Diabetes.

1. 1 Introduction The global issue addressed in this paper is diabetes, the incidence of which has increased significantly in recent years. Diabetes threatens the health and lives of more than 400 million people (Ford et al., 2021). However, according to research, a healthy diet and 150 minutes of physical activity per week significantly reduce the risk of diabetes (Ford et al., 2021). Nevertheless, most people have low health literacy and motivation to apply these measures and require education on this topic. This research aims to analyze and synthesize evidence of good quality from three quantitative research and three non-research sources to present the problem of diabetes and justify the intervention to address it. Analysis of the Practice Problem Diabetes mellitus is a severe problem in all countries of the world, including the United States. Although diabetes is not a fatal disease, high blood glucose levels negatively affect blood vessels and, as a result, harm the functioning of all organs (World Health Organization, 2021). People living with diabetes can face such complications as vision loss, kidney disease, heart disease, and tissue death, leading to limb amputation (World Health Organization, 2021). More than 400 million people are living with diabetes in the world today, while 34 million and 88 million Americans have diabetes and prediabetes, correspondingly (Ford et al., 2021; Centers for Disease Control and Prevention, 2021). Simultaneously, 1.5 million people died in 2019 from diabetes-related causes (Centers for Disease Control and Prevention, 2021). While a part of the population has a higher risk of morbidity due to adverse socio-economic conditions and limited access to medical services, most people are faced with diabetes due to a sedentary, unhealthy lifestyle. It is possible to state that the problem of diabetes in the US is serious because the preventable disease is becoming more threatening to the population.

2. 2 The US government and health care system needs to take action to promote diabetes prevention in the population. This solution also has economic advantages for the country, as compared to the cost of treatment of diabetes and its consequences, prevention programs are not expensive. According to the Centers for Disease Control and Prevention (2021), the economic cost of diabetes in the US is $327 billion per year. When it comes to Maryland, a non-research source reveals that diabetes results in essential disadvantages for this state. According to the American Diabetes Association (2020), more than 500,000 people in Maryland have confirmed diabetes, while 1.6 million people are diagnosed with prediabetes. As a result, annual spending on diabetes in the state of Maryland is approximately $7 billion (American Diabetes Association, 2020). However, preventive measures aimed at reducing the incidence of diabetes and avoiding its consequences can significantly reduce these costs. Thus, diabetes prevention is a significant health issue in the United States and the national health care system, both from a perspective of people’s well-being and economic cost. Evidence Synthesis Analysis of the literature has also demonstrated that diabetes is a severe problem that requires research and prevention. Ford et al. (2021), Mathe et al. (2017), and Pham and Nguyen (2019) focused on diabetes and assessed how it is possible to mitigate the burden of this disease in the population. (Appendix A). For example, the authors of the three articles were unanimous in highlighting the harmful effects of diabetes on human health, talking about its dangers to the functioning of the heart, blood vessels, and the fragility of bones. In particular, Ford et al. (2021) and Mathe et al. (2017) focused on the well-known adverse consequences of diabetes, such as an increased risk of heart and vascular disease. Simultaneously, Pham and Nguyen (2019) considered a lesser-known effect of diabetes, such as an increased risk of fractures. Pham and

3. 3 Nguyen (2019) found this complication to be associated with a low trabecular bone score in people living with diabetes. These findings demonstrate that there is no doubt that diabetes is a significant health issue at the national level. Scientists focus on problematic issues and options for solving them. Mathe et al. (2017) and Ford et al. (2021) considered this measure and found that most people at high risk of diabetes do not do the recommended amount of exercise or other activity, namely 150 minutes per week. More precisely, Mathe et al. (2017) found that only 10% of respondents performed the recommended amount of physical activity per week, while in the study by Ford et al. (2021), the recommendation was followed by 24.8% of the participants. For this reason, the interventions should be directed toward solving the problem of insufficient physical activity. Researchers mention the need to take action to increase physical activity in people with prediabetes or diabetes but take different approaches. Ford et al. (2021), in contrast to Mathe et al. (2017), not only identified the problem but also developed an educational program to determine whether the provision of information can increase the physical activity of participants and reduce the risks associated with diabetes. The study demonstrated that lectures and personalized meal plans for participants positively impacted their lifestyles and reduced the risk of diabetes (Ford et al., 2021). However, this program did not include the information on increased bone fragility found by Pham and Nguyen (2019). It is worth admitting that Pham and Nguyen (2019) identified a more robust connection between diabetes and bone fractures in women than in men. Thus, the research results demonstrate that an intervention such as an educational program adjusted for the US cultural context and findings of an increased risk of fractures should be used to prevent diabetes and its consequences. Practice Question

4. 4 The practice question is: In people with prediabetes (P), does the education program to increase physical activity (I), as compared to current practice (C), lead to reduced incidence of diabetes (I) over 8 weeks (T)? Selecting a Translation Science Model Regarding the intervention under analysis, the Knowledge-to-Action translation science model seems appropriate. This model stipulates that any practice change initiative should be supported by research activities. This approach implies that turning evidence into practice is a dynamic, iterative, and complex problem. When it comes to the proposed intervention to address diabetes, this practice change project should accumulate sufficient knowledge to identify the most appropriate action plan. Since the Knowledge-to-Action translation science consists of two components, it can serve as a framework for implementing the practice change project. On the one hand, the knowledge creation component stipulates that the first step is to find, synthesize, and evaluate data on a selected topic. On the other hand, the action cycle element is helpful in understanding how the identified knowledge can be implemented. Researchers can rely on this framework to develop practice change projects in various medical fields. It is also reasonable to explain that various stakeholders are integrated into the model under analysis. Firstly, healthcare researchers play a crucial role during the knowledge creation phase. Secondly, medical practitioners access the obtained results and implement them during the action cycle stage. Finally, this phase also contributes to the fact that patients receive improved care that leads to better health outcomes. This information demonstrates that the Knowledge-to-Action model covers and offers benefits to all the essential stakeholders, which will finally result in improved medical care and better population health.

5. 5 Conclusion The analysis of the information above demonstrates that diabetes is a severe health problem in the United States and Maryland, in particular, as the disease is becoming more and more prevalent among Americans, mainly due to the lack of preventive measures. However, a simple intervention such as educational programs for people at high risk of diabetes aimed at promoting healthy habits and active lifestyles can reduce this problem. The research presented in the paper demonstrates that people need information about healthy eating and safe ways to increase physical activity to reduce the risks of diabetes. Thus, this intervention will promote the health of the population as well as reduce the costs associated with diabetes treatment, which is a significant benefit for the national health care system.

6. 6 References American Diabetes Association. (2020). The burden of diabetes in Maryland [PDF document]. Retrieved October 09, 2021, from http://main.diabetes.org/dorg/docs/state-fact- sheets/ADV_2020_State_Fact_sheets_MD.pdf Ivypanda Study Blog. (2024).Diabetes Mellitus: Symptoms, Types, Effects Essay. https://ivypanda.com/essays/diabetes-mellitus-symptoms-types-effects/ Centers for Disease Control and Prevention. (2021). Cost-effectiveness of diabetes interventions. Retrieved September 20, 2021, from https://www.cdc.gov/chronicdisease/programs- impact/pop/diabetes.htm Ford, C. N., Do, W. L., Weber, M. B., Narayan, K., Ranjani, H., & Anjana, R. M. (2021). Moderate-to-vigorous physical activity changes in a diabetes prevention intervention randomized trial among South Asians with prediabetes - The D-CLIP trial. Diabetes Research and Clinical Practice, 174. https://doi.org/10.1016/j.diabres.2021.108727 Ho-Pham, L. T., & Nguyen, T. V. (2019). Association between trabecular bone score and type 2 diabetes: A quantitative update of evidence. Osteoporosis International, 30(10), 2079– 2085. https://doi.org/10.1007/s00198-019-05053-z Mathe, N., Boyle, T., Al Sayah, F., Mundt, C., Vallance, J. K., Johnson, J. A., & Johnson, S. T. (2017). Correlates of accelerometer-assessed physical activity and sedentary time among adults with type 2 diabetes. Canadian Journal of Public Health,108(4), 355–361. https://doi.org/10.17269/cjph.108.5954 World Health Organization. (2021). Diabetes. Retrieved September 20, 2021, from https://www.who.int/news-room/fact-sheets/detail/diabetes

7. 7 Appendix A. Individual Evidence Summary Tool Article Numbe r Sample, Sample Size, Setting Observable Measures Evidence Level, Quality Findings That Help Answer the EBP Question ●Adults living with type 2 diabetes are highly sedentary and lack mobility. ●Activity level is related to gender and employment, since men and unemployed people spend more time for moderate- vigorous physical activity. ●A high body mass index is associated with a high sedentary time. ●Only 10% of adults living with type 2 diabetes comply with physical activity Author and Date Evidence Type Limitations ●People living with type 2 diabetes in Alberta, Canada. Respondent characteristics ●included a mean age 65.4 years, 46% female, ●88% married, 54% college education or higher, 39% employed. ●166 participants ●Home-based setting ●Sedentary behavior, light intensity physical activity ●(LPA) and moderate- vigorous physical activity (MVPA) – dependent variables ●Age, sex, education, marital status, employment status, ethnicity, and smoking status – independent variables ●Possible accelerometers’ errors such as inability to detect differences between sitting and standing and thresholds used to define intensity levels of activity were not adopted to older adults. ●Possibly the sample was formed from people inclined to diet and exercise ●Level III of evidence. ●Good quality 1. Mathe, N., Boyle, T., Al Sayah, F., Mundt, C., Vallance, J. K., Johnson, J. A., & Johnson, S. T. (2017). Correlates of accelerometer-assessed physical activity and sedentary time among adults with type 2 diabetes. Canadian Journal of Public Health, 108(4), 355–361. https://doi.org/10.17269/cjph.108.5954 Non- experimental quantitative study

8. 8 guidelines. ●35,546 women and 4962 men aged 30 years and older. ●Home-based setting; Scientific databases. ●The results of the study demonstrated that diabetic patients have a much lower trabecular bone score (TBS) than non-diabetic people, which can explain the higher fracture risks with a higher areal bone mineral density. ●There was a more significant difference in results for women than men. ●People with prediabetes also had significantly lower TBS than non- diabetic people. ●Trabecular bone score (TBS) – dependent variable. ●Age, gender, and ethnicity, diabetes – independent variables. ●The association between TBS and glucose levels might not be linear. ●The discrepancy of sample sizes and measurement of variables. ●Cause association between ●Level I of evidence; ●Good quality 2. Ho-Pham, L. T., & Nguyen, T. V. (2019). Association between trabecular bone score and type 2 diabetes: A quantitative update of evidence. Osteoporosis International, 30(10), 2079–2085. https://doi.org/10.1007/s00198-019-05053-z Quantitative systematic review

9. 9 ●The intervention included classes and individual plans to promote increased MVPA to over 150 minutes per week, 7% weight loss, and dietary changes. ●Metformin was used when needed in an intervention group. ●The number of respondents who reported more than 150 weekly minutes of MVPA has grown exponentially. ●The increase was due to the addition of minutes to exercise sessions and the number of exercises per week, ●Independent variable is a participation in a lifestyle education program. ●Dependent variable is moderate-to- vigorous intensity physical activity (MVPA) ●Demographic measures are gender, age, type of prediabetes, IBM, waist circumference, income, education, history of diabetes, etc ●Self-reported questionnaire that was not validated; ●Respondents were not blinded to treatment allocation; ●Genetic data was not included. ●Level I of Evidence; ●High quality 3. Ford, C. N., Do, W. L., Weber, M. B., Narayan, K., Ranjani, H., & Anjana, R. M. (2021). Moderate-to-vigorous physical activity changes in a diabetes prevention intervention randomized trial among South Asians with prediabetes - The D-CLIP trial. Diabetes Research and Clinical Practice, 174. https://doi.org/10.1016/j.diabres.2021.108727 https://www.diabetesresearchclinicalpractice.com/article/S0168- 8227(21)00080-2/fulltext Quantitative study Randomized Control Trial ●573 individuals with prediabetes from Chennai, India; ●Clinical and home-based setting.

10. 10 although the most recent change was more frequent. ●The greatest effectiveness of the program was after six months, after which the respondents' MVPA began to decline. ●Respondents who used Metformin and exercise had a 32% lower risk of prediabetes. Permalink: https://chamberlain.primo.exlibrisgroup.com/permalink/01CUCON_INST/f6kb8f/cdi_doaj_primary_oai_doaj_org_article_ 8fbd40815c8f44349a3b3ab1796d467d (Links to an external site.)