Sara Kinne, Chinyere Portee, Deborah Schaefer, Jacqueline Swanton Ferris State University Nursing 350

  Would utilizing preventative measures to reduce BMI help to decrease the likelihood of developing type II diabetes? PICO

  Determine nursing implications in regards to the association of BMI of adolescents to the diagnosis of type 2 diabetes.  How to affect the rising numbers of patients who are struggling to manage chronic disease, specifically those that are obesity-related such as diabetes.  As a professional nurse, we are continuously looking for opportunities to assist in prevention measures to help reduce the number of young patients affected with diabetes. Introduction

  Articles were chosen according to their association to the PICO question, “ what does literature reveal about children, years of age who have been diagnosed with type 2 diabetes”?.  Using internet database searches, such as :  Ferris states University library  CINAHL  PubMed  Medline LITERATURE REVIEW STRATEGIES

  Researching Effective Strategies to Improve Insulin Sensitivity in Children and Teenagers - RESIST.  METHOD: A randomized control trial investigating the effects of two different diets on insulin sensitivity in young people with insulin resistance and/or pre-diabetes  OUTCOME: This study will inform clinical practice guidelines for adolescents with clinical insulin resistance and may assist in preventing metabolic complications, type II diabetes and early cardiovascular disease.  Garnett, S. P., Baur, L. A., Noakes, M., Steinbeck, K., Woodhead, H. J., Burrell, S., & Chisholm, K. (2010, September 24). Researching effective strategies to improve insulin sensitivity in children and teenagers-RESIST. a randomized control trial investigating the effects of two different diets on insulin sensitivity. BMC Public Health, 10(575). doi: /  Level I hierarchy LITERATURE REVIEW

  Body mass index and obesity in adolescents in a psychiatric medium secure service.  METHOD: A cross-sectional survey of body mass index (BMI) for patients using psychotropic medications and also known to have type II diabetes mellitus and hypertension to determine any relationship.  OUTCOME: Being overweight and obesity were very common in the young people studied and appeared to be related to the prescription of antipsychotics. Interventions are needed to reduce unhealthy raised BMI and prevent the physical complications of obesity.  Haw, C., & Bailey, S. (2011, May 17). Body mass index and obesity in adolescents in a psychiatric medium secure service. Journal of Human Nutrition and Dietetics. doi: /j X x  LEVEL II HIERARCHY LITERATURE REVIEW

  Adolescent BMI Trajectory and Risk of Diabetes versus Coronary Disease  METHOD: a prospective study of healthy young 17 year old men from the Israeli Army Medical Corps. The height and weight of participants were measured at regular intervals, with the first measurements taken when they were 17 years of age.  OUTCOME: midlife risk of diabetes is mainly associated with increased BMI close to the time of diagnosis, the risk of coronary heart disease is associated with an elevated BMI both in adolescence and in adulthood  Tirosh, A., Shai, I., Afek, A., Dubnov-Raz, G., Ayalon, N., Gordon, B., & Derazne, E. (2011, April 7). Adolescent BMI trajectory and risk of diabetes versus coronary disease. New England Journal of Medicine, 364,  LEVEL II HIERARCHY LITERATURE REVIEW

  New directions in childhood obesity research: how a comprehensive biorepository will allow better prediction of outcomes  METHOD: Australia’s Childhood Overweight Birorepository did a baseline study for longitudinal data collection. This study inolved blood samples for profiling.  OUTCOME: This is still in the experimental stages. The goal is early identification and prevention  Sabin, M. A., Clemens, S. L., Saffery, R., McCallum, Z., Campbell, M. W., Kiess, W., & Crimmins, N. A. New directions in childhood obesity research: how a comprehensive biorepository will allow better prediction of outcomes. BMC Medical Research Methodology, 10(100), Retrieved November 25, 2011, from  LEVEL III HIERARCHY LITERATURE REVIEW

  Prevalence of impaired glucose tolerance and insulin resistance among obese children and adolescents  METHOD: A study obese children and adolescents (body mass index > 95th percentile for age and gender) 4–18 years of age referred to the endocrine clinic of the Children’s Hospital at Tabriz University in a descriptive cross-sectional study. ­Fasting glucose, insulin, and lipid profile in all subjects were determined. Oral glucose tolerance test after eating 75 g/kg glucose was performed. Homeostatic model assessment was used to ­estimate insulin resistance. OUTCOME: With prompt identification and treatment of obese children with impaired glucose tolerance, it can be prevented from progressing towards DM II.  Ghergherechi, R., Tabrizi, A. Prevalence of impaired glucose tolerance and insulin resistance among obese children and adolescents. Therapeutics and Clinical Risk Management. Dovepress Journal: Volume 2010:6 Pages DOI: Therapeutics and Clinical Risk Managementhttp://dx.doi.org/ /TCRM.S12033  LEVEL III HIERARCHY LITERATURE REVIEW

  Most current articles within five years were selected  Inclusive review on the basis of their quality and relationship to a selected practice problem.  Children 12 to 18 years old with type 2 diabetes’  The identified population needed to have the ability to communicate and make their needs known.  Exclusive sampling criteria are those characteristics that cause a person or element to be exclude from the target population. Criteria for Inclusion / Exclusion

  For children and teens at risk, health care professionals can encourage, support, and educate the entire family to make lifestyle changes that may delay -- or lower the risk for -- the onset of type 2 diabetes. Such lifestyle changes include keeping at a healthy weight and staying active. New research findings will help determine effective ways to lower risk factors in high risk children. Prevention Strategies for Type 2 Diabetes and Obesity

  Research shows evidence that several risk factors including obesity, dyslipedemia, and hypertension in children and adolescents have a significant role in elevating the risk of insulin resistance (Ghergherechi and Tabrizi, 2010).  With the rise in childhood obesity there has also been a considerable increase in the number of adolescents that show clinical characteristics of insulin resistance and pre-diabetes (Garnett, et. Al, 2010).  Elevated BMI on adolescence “constitutes a substantial risk for obesity-related disorders in midlife” (Tirsoh, et. al, 2011).  The study by Tirsoh, et. al, 2011, concluded that the BMI of adolescents can be a forecaster of type 2 diabetes; the threat is not detached from what is foreseen by BMI in adulthood. Findings and Recommendations

  longitudinal data collection  blood samples for genetic, metabolic and hormonal profiles  National and international harmonisation of data and sample collection will achieve required statistical power,” (Sabin, M. A., Clemens, S. L., Saffery, R., McCallum, Z., Campbell, M. W., Kiess, W., & Crimmins, N. A., 2010)  8 experts in the field of adolescents diabetes.  cross-sectional survey of routinely collected data, BMI (Body mass index), serum cholesterol, and psychotropic medication use, (Haw, C., & Bailey, S. (2011, May 17). STUDIES

  The patient population that we focused our research on was adolescents; age  Interventions that our research focused on were decreasing the BMI in our patient population. We wanted to see if decreasing the BMI would help to decrease the likelihood of developing type II diabetes.  We did not have definitive evidence that decreasing BMI would decrease the FBS (fasting blood sugar)  However, we did have results that indicated decreasing the BMI will either slow the progression of Diabetes Type II, or prevent from happening. Summary

  Burns, N., & Grove, S. (2011). Understanding Nursing Research. Maryland Heights: Elsevier Saunders.  Centers for Disease Control and Prevention. (2011). Diabetes at a Glance. Retrieved from:  Garnett, S. P., Baur, L. A., Noakes, M., Steinbeck, K., Woodhead, H. J., Burrell, S., & Chisholm, K. (2010, September 24). Researching effective strategies to improve insulin sensitivity in children and teenagers-RESIST. A randomized control trial investigating the effects of two different diets on insulin sensitivity. BMC Public Health, 10 (575). doi: /  Ghergherechi, R., Tabrizi, A. Prevalence of impaired glucose tolerance and insulin resistance among obese children and adolescents. Therapeutics and Clinical Risk Management. Dovepress Journal: Volume 2010:6 Pages DOI: and Clinical Risk Managementhttp://dx.doi.org/ /TCRM.S12033  Goodell, S.L., Pierce, M.B., Bravo, C., Ferris, A., (2008). Parental Perceptions of Overweight During Early Childhood. Qualitative Health Research, 18 (11), doi: / Retrieved from  Haw, C., & Bailey, S. (2011, May 17). Body mass index and obesity in adolescents in a psychiatric medium secure service. Journal of Human Nutrition and Dietetics. doi: /j X x REFERENCES

  Isasi, C. R., Soroudi, N., Wylie-Rosett, J. (2006). Youth Waver Screener: Addressing Weight Related Behaviors With School Age Children. The Diabetes Educator. 32.3, p Retrieved from: &v=2.1&u=lom_ferrissu&it=r&p=AONE&sw=w  Linchey, J., and Madsen, K.A., (2010). State Requirements and Recommendations for School-Based Screenings for Body Mass Index or Body Composition. Preventing Chronic Disease Public Health Research, Practice, and Policy, 2011, September, 8(5): A101. Retrieved from: =pubmed =pubmed  Overview of diabetes in children and adolescents. (2011, June). In National Diabetes Education Program. Retrieved November 25, 2011, from REFERENCES

  Sabin, M. A., Clemens, S. L., Saffery, R., McCallum, Z., Campbell, M. W., Kiess, W., & Crimmins, N. A. New directions in childhood obesity research: how a comprehensive biorepository will allow better prediction of outcomes. BMC Medical Research Methodology, 10 (100), Retrieved November 25, 2011, from pdf  Tirosh, A., Shai, I., Afek, A., Dubnov-Raz, G., Ayalon, N., Gordon, B., & Derazne, E. (2011, April 7). Adolescent BMI trajectory and risk of diabetes versus coronary disease. New England Journal of Medicine, 364,  Type 2 diabetes in children and adolescents. (2000, March). Diabetes Care, 23 (3), Retrieved November 25, 2011, from /RelativeResourceManager/sfsid/ REFERENCES