitus globally. It's approximated that in 2000 there had been roughly a hundred and fifty million people with the illness and that this quantity is most likely to increase twofold by the year 2025 (Kaveeshawar &Cornwall, 2014; King, Aubert, & Herman, 1998). Type II diabetes will be the fourth or perhaps fifth prominent cause of demise in many developed nations and there's expanding proof that this has attained epidemic dimensions in quite a few developing and recently industrialized nations (Amos, McCarty, & Zimmet, 1997). All-time low levels of type II diabetes are generally noticed in places where individuals retain traditional life-style (Gray, 2015; Bennett, 1999). Dramatic modifications in the frequency or occurrence of type II diabetes happen to be noticed in places where there have already been significant modifications in the kind of foods utilized, from the conventional native diet plan to a common western diet plan (Hu, 2011; Bennett, 1999; Lako and Nguyen, 2001; Hetzel and Michael, 1987). Changing illness levels are revealed by modifications in a number of dietary elements along with modifications in other life-style associated elements, notably a decrease in physical exercise (Sami, Ansari, Butt, Rashid, & Hamid, 2017; Steyn et al, 2004).

Because of these facts, the objective of this study is to assess the awareness and knowledge of diabetes amongst patients with prediabetes in an internal medicine/family practice clinic. After carrying out DSME pre-intervention assessments on patients with prediabetes, gaps are going to be recognized in awareness and understanding of diabetes amongst the subjects. The pre-assessment outcomes will be utilized to enhance and modify the educational plan to satisfy the individual requirements of patients with prediabetes.

Absent from the literature is information on how patients respond to self-management methods that should be adopted to attain the preferred benefits; and precisely what they will do with the understanding knowledge they develop gain from DSME educational interventions. There's an expanding demand for interventions that enhance patients understanding and knowledge of diabetes (Islam et al., 2014). The substantial population at an increased risk for or with diabetes is actually within the age bracket of 25 - 65 years. Insufficient steps to decrease occurrence of pre-diabetes might result in a consequential boost in health investment, morbidity, as well as other associated health circumstance (National Diabetes Statistics Report, 2014, para 8).

To manage an increased incidence of diabetes diagnoses, health interventions will be essential to avoid diabetic issues or postpone their development (Islam et al., 2014). Such endeavors can consist of complete life-style change for all those at an increased risk for metabolic syndrome/pre-diabetic issues and timely treatment for patients suffering from the disorder. An aAmbitious self-management methods focusing on individuals at an increased risk of diabetes is definitely an importan public health strategy targeted at reducing the threat elements for diabetes (International Diabetes Federation, 2013).

Criterion

Learner Score

(0, 1, 2, or 3)

Chairperson Score

(0, 1, 2, or 3)

Comments or Feedback

Problem Statement

This section includes the problem statement, the population affected, and how the project will contribute to solving the problem. (2-3 paragraphs)

2

States the specific problem proposed for research by presenting a clear declarative statement that begins with It is not known if and to what degree/extent..., or It is not known how/why and.

1

Unclear please see above

Identifies the need for the project.

2

Not clear as yet what the intervention is

Identifies the broad population affected by the problem.

2

Suggests how the project may contribute to solving the problem.

1

Unclear what the patient or practice outcome is

Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.

2

NOTE: Once the document has been approved by your Chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.

Score 0 (not present); 1(unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready).

Purpose of the Project

The objective of this study is to evaluate awareness and understanding concerning metabolic syndrome and diabetes in pre-diabetic individuals and the effects on BMI. To determine if the patients qualify for prediabetes stage, the researcher will utilized patients healthcare records to choose individuals with an increased fasting glucose (IFG), and hypertension in the healthcare facility Copperview Medical Center. In addition, the individuals will be recognized as obese if they have a body mass index (BMI) of more than 30kg/m2. The independent variables will be the DSME intervention plan and the dependent variable will be patients awareness level about the threat of acquiring T2D and awareness concerning risk lowering habits and treatments; and these factors will be assessed utilizing adopting a a qualitative surveyquantitative method and using a descriptive design. The Other dependent variables will be BMI assessment. The BMI will be measured by weighing the patient before awareness education and eight weeks after receiving the intervention. Additional independent variables are how awareness and understanding levels amongst individuals differ based on education level and lastly the health belief model will be utilized as the theoretical foundation of this study.

This project will make use of diabetes associated queries in the pre-assessment to evaluate and classify individuals according to their understanding and knowledge of diabetic issues. Dedication of a towards increasing patients their understanding and awareness of diabetes as well as their risk of acquiring type II diabetes might encourage them to alter their life-style and embrace new treatments to decrease the threat of diabetes. This project will target inclusion criteria for this study will be adults of both sexes with a BMI of more than 30kg/m2. Furthermore, the results might be helpful in the advancement of future interventions towards decreasing diabetes risk in communities with higher risk of acquiring type II diabetes.

Criterion

Learner Score

(0, 1, 2, or 3)

Chairperson Score (0, 1, 2, or 3)

Comments or Feedback

Purpose OF THE PROJECT

The purpose statement section provides a reflection of the problem statement and identifies how the project will be accomplished. It explains how the proposed project will contribute to the field. (2-3 paragraphs)

1

Not clear what the intervention is therefore its missing as to how the project will be accomplished. With the way its worded its currently understood that the project is to measure awareness of a pre-condition and if that awareness impacts BMI? The intervention appears to be missing.

Presents a declarative statement: "The purpose of this project is...." that identifies the research design, population, variables…

Running head: EARLY AWARENESS

EARLY AWARENESS

Metabolic Syndrome/Pre-diabetes Early Awareness Education and Its Effects on BMI

Submitted by:

Nancy L. Gee

Direct Practice Improvement Project Proposal

Doctor of Nursing Practice

Grand Canyon University

Phoenix, Arizona

1/13/18

Chapter One: Introduction to Project

Introduction

In society today, obesity is really a recurrenthas become a widespread co-morbidity related toleading to excessive rise in bodyweight. Additionally, it is considered as one of the most essential and changeable risk factors within the pathogenesis of health problems like type-1 and type-2 diabetes, which has been

documented in most biochemical studies as well as cross-sectional research (Piven, 2014). In current times, there are many crucial biochemical studies in the inter-relationship amid body mass index (BMI) and its connection with advancement of diabetic issues (Innocent, Oweh, Sandra & Josiah, 2013). The Center for Disease Control (CDC) anticipates that one-in-threenearly 33% adults may have diabetes by the year 2050 (CDC, 2010; Robert Wood Johnson Foundation, 2016); as presently, more than twenty-nine million adults in America has been diagnosed with diabetic issues and an additional eighty-six million have pre-diabetes (Statistics about Diabetes, n.d; Robert Wood Johnson Foundation, 2016).

Pre-diabetes is a condition where blood sugar levels are elevated, however lesser than the established inception of diabetes level related to diabetes (Kowall et al., 2012). Kowall, et al (2012) writes pre-diabetes is a result of Impaired Fasting Glucose (IFG), Impaired Glucose Tolerance (IGT), or perhaps a mixture of IFG and IGT (p. 828). Further, diabetes has numerous effects which might consist of several health disorders and, in a few instances, failure of bodily organs (Tabk, Herder, Rathmann, Brunner, & Kivimki, 2012; Brown, 2017). Thus, Type-2 diabetes (T2D) puts individuals at risk for a variety of ailments like cardiac condition, amputations, renal malfunction, vision loss, as well as obesity. Weight reduction has been seen to stop the triggering of T2D and morbid obesity in individuals having pre-diabetes (Brown & Kuk, 2015). As a result, early diagnosis and management of pre-diabetes can avoid its crossover to complete onset diabetes and thus reduce the related problems (Brown & Kuk, 2015, p. 79).

Given that diabetes educational interventions have been a successLittle is known about how patients respond to Diabetes Self-Management Education (DSME), the goal of this study will be to measure the awareness and knowledge of metabolic syndrome/pre-diabetes risk factors among obese patients (BMI >30) in an internal medicine/family practice clinic with a BMI >30. Th. The study makes use of a adopts a quantitative approach using a descriptive method and pre-post test research structure to determine subjects' understanding and knowledge of metabolic syndrome/prediabetes, and T2D. The pretests will establish current knowledge and gaps about diabetes awareness and post-test will determine the information they gained from the intervention (DSME) and how they plan to use that information in their life. The results, will state the help in the advancement and improvement of the pre-diabetes and diabetes informative and knowledge-based self-management ntervention programs.

Thereafter, tThis chapter places the research within the much larger framework of the scholarly materials and after that reaches up to a particular target audience while describing the idiosyncrasies of this DPI project such as background of the study, problem statement, purpose of the study, clinical question(s), advancing scientific knowledge, significance of the study, rationale for methodology, nature of the study, definition of terms, assumptions, limitations and delimitations and lastly, summary and organization of the remaining chapters.

Criterion

Learner Score

(0, 1, 2, or 3) Comment by Segovia, Julie H: Learner scores have not been completed these table need to be completed as a self-assessment

Chairperson Score

(0, 1, 2, or 3)

Comments or Feedback

Introduction

This section briefly overviews the project focus or practice problem, why this project is worth conducting, and how this project will be completed. (3-4 paragraphs or approximately 1 page)

1

Not clear what the project intervention is or what the project design is

Practice improvement project topic is introduced.

1

Not clear what the improvement is

Discussion provides an overview of what is contained in the chapter.

2

Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.

1

Review sentence structure, grammar and choice of words for scholarly writing

NOTE: Once the document has been approved by your Chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.

Score 0 (not present); 1(unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready).

Background to the Project

The frequency of identified diabetic issues amid U.S. adults has gone up twofold within the past four decades and seventy five percent in the past twenty-five years (NCD Risk factor Collaboration, 2016; Gregg et al, 2004; Centers for Disease Control and Prevention, 2006). The life-time danger of acquiring diabetes within the U.S. in 2000 had been 33% for males and 39% for females and this had been even greater amid U.S. minority communities (Narayan et al, 2003). Since 2000 research related to the life-time danger of acquiring diabetes could not be found in the literature.

BMI is a highly effective strongand flexible, yet controllable, risk element for diabetes (ADA, 2017; Ford, Williamson and Liu, 1997; Diabetes Prevention Program Research Group, 2002). Nevertheless, the outcome link between of prediabetes knowledge on and BMI hasn't been extensively examined (Arayan, James, Theodore et al, 2007). Medical experts use the Body Mass Index to determine whether a person is overweight, obese, normal or underweight. Its a determination of the ratio between a persons weight and their height (Lo, Wong, Khalechelvam and Tam, 2016).

The following are details of the findings from research, with regard to the relationship between the BMI ratio and diabetes. Relationship between BMI and Diabetes: Iit was found by Narayan et al (2007) that ones risk of developing diabetes in their lifetime is one in three, at the point of birth. He further noted that the risks of developing the condition across the categories of BMI over a lifetime are still unclear. The study sought to demonstrate the specific lifetime risks for the various BMIs for people in the US, based on sex, ethnicity and age subgroups (Narayan et al., 2007).

The survey data for the National Health Interview n=780, 694, from 1997 to 2004 was the basis for indicating race, sex, age, ethnicity and the prevalence of BMI-linked occurrence of diabetes in the US in 2004 (Narayan et al., 2007). The data from the US Census Bureau including age, sex-specific mortality, population rate projections and race were used along with two earlier studies relating to mortality, to project the mortality rates related to BMI ratios (Narayan et al., 2007).

The findings and estimates informed the Markov Model projection of the lifetime risks of diabetes diagnosed by race, sex baseline age and BMI. According to the results, the lifetime risk of developing diabetes at the age of 18 for underweight people was shot from 7.6 to and those who were obese was 70.3% between underweight people and those who were significantly obese. The figures also increased from 12.2 to 74.4 for women in the same weight categories. The difference in lifetime risk was lower at advanced ages. For example, at age 65, normal weight males had their lifetime risk difference rise from 3.7 to 23.9 points in percentages between overweight people and the ones regarded as very obese. The figure increased by 8.7 percentage points to 26.7 for women (Narayan et al., 2007a). It was also noted that the effect of BMI on the duration of diabetes compounded with an increase in ones age (Narayan et al., 2007b).

The risk of developing diabetes type II diabetes was investigated in a case control research by Ganz et al (2014) by studying its incidence versus BMI ratios. The rising effect of BMI, basing on BMI categories was also assessed. Those who recorded weights between 25 and 29.9 were labelled as overweight. And then there was the Obesity Class I who measured between 30 and 34.9. Class II Obesity group registered BMI index from 35 to 39.9. Obesity Class III on its part recorded figures equal to or over 40 (Ganz et al., 2014).

Relative risks and ratios regarding the odds were calculated from a range of logistic regression outcomes. Age, cardiac history, sex and hyper-inflammatory identified by erythrocyte sedimentation and C- reactive protein states and use of psychiatric medications were used to select group, memberssubjects. (Ganz et al., 2014). Measures of BMI were taken a year preceding the first diagnosis of type II diabetes. BMI was obtained from dates that were randomly assigned for those that were in the control. The relationship between BMI and the incidence of diabetes was not only found to be…

Running head: EARLY AWARENESS

EARLY AWARENESS

Metabolic Syndrome/Pre-diabetes Early Awareness Education and Its Effects on BMI

Submitted by:

Nancy L. Gee

Direct Practice Improvement Project Proposal

Doctor of Nursing Practice

Grand Canyon University

Phoenix, Arizona

1/13/18

Chapter One: Introduction to Project

Introduction

In society today, obesity is really a recurrenthas become a widespread co-morbidity related toleading to excessive rise in bodyweight. Additionally, it is considered as one of the most essential and changeable risk factors within the pathogenesis of health problems like type-1 and type-2 diabetes, which has been

documented in most biochemical studies as well as cross-sectional research (Piven, 2014). In current times, there are many crucial biochemical studies in the inter-relationship amid body mass index (BMI) and its connection with advancement of diabetic issues (Innocent, Oweh, Sandra & Josiah, 2013). The Center for Disease Control (CDC) anticipates that one-in-threenearly 33% adults may have diabetes by the year 2050 (CDC, 2010; Robert Wood Johnson Foundation, 2016); as presently, more than twenty-nine million adults in America has been diagnosed with diabetic issues and an additional eighty-six million have pre-diabetes (Statistics about Diabetes, n.d; Robert Wood Johnson Foundation, 2016).

Pre-diabetes is a condition where blood sugar levels are elevated, however lesser than the established inception of diabetes level related to diabetes (Kowall et al., 2012). Kowall, et al (2012) writes pre-diabetes is a result of Impaired Fasting Glucose (IFG), Impaired Glucose Tolerance (IGT), or perhaps a mixture of IFG and IGT (p. 828). Further, diabetes has numerous effects which might consist of several health disorders and, in a fe instances, failure of bodily organs (Tabk, Herder, Rathmann, Brunner, & Kivimki, 2012; Brown, 2017). Thus, Type-2 diabetes (T2D) puts individuals at risk for a variety of ailments like cardiac condition, amputations, renal malfunction, vision loss, as well as obesity. Weight reduction has been seen to stop the triggering of T2D and morbid obesity in individuals having pre-diabetes (Brown & Kuk, 2015). As a result, early diagnosis and management of pre-diabetes can avoid its crossover to complete onset diabetes and thus reduce the related problems (Brown & Kuk, 2015, p. 79).

Given that diabetes educational interventions have been a successLittle is known about how patients respond to Diabetes Self-Management Education (DSME), the goal of this study will be to measure the awareness and knowledge of metabolic syndrome/pre-diabetes risk factors among obese patients (BMI >30) in an internal medicine/family practice clinic with a BMI >30. Th. The study makes use of a adopts a quantitative approach using a descriptive method and pre-post test research structure to determine subjects' understanding and knowledge of metabolic syndrome/prediabetes, and T2D. The pretests w.......nformation they gained from the intervention (DSME) and how they plan to use that information in their life. The results, will state the help in the advancement and improvement of the pre-diabetes and diabetes informative and knowledge-based self-management intervention programs.

Thereafter, tThis chapter places the research within the much larger framework of the scholarly materials and after that reaches up to a particular target audience while describing the idiosyncrasies of this DPI project such as background of the study, problem statement, purpose of the study, clinical question(s), advancing scientific knowledge, significance of the study, rationale for methodology, nature of the study, definition of terms, assumptions, limitations and delimitations and lastly, summary and organization of the remaining chapters.

Criterion

Learner Score

(0, 1, 2, or 3) Comment by Segovia, Julie H: Learner scores have not been completed these table need to be completed as a self-assessment

Chairperson Score

(0, 1, 2, or 3)

Comments or Feedback

Introduction

This section briefly overviews the project focus or practice problem, why this project is worth conducting, and how this project will be completed. (3-4 paragraphs or approximately 1 page)

1

Not clear what the project intervention is or what the project design is

Practice improvement project topic is introduced.

1

Not clear what the improvement is

Discussion provides an overview of what is contained in the chapter.

2

Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.

1

Review sentence structure, grammar and choice of words for scholarly writing

NOTE: Once the document has been approved by your Chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.

Score 0 (not present); 1(unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready).

Background to the Project

The frequency of identified diabetic issues amid U.S. adults has gone up twofold within the past four decades and seventy five percent in the past twenty-five years (NCD Risk factor Collaboration, 2016; Gregg et al, 2004; Centers for Disease Control and Prevention, 2006). The life-time danger of acquiring diabetes within the U.S. in 2000 had been 33% for males and 39% for females and this had been even greater amid U.S. minority communities (Narayan et al, 2003). Since 2000 research related to the life-time danger of acquiring diabetes could not be found in the literature.

BMI is a highly effective strongand flexible, yet controllable, risk element for diabetes (ADA, 2017; Ford, Williamson and Liu, 1997; Diabetes Prevention Program Research Group, 2002). Nevertheless, the outcome link between of prediabetes knowledge on and BMI hasn't been extensively examined (Arayan, James, Theodore et al, 2007). Medical experts use the Body Mass Index to determine whether a person is overweight, obese, normal or underweight. Its a determination of the ratio between a persons weight and their height (Lo, Wong, Khalechelvam and Tam, 2016).

The following are details of the findings from research, with regard to the relationship between the BMI ratio and diabetes. Relationship between BMI and Diabetes: Iit was found by Narayan et al (2007) that ones risk of developing diabetes in their lifetime is one in three, at the point of birth. He further noted that the risks of developing the condition across the categories of BMI over a lifetime are still unclear. The study sought to demonstrate the specific lifetime risks for the various BMIs for people in the US, based on sex, ethnicity and age subgroups (Narayan et al., 2007).

The survey data for the National Health Interview n=780, 694, from 1997 to 2004 was the basis for indicating race, sex, age, ethnicity and the prevalence of BMI-linked occurrence of diabetes in the US in 2004 (Narayan et al., 2007). The data from the US Census Bureau including age, sex-specific mortality, population rate projections and race were used along with two earlier studies relating to mortality, to project the mortality rates related to BMI ratios (Narayan et al., 2007).

The findings and estimates informed the Markov Model projection of the lifetime risks of diabetes diagnosed by race, sex baseline age and BMI. According to the results, the lifetime risk of developing diabetes at the age of 18 for underweight people was shot from 7.6 to and those who were obese was 70.3% between underweight people and those who were significantly obese. The figures also increased from 12.2 to 74.4 for women in the same weight categories. The difference in lifetime risk was lower at advanced ages. For example, at age 65, normal weight males had their lifetime risk difference rise from 3.7 to 23.9 points in percentages between overweight people and the ones regarded as very obese. The figure increased by 8.7 percentage points to 26.7 for women (Narayan et al., 2007a). It was also noted that the effect of BMI on the duration of diabetes compounded with an increase in ones age (Narayan et al., 2007b).

The risk of developing diabetes type II diabetes was investigated in a case control research by Ganz et al (2014) by studying its incidence versus BMI ratios. The rising effect of BMI, basing on BMI categories was also assessed. Those who recorded weights between 25 and 29.9 were labelled as overweight. And then there was the Obesity Class I who measured between 30 and 34.9. Class II Obesity group registered BMI index from 35 to 39.9. Obesity Class III on its part recorded figures equal to or over 40 (Ganz et al., 2014).

Relative risks and ratios regarding the odds were calculated from a range of logistic regression outcomes. Age, cardiac history, sex and hyper-inflammatory identified by erythrocyte sedimentation and C- r