DiabetesDiabetes mellitus happens because the body is not able to produce or respond to insulin appropriately. Insulin is a hormone that is required by the body in order to absorb and utilize glucose to provide fuel for cells in the body. If the insulin system does not signal properly, the blood glucose levels elevate which results in a host of abnormalities and serious complications. The three most common forms of diabetes are Type 1, Type 2, and gestational diabetes.

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At Risk
In this community, minority populations are more frequently diagnosed with type 2 diabetes. The average age-adjusted rate of mortality between 2009 and 2011 for this population was 13.0 per 100,000 individuals. The prevalence of diabetes in this area is 11%. In addition, 6.2% of individuals in this area report they have pre-diabetes. In terms of insurance coverage, diabetes is highest for participants of Medicaid and those diabetics without insurance at increased risk compared to individuals with private insurance.

Significance
People with diabetes go through tremendous life changes, which include taking medication, insulin injections, special diet and regular exercise. Self-management is necessary to maintain levels of blood sugar, which is a priority. Diabetes can also affect the physical, mental and social well-being of the individual. Diabetics are at increased risk for depression and due to the demands of living with the disease, social relationships may be impacted. The complications of diabetes have an impact on society. For example, diabetics are at increased risk for heart disease, kidney disease, eye problems, amputations, disability and death. Diabetes also has a direct impact on families and loved ones. The America Diabetes Association estimates the cost of diabetes averages 174 billion dollars per year from direct medical costs, disability, loss of work and mortality.

Resources
Although the area has many available resources and programs, there is a misalignment of these resources. For example, the county has an excess of inpatient capacity however there is a lack of outpatient facilities and community based resources. Further, these locations are not located to hotspot areas for Medicaid participants and the uninsured. There is a lack of standardization in coordination of care. Also, nurses are not being used at the top of their licensure. Lastly, the ratio of primary care providers and the population is far below the national average.

Other lack of resources in this population is limited access to fresh produce and access to walking trails. Also, there is a lack of prevention programs for diabetes, lack of screening and referrals and a lack of education for patients and their families. A lack of appropriate nutritional counseling is lacking in addressing cultural needs.

Conclusion
Diabetes is a significant problem within this community, with minority groups, the uninsured, and Medicaid participants at increased risk. This community has limited access to resources that would facilitate in self-management and preventative measures of diabetes, including fresh food access and walking trails. Also, there are limitations in terms of referrals, screening, and educational resources for both patients and their families. Diabetics face challenges in self-managing their disease, maintaining relationships, and employment. Further, diabetics are at risk for other chronic diseases and a host of physical and psychological issues. Noted areas of improvement include standardizing coordination of care and providing educational resources on self-managing diabetes. Nurses are positioned well to implement evidence-based practice initiatives in the context of providing educational programs and standardizing the coordination of care for this population. This gap in resources allows nurses to come to the forefront in finding solutions to improve the health outcomes of this vulnerable population.

    References
  • http://epodunk.com
  • United States Census Bureau: http://www.census.gov/2010census/
  • Maurer & Smith (2013): Community/Public Health Nursing Practice, 5th Edition
  • https://211longisland.communityos.org/zf/taxonomy/directory
  • https://health.data.ny.gov/Health/Medicaid
  • New York State Prevention Agenda https://apps.health.ny.gov/doh2/applinks/ebi/
  • https://health.data.ny.gov/Health/Medicaid‐ Inpatient‐Prevention‐Quality‐Indicators‐P/6kjt‐