Disease management in the setting of a clinic

HHS Prevention strategies that is of interest to you and relevant to advance practice nursing


Diabetes disease management in the setting of a clinic is a multicomponent, proactive and organized approach in order to deliver healthcare to every member of the society who has diabetes. Every aspect of the healthcare delivery system is embraced by the management with care focusing on the entire range of the disease along with its complications and preventions. The main goal of this prevention program is to improve the long and short-term economic or health outcomes among the diabetic population. The main elements of a disease management are: to identify the population of individuals with diabetes; using performance standards or guidelines to manage the people identified with diabetes; an information system to monitor and track the interventions and results; management and measurement of population and patient outcome. Other than that, the rest of the interventions can be merged in the management and might focus on: the health care system including care model changes, electronic system of information or practice redesign; the provider including decision support, feedback, education and reminders; the population or patient including telephone outreach call, feedback, reminders, DSME, and patient centered care strategies (Task Force Finding, 2000).

a) Provide a brief overview of the mission of the program.

The main aim of the intervention program is to decrease the economic burden of healthcare and management of diabetes on the patients so they can live a good quality life even with diabetes. Diabetes mellitus (DM) occurs when a person’s body cannot make enough insulin; a hormone, which the body requires to dissolve sugar (glucose) as a fuel for body cells. When the body does not dissolves glucose, different abnormalities take place leading to various complications (Diabetes, 2014).

The introduction of HbA1c has confused the people for diabetes diagnosis as it is still not fully satisfactory for some types of diabetes. New similar products are also under consideration that might help in preventing diabetes. Several evidence-based studies reveal that type 2 diabetes can be delayed or prevented which has stimulated different emerging researches in the healthcare sector; so it might be possible to decrease diabetes risk and complications by affecting different factors like dietary choices (Diabetes, 2014).

b) Define the community or population being targeted.

The target population for this study is low income minority adults aged 45-64 and diagnosed with type 2 diabetes in the U.S. The individuals under this population are the ones who cannot afford high priced healthcare treatments to prevent the disease. Twenty five percent of the minority population in the United States is suffering from type 2 diabetes. The majority of the minority includes Pacific Islanders, Native Hawaiians, Asian-Americans, American Indians, Latino/Hispanic-Americans and African-Americans. The prevalence rate of diabetes among the American Indians is two to five times as compared to the white people. At an average, the African-American adults are likely to have risk of diabetes 1.7 times more and the Puerto Ricans and Mexican Americas twice as much as well as the non-Hispanic of the same age group (Diabetes, 2014).

2) Define the health promotion / wellness topic: include background & clinical significance

A therapy that is appropriate and effective can delay or prevent the complications of diabetes; but twenty five percent of the people living in America are still not diagnosed while fifty seven million Americans’ glucose levels are still high, which increases the risk of diabetes in them and its development in their bodies over the years. Yet, very few of such individuals receive appropriate care which can prevent diabetes in them and that makes it very challenging for the health of the society (Diabetes, 2014). The main types of diabetes includes: type 1 diabetes which occurs when insulin is not produced by the body; type 2 diabetes which occurs when the body does not produce enough insulin and glucose is not dissolved; and gestational diabetes that is a common problem during pregnancy. This can lead to the possibility of C-section and development of type 2 DM after the pregnancy (Diabetes, 2014).

a) Describe the effect of the issue/topic on the client & community.

With the 45-64 aged population, the risk will continue to increase and different therapies have proved that comorbid macrovascular and microvascular complications would also needed to be tested (Diabetes, 2014). People in the target population lead a very inactive lifestyle and studies have proven that changing the lifestyle to suit particular changes would prevent diabetes; so the new approaches in public healthcare are taking place to monitor it in the higher level. The Diabetes Prevention Program showed that the changes in lifestyle of the older adults helped prevent or delay diabetes in the ethnic or racial minorities (Diabetes, 2014)

b) Describe the effect of the issue/topic on the health care system as a whole.

Different researches in the past five years have randomized the disseminated studies which have changed the whole structure of the Diabetes Prevention Program. Programs of proper duration and doses have reported loss of weight in four to seven percent along with improvement is risk factors of cardio metabolism within six to twelve months. Even though the Diabetes Prevention pan has provided a positive change and step in the prevention of diabetes, there still are a lot of challenges to overcome. The most important part is recruiting and training the effective workforce to mobilize them to deliver the best healthcare system. There is a large demand of public health care and there is an influence of environmental and social factors on the change of behavior as well including cultural and social norms, economic disparities and health literacy etc.(Venditti & Kramer, 2013).

3. Explain (in detail) program goals/interventions

The prevention program is tailored to achieve the needs of every person by changing their lifestyle and increasing physical activity (Diabetes, 2014). The program also teaches the behavioral skills which includes:

Self-monitoring and goal setting progress

Constructing social support for the new behaviors

Reinforcement of behavioral skills through positive self-talk and reward

Maintaining behavioral change through structured problem solving (Diabetes, 2014)

Campaigns for community wide interventions to promote physical activity are:

Involve different sectors of the community

Include multicomponent, broad based and visible strategies like risk factor screening, social support and awareness campaigns

Address risk factors of cardiovascular diseases including smoking and diet (Diabetes, 2014)

a) How are the goals carried out?

Mass media has spread all over the world in the recent years and that is the most reliable and accessible component that can address a larger population. Mass media can help to target the emotions of the people that would involve the entire family of the person with the disease to promote physical activity. The target population chosen in this program is the people whose beliefs have been formed over a long time making it challenging to convince them to change their ways. That is why the whole family has to be involved in order to help foster change in their physical as well as mental beliefs about their diet and behavior. The mass media campaigns are structured to:

Increase knowledge and awareness about the advantages of physical activity

Influence the beliefs and attitudes of the individuals regarding physical activity and dietary control

Modify the behaviors of physical activity among the target population

The messages of the prevention programs are transferred through billboards, television advertisements, radio, brochures, and newspapers as well as door-to-door campaigns (TCG, 2010). The family-based program interventions are attempted to change the behavior of the diagnosed individuals by using different strategies through increased family support and involvement. These programs include educational sessions in the community about diabetes, problem solving and goal setting management practices to spread the importance of physical activities etc. Such support systems focus on the modification of physical activities by maintaining, strengthening and building social networks in the society and making contact with maximum people diagnosed with diabetes, so that the shared experiences helps the vulnerable to accept and start preventing diabetes (TCG, 2001).

b) What organizations are involved in the program?

The Community Preventive Services Task Force is a nonfederal and independent panel of experts of public health, which provides different evidence-based recommendations and researches about policies, programs and services to prevent diabetes in older adults. The members of this task force are highly authentic and they represent a wide variety of expertise in policy making, practice and research in the preventive activities in the community, disease prevention, health promotion and public health (Task Force Finding, 2000).

4) Evidence-based literature to support the intervention / program

a) Find literature to support the need for the program.

The individuals who used the Prevention program experienced reductions in A1c and body weight. Similar to the progression that was expected before diabetes till the disease itself, the A1c levels showed average regression from the prediabetes range which were 5.7%-6.4%. The investigation further showed the digital therapeutics as a solution to present prevention struggle of cardiovascular and diabetes (Sepah, Jiang, & Peters, 201).

The Prevention team of Diabetes has trained more than 1200 professionals that are linked with community workers internationally as well as within the United States. The individuals trained for such tasks represent the prevention programs which includes community and senior centers, churches, military bases, fitness centers, hospital foundations, outpatient centers, care offices, Indian health services (IHS), health ministries and state departments etc. Currently there are more than forty intervention programs that offer such settings (Venditti & Kramer, 2013).The different strategies for goal setting with diabetic patients includes: addressing and identifying language, cultural barriers and numeracy, integrating clinical data and evidence-based rules, incorporating teams which includes pharmacists and nurses and other workers (Tsimikas & Gallo, 2014).

5) Assessment of resources

a) What resources are currently available?

Systematic Review: This is an important evaluation and assessment of the research findings which address specific issues. The researchers use organized methods for evaluating, assembling and locating literature of different topics following a specific set of criteria. Systematic review includes the explanation of the findings that are collected during the research studies. This might or might not include meta-analysis which is quantitative merging of data (Diabetes, 2014)

Randomized Control Trial: This randomizes the participants to two or more than two groups using different methods.

Cohort Study: This is a clinical research in which the people suffering from diabetes receive a follow-up or further treatment for it along with comparison with other groups who do not suffer from the same condition (Diabetes, 2014)

b) Is there adequate access to the resources?

The rating system is not fully accessible as it does not provide study design, additional effect over control, and meaningfulness of effect, effect size and statistical significance

Barriers to change / implementation

The variables of the design do not make it easy to find out the effectivity of some programs over the others. A challenge in the comparison of the studies includes the difference in design, setting, eligibility, intervention, duration and criteria. Without uniformity of the results, comparing different studies is challenging (Chou, Burnet, Meltzer, & Huang, 2015).

Long-term effects of the lifestyle interventions of the communities have not been tested properly. Some studies do show the follow-ups in the community right after the interventions but very few studies show follow-ups or their track after a year (Chou, Burnet, Meltzer, & Huang, 2015)


Within years of origination of the Diabetes Prevention Program, further studies were done to get important information into the modification of behavioral lifestyle to help individuals prevent type two diabetes and its risk factors. Different studies found out weight loss and delay of this disease in individuals after they made changes in their lifestyle and adopted the increase in physical activities. Different researches stated that diabetes prevention should focus on losing weight, which would be done by increasing physical activity (NIH, 2013).

Different analysis of Diabetes Prevention program has provided evidence that modifications in physical activities and dietary plans leads to weight loss and helps in reducing the risk factors that are linked with cardiovascular health and diabetes including metabolic syndrome, and high blood pressure. The target population of the prevention program used in this study is somewhat difficult to manage and persuade because they have adopted a fixed lifestyle at this stage after spending and experiencing different phases of life. Family support and involvement would help to increase awareness and modify the behavioral skills among the target population (NIH, 2013).


Chou, C. H., Burnet, D., Meltzer, D., & Huang, E. (2015). The effectiveness of Diabetes Prevention Programs in Community Settings. NYS Health Foundation.

Diabetes. (2014). Retrieved from Healthypeople.gov: http://www.healthypeople.gov/2020/topics-objectives/topic/diabetes

NIH. (2013). Diabetes Prevention Program. National Institute of Diabetes and Digestive and Kidney Diseases.

Sepah, C., Jiang, L., & Peters, A. (2015). Long-Term Outcomes of a Web-Based Diabetes Prevention Program: 2-Year Results of a Single-Arm Longitudinal Study. JMIR Publications.

Task Force Finding. (2000, December). Retrieved from The Community Guide: http://www.thecommunityguide.org/diabetes/supportingmaterials/RRdiseasemgmt.html

TCG. (2001). Behavioral and Social Approaches to Increase Physical Activity: Social Support Interventions in Community Settings. Retrieved from The Community Guide: http://www.thecommunityguide.org/pa/behavioral-social/community.html

TCG. (2010, March). Submit your email address to get updates on The Community Guide topics of interest. Retrieved from The Community Guide: http://www.thecommunityguide.org/pa/campaigns/massmedia.html

Tsimikas, A., & Gallo, L. (2014). Implementing Community-Based Diabetes Programs: The Scripps Whittier Diabetes Institute Experience. NCBI.

Venditti, E., & Kramer, K. (2013). Diabetes Prevention Program Community Outreach Perspectives on Lifestyle Training and Translation. NCBI.

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