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Description
Diabetes mellitus (DM) is a disease characterized by chronically elevated levels of glucose in the bloodstream. Glucose is a form of sugar that is used as fuel by the body’s cells. Blood glucose levels are usually tightly controlled and regulated through a negative feedback system. When this system fails, however, glucose can accumulate in the bloodstream. This system failure typically results from insufficient insulin release due to malfunctioning pancreatic beta cells or the body has developed a resistance to insulin. Excessive glucose accumulation contributes to chronic inflammation and the hardening of blood vessels in the body. This inflammation contributes to a multitude of debilitating health issues such as neuropathy, nephropathy, retinopathy, renal failure, and/or gangrene of the limbs. Additionally, DM is the 7th leading cause of death in the United States and its treatment comes with a significant economic deficit. While there is currently no cure, pharmaceuticals, dietary modification, physical activity, and weight control are the four main approaches for DM intervention and control. These four approaches each operate to regulate glucose using different biological pathways in order to reduce and regulate blood glucose levels. These pathways include improving insulin sensitivity and correcting pancreatic beta cell function. The purpose of this paper will be to provide an overview of type II diabetes mellitus (T2DM) as well as to review the physiological mechanisms involved with glucose control and finally to discuss the use and effectiveness of the main interventional approaches used with the treatment of T2DM: pharmaceuticals, dietary control, physical activity and weight control.
ContributorsWoods, Jessica M (Author) / Swan, Pamela (Thesis director) / Larson, Rachel (Committee member) / College of Health Solutions (Contributor) / Barrett, The Honors College (Contributor)
Created2019-05
Description
Introduction: The incidence of type 2 diabetes (T2D) in youth is projected to increase through 2060, especially in minority youth. Every Little Step Counts (ELSC) has demonstrated efficacy in reducing T2D risk factors in Latino youth. Documenting the adaptation of ELSC to a family diabetes prevention program (FDPP) could support future adaptation and scaling of FDPPs.Purpose: To describe the process that guided the adaptation of a culturally grounded evidenced-based DPP tailored to Latino families, with the aim of using the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) to classify adaptations.
Methods/Design: The approach that guided the adaptation involved community-based participatory research (CBPR) and phases commonly used to adapt health interventions. Inductive and deductive content analysis guided by the FRAME was conducted on data collected throughout the phases to identify and classify adaptations. Data was then triangulated with the entities involved in the adaptation, analyzed to determine the frequency and proportion of adaptations across the FRAME categories and levels, and cross tabulated.
Results: A total of N=66 adaptations were identified. Adaptations occurred with the highest frequency during the grant preparation and after the pilot study. Most adaptations were led by both the academic institution and community partners. Content modifications were most common. Prominent reasons for adaptation included organization/setting time constraints and integrating community partners’ and interventionists’ feedback.
Discussion: Study results align with the CBPR approach that guided the adaptation and the ELSC core tenet of integrating community partnerships throughout all aspects of the intervention. To efficiently track adaptations, consensus as to what constitutes varying levels of adaptation granularity (i.e., macro, meso, micro) is needed. While tracking adaptations can be time and resource intensive, tracking adaptations may support the development of strategies to tie adaptations to outcomes.
Conclusion: It is critical to determine when adaptations are needed to avoid a “culture of adaptation hyperactivity”. There is an opportunity to analyze past and future ELSC adaptations to better understand the intervention’s core tenets and the relationship between adaptations and outcomes. Future ELSC adaptations would benefit from considering how to incorporate feedback from diverse stakeholders and populations in preparation for scaling.
ContributorsDiaz, Monica (Author) / Shaibi, Gabriel Q (Thesis advisor) / Bruening, Meg (Committee member) / Shepard, Christina (Committee member) / Arizona State University (Publisher)
Created2024