Mississippi Diabetes Prevention and Control Program

Introduction

Abstract

Diabetes mellitus type 2 is a common type of diabetes that is a as a result of either the body failing to produce sufficient insulin or the cells in the human body ignores the insulin; which is a vital element for the human body to be able to digest glucose for energy, failure to which results to diabetic complications such as heart disease and stroke, blindness, high blood pressure, kidney disease, amputations and nervous system disease. A large number of Americans have been diagnosed with diabetes mellitus type 2 and a majority of them are not informed of the risks of diabetic complications. The American Diabetes Association (A.D.A) reports that 7.8% of the American population which equates to 23.6 million people has diabetes. It also infers that diabetes is responsible for many deaths in America (Knowler et al 2002). Type 2 diabetes is prevalent among the African Americans, Latin Americans, Native Americans and the Asian Americans. Recent surveys have reported worrying trends concerning the number of people with diabetes in the state of Mississippi and the resulting diabetic complications. The objectives of Mississippi Diabetes Prevention and Control Project include: reduce the incidences of diabetes mellitus type 2, increase awareness of the risks of diabetes type 2 among the African American community in Mississippi, development of wellness programs aimed at a healthy nation that is diabetes free, prevent the complications associated with diabetes in Mississippi, estimate and evaluate diabetes related health disparities in Mississippi state.

 

 

Statement of need / organization to be served

The US obesity trends indicate that 51% percent of the blacks living in the United States suffer diabetes mellitus type 2 complications (CDC 2004). In Mississippi 8.9 out 100 adults have diabetes type 2, making it the second state with the highest number of diabetic people. 24.2 out of 1000 deaths are as a result of diabetes making rank 33^rdwith the lowest death cases as a result of diabetes. During 2005, the number adults diagnosed with diabetes was 206,000 and by 2007, the total number of population diagnosed with diabetes amounted to 11% of the total population. In Mississippi, the African American community has a high rate of this type of diabetes mellitus type 2. The priority of Mississippi Diabetes Prevention and Control Program is to examine the prevalent increase in diabetes mellitus type 2 among the African American community living in Mississippi and establish preventive measures to combat diabetes type 2 and improving the life of individuals already diagnosed with this kind of diabetes. The magnitude of the problem worsens due to the majority of the population are not well informed of the risks associated with diabetes and the complications that arise due ignored diabetes treatment. The sole purpose of the project is to reduce the incidences of diabetes mellitus type 2 and increase the quality of lives of individuals living in Mississippi through increasing their awareness of the risks of diabetes mellitus type 2 and informing them of the cautionary measures against diabetes. As the survey indicates, if immediate attention and measures are not put in place, the diabetic complications and deaths in Mississippi State will get out of hand and reach extreme levels that will become disastrous and not manageable. There is no presently known cure for diabetes and this poses a major challenge in terms of curative measures towards diabetes. Although  preventive measures and awareness campaigns can be implemented to help reduce cases of diabetes, deaths and complications that are as result of diabetes in Mississippi and the whole of the United States (Manfred  2005).

Program Description

The Mississippi Diabetes prevention and control program will reduce the cases of diabetes and its complications and deaths resulting from diabetes through facilitation of awareness campaigns of the risks of diabetes. These awareness campaigns will be used to inform the residents of the Mississippi state some of the dietary measures they should observe in order to prevent diabetic infection. The program will implement the awareness campaigns through outdoor mass communication, focus groups, door to door visitation, internet forums and general sensitization of the public on the risks of diabetes complications. Included in the mass awareness campaigns will be dietary consultants who are equipped with enough knowledge on dietary measures to control diabetes, well trained and practitioner medical doctors with knowledge of diabetes and pharmacists who will advice the public on ways of managing diabetes once you are diagnosed with it.

The program will attempt to design and implement control measures aimed preventing and controlling a further increase in cases of diabetes. These will be realized through educating the residents of the Mississippi state about the preventive measures to help curb diabetes. Educative centers will be set up in the various public and private hospitals at Mississippi to offer both educative and consultative sessions to patients already diagnosed with diabetes and to the general public on the various means of prevention of further spread of diabetes.

Patients already diagnosed with diabetes will have easy access to the educative centers for dietary advice from our dietary consultants and medical doctors on ways of managing diabetes to reduce the risks of its complications. The residents of Mississippi will be informed of the risks of unmanaged diabetes and proper preventive measures of avoiding diabetes. On the whole the Mississippi Diabetes Prevention and Control project will result to a reduction in the incidences of diabetes and therefore a reduction in death cases related to diabetes. The project will also result to well informed public about diabetic issues and how to manage and control diabetes and this will improve the quality of lives of the residents of Mississippi particularly the African Americans.

Funding source

One of the potential funding sources to this project is the Mississippi State and Local government. One of the policies and top agenda of the Mississippi State local government is increasing the quality of lives of the people of Mississippi, one of the ways towards realization of that policy is to ensure that the resident of the Mississippi State live a healthy life; this can only be achieved if measures to combat diabetes and its related complications and deaths are put in place. This project will implement strategies to combat diabetes and educate the public on means of controlling and preventing the complications and deaths that are related to diabetes. Therefore the Mississippi Diabetes prevention and control project provides great avenues towards the realization of this policy set by the Mississippi State local government. Another reason why the Mississippi state government will be interested in funding the project is because the goals of the project are directed towards the general public interest and the outcome of the project will be of ultimate significance to the people of Mississippi State.

The project will be implemented primarily using state’s resources and therefore will not require initial heavy financial support; the use of the states resources such as state hospitals is in line with the Mississippi state local government policy of ensuring maximum utility of state’s resources resources.

Project implementation

Location

The Mississippi Diabetes prevention and control program will be implemented at Mississippi State; in all the counties in the state. The diabetes educative and information centers will be placed at the private and public hospitals in the Mississippi state that will give us the permission to do so. Majority of the hospitals in the area have been contacted and they agreed that diabetes educative and information centers can be established at their premises. Some of the hospitals that have already agreed for the establishment of such educative centers include: Pioneer Community Hospital of Aberdeen, Choctaw County Medical Center, Gilmore Memorial Regional Medical Center, Humphreys County Memorial Hospital, Madison County Medical Center, Northwest Mississippi Regional Medical Center, Greene County Hospital and many more. More educative centers will be established at the counties in Mississippi State at the urban trading centers such as Rayburn Trading Center in Carrollton.

The public awareness campaigns will be carried out on all the counties in Mississippi State along the major streets and open social places. The door to door campaigns will take place at the households in Mississippi with particular focus to areas inhabited by the African American community. The implementation of the project will be primarily focused at the Mississippi area with the view of expansion to other states in the future.

Included people during project implementation

The implementation of Mississippi diabetes prevention and control project will involve many participants with different capacities and roles during its implementation. Some of the people who will be included in the implementation phase include project team who are responsible for ensuring the realization of the goals of the project, the various hospitals management people, the governors of the various counties in the Mississippi state; as they form part of the signatories for the project implementation.

Other people also included during the implementation of the project include professionally trained dietary consultants and a team of well trained medical doctors who will be stationed at the various educative and information centers. Among the included people during the diabetes control program will be specially trained nurses with knowledge of handling patients diagnosed with diabetes mellitus type 2. The duty obligations of the nurses will be to provide required patients care in situation where the patient will require attention from a trained personnel.

People excluded during the project implementation

On assumption that the hospitals will provide us with a space on their premises to establish the diabetes educative centers, there will be no need to have specialized architects to design premises for the implementation of the project.

Other people that will be excluded from the project implementation will the various suppliers of the medical equipments that will be needed during the project. The technical personnel that will be needed temporarily will also be excluded from the project process. Such personnel include the people that will install the required equipments, the personnel that will be involved in the moving the equipments to the various designated destinations will also be excluded from the project process.

Project implementation

The implementation of the Mississippi Diabetes prevention and control project will be carried in the following two major phases

• Planning phase
• The actual implementation phase

 

The planning stage

The planning stage is the first stage towards the realization of the project’s objectives and its postulated goals and objectives. The planning stage is very important because it will facilitate the actual implementation of the project (Robert 1988). It involves coming up with the various strategies aimed towards the realization of the projects deliverables.

This stage will involve the survey of the potential areas for the establishment of the diabetes informative and educative centers. This will involve a survey of the available areas in the various urban centers and rural centers that are suitable for the establishment of the diabetes educative centers.

The planning stage will also involve coming up with strategies that we will use to look for dietary consultants and the medical doctors who have specialized in the treatment of diabetes. Strategies will also be established that are aimed towards the search for the necessary support staff members who will be required for the daily running of the projects activities.

This project planning phase will also include a survey plan on the distribution of the cases of diabetes type 2 in Mississippi State. These will aid in deciding in which areas to have more educative and information centers and more doctors and dietary consultants and the necessary support staff.

The planning stage will also involve developing a budget plan for the project. A detailed budgetary analysis and evaluation of the scope of the project will be required. The budget plan will base on the project scope so as to avoid premature closure of the project and to avoid working under budget constraints and tight time frames. Identification of required resources; both human and equipments required for the project will be done prior to the budget plan.

The final task in the planning phase will be coming up with a time frame for the implementation of the Mississippi Diabetes prevention and control project. The required time plan will be based strictly in accordance with the budget and the available resources. The time frame will is essential for description of how the project will be carried out.

 

 

The actual implementation phase

The implementation of the Mississippi Diabetes prevention and control project will entail performing a series of activities as outlined in the project plan. The actual project will be done in the following procedures:

The first task in project process will involve choosing the areas where the diabetic educative centers will be established prior to the survey of the Mississippi state. The locations that have been identified will be analyzed the surrounding environment evaluated to see if it will be conducive for the establishment of the educative and information centers.

The next task will be looking for the medical doctors who have specialized in the treatment of diabetes and dietary consultants who have full knowledge of dietary measures to combat diabetes. This will be done through announcement of the vacancies for the required personnel and subsequent interviews will be carried out so as to choose the best doctors and dietary consults. The interviews will also be carried out for the necessary supporting staff members who will be required for running of the daily operations of the project once the project has been put in place.

The third task during the implementation of the Mississippi Diabetes prevention and control program will be to survey the various areas of the Mississippi state and evaluate the distribution of the cases of diabetes to as to see which areas will need more educative and informative centers. This will be done through conducting a research on Mississippi State. The survey will also include an analysis of the level of diabetic complications so as to evaluate the need for mobile diabetic clinics and educative centers.

The next task of project implementation process will be contacting the suppliers of the required equipment and technical services. The necessary equipments will be needed early in time so as to facilitate the smooth implementation of the project.

The final task is this phase is the realization of the project goals and objectives. This involves putting all the resources together so that the project is up and running towards the achievement of the projects objectives. Some of the extra deliverables that will be done will include the introduction of mobile diabetes clinics and information center. This will be achieved through acquisition of truck that is spacious enough to accommodate all the equipments and the clinical personnel. Awareness campaigns will also be addressed through public campaigns. This will be done through the various mass media channel such as focus groups and internet forums. This will increase the awareness of the risks that come with diabetes type 2. Household campaigns will also be carried out in bid to further increase awareness of the diabetes type 2 and ways to help combat type 2diabetes, for those already diagnosed with type 2 diabetes; they will be advised on ways of managing the situation.

Project timeline and implementation tasks

Time	Duration	Task
Week 1	1 week	Recalling of project team members
Week 2	1 week	Geographical survey of Mississippi state area
Week 3	1 week	Data collection and analysis
Week 4	2 weeks	Establishment of informative centers at the hospitals
Week 5	1 week	Establishment of educative centers at the urban centers
Week 6	1 week	Acquisition of equipments for treatment of diabetes mellitus of type 2, exercising equipments and Medicare supplies.
Week 7	1 week	Acquisition of trucks for the mobile clinics and public campaigns
Week 8	2 weeks	Installation and testing of equipments for the project
Week 10	2 weeks	Interviewing of medical doctors ,dietary consultants, medical nurses and supporting staff for the program
Week 11	1 week	Cross-checking the various equipments functionality
Week 12	onwards	Starting of the program

 

 

Resources

Human resources

The Mississippi Diabetes prevention and control project will require human resources during and after its implementation. Some of the human resources that will be needed during the project include:

a)      Data analyst: Whose task during the project will be to take statistics in the Mississippi state about the prevalence of diabetes mellitus of type 2.It will be his/her task to provide an analysis and evaluation of the cases of type 2diabetes in the state of Mississippi. The project team will then base on the evaluations by the data analyst to draw conclusions and take necessary steps. Data analysis will also be carried periodically in order to monitor the progress of the project.

b)      Specialized dietary consultant: his/her main task during the diabetes control program will include advising patient of the dietary measures they should observe in order to prevent and control diabetes of type 2. He will also offer dietary advices to those already diagnosed with diabetes mellitus of type 2. The dietary consultant will also make sure that the correct diet is followed by the patients during their treatment course. The dietary consultants will also offer advise to patients about the exercises and activities that they will need in order to keep off diabetes mellitus of type 2

c)      Specialized diabetes medical doctor (podiatrist): his/her task during the program will be offering the treatment of diabetes mellitus of type 2 to patients already diagnosed with diabetes. It will also be his task to follow up patients to ensure that the treatment is administered completely. He will also administer diagnosis of diabetes mellitus of type2.

d)     Specially trained Medical nurses: their main job will be taking care of type 2diabetes patients who will need attention. They will also assist the medical doctors in administering of the treatments to patients with diabetes type 2. They will also follow up patients in cases where need will arise to ensure completion of the treatment.

e)      Public campaign staff: their main task will be to facilitate the public campaign awareness campaigns through the use of public address media. The public campaign staff will comprise of sound technicians, drivers of the customized trucks that will be used for moving from one location to another during the public campaigns.

f)       Professional physical exercise instructor: the main task of the instructor will be to coordinate physical exercise training session to the diabetic patients as per instructions of the medical doctors to the various patients.

Physical resources

The project will also require some physical equipment that will be used during its implementation and after. Some of the physical resources that will be required include:

a)      Type 2 diabetes treatment equipment: for this particular project we intend to use a HUAHANZHENSHEN DJT-4T Diabetes Treatment Instrument which is one of the newest equipments currently in the market that is used for treatment of type 2 diabetes (). The choice of this equipment was arrived at because of its safety and durability, it also does not pierce the skin as other equipments do, it does not have any side effects and in addition it offers natural therapy. The equipment will be used to offer treatment of diabetes type 2.

b)      Exercise equipments: physical exercising is one of the best ways to prevent and control type 2diabetes (). Many people in Mississippi do not have access to professional exercise equipments. Therefore, part of the project will be to control and prevent type 2 diabetes through physical therapy and therefore the need for physical exercises equipments. The physical exercise training equipments will be placed on majority of the areas in Mississippi State.

c)      Diabetes Medicare supplies: this will be a major requirement during the kick-start of the project. The Medicare supplies will be used mainly to administer the treatment of type 2 diabetes to the patients. The Medicare supplies will include therapeutic shoes and inserts; which will include depth inlay shoes and custom molded shoes. It Medicare supplies will also include a number of insulin pumps and the insulin that will be used in the pumps.

d)     Custom made trucks for mobile clinics and public awareness campaigns:  the need for mobile diabetes clinics is due to some patients residing in areas that they cannot have access to our services and due to some patients having severe complications such that their movement is limited. The customized trucks will also be used for the public awareness campaigns in Mississippi.

e)      Other miscellaneous equipments that will be needed to implement the project include furniture, sanitation facilities, stationary and the required medical tools and apparatus.

 

 

Data collection and analysis

Data collection methods

The research methods will be aimed at obtaining qualitative data and quantitative data. The main primary data collection methods that will be used during the research include

a)      Questionnaires

b)      Direct interviews

c)      Focus group interviews

d)     Observation

 

Questionnaires

Very precise questions will be developed and the questionnaire will be distributed in the various counties in the Mississippi state with major focus at the area where the African American community are living. The questions formulated will be very precise. The questionnaire will be carried on a periodical basis to monitor the progress of the project. A sample questionnaire that will be used during research is shown below.

 

THE MISSISSIPPI DIABETES PREVENTION AND CONTROL

Questionnaire

Name…………………………………………………… Today’s date……………………………

Date of birth ……………………………………………

Address ………………………………………………   Telephone No. …………………………

BACKGROUND

1. Ethnic origin (please tick one)

 African American          Latin America

 American Indian            white American

 Other

2. What is the highest level of school you attended?  (circle one)

1 2 3 4 5 6         7 8 9 10 11 12 13 14 15 16         17 18 19 20 21 22       23+                            (Primary)                                         (High school)                                 (College/university)          (Graduate sch.)

3. Marital status (please tick one)

 Married  Single divorced  widowed ` separated

4. Please specify which chronic condition(s) that you have (tick where appropriate)

diabetes type 2 diabetes type1  high cholesterol  high blood pressure

heart disease    lung disease

 Other chronic diseases specify……………………………….

 I don’t know/ I have never been diagnosed

GENERAL HEALTH

1. Generally, you would say your health is        (please tick one)

Excellent   Good          Fair         Poor

 

SYMPTOMS

1. Do you know the symptoms of type 2diabetes?                                       Yes No 

(Please tick one)

If yes what are the symptoms that you know of?

……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….

2. Would you notice if a diabetic person was near you?                                Yes No 

(Please tick one)

Currently are you in any diabetes Medicare scheme?                                       Yes No 

(Please tick one)

 

3. Have ever suffered from type 2 Diabetes? (Please tick one)                        Yes No 
4. Have your family members ever suffered from type 2diabetes?                  Yes No

(Please tick one)

5. What are some of the efforts you as an individual are undertaking to help you avoid suffering from type 2diabetes?

…………………………………………………………………………………………………

…………………………………………………………………………………………………

…………………………………………………………………………………………………

6. Do you know of any preventive and control measures against type 2diabetes?

Yes No 

7. If yes what are some of them?

…………………………………………………………………………………………………

…………………………………………………………………………………………………

…………………………………………………………………………………………………

…………………………………………………………………………………………………

…………………………………………………………………………………………………

8. What are some of the government’s efforts and non governmental organizations efforts that you know of that are aimed towards preventing and controlling of diabetes mellitus of type 2?

…………………………………………………………………………………………………

…………………………………………………………………………………………………

…………………………………………………………………………………………………

…………………………………………………………………………………………………

…………………………………………………………………………………………………

Would say my visitation was helpful?                                                               Yes No 

(Please tick one)

Any other comments or suggestions you would like to add

…………………………………………………………………………………………………

…………………………………………………………………………………………………..

 

Direct interviews

Direct interview will be carried out on a one-on-one approach at the various households and along the urban centers in Mississippi State. It will be conducted also at the various places of work, shopping centers and along the streets in the urban areas of Mississippi State. The interview form will be structured and based on personal opinion.

The direct interview will be carried out by specialized diabetes doctors in the various hospitals at Mississippi State. The specialized doctors formulate questions of their choice in order to gather information related to type2 diabetes.

Focus group interviews

Focus groups will be formed at the various counties of Mississippi State in order to evaluate their knowledge of type 2 diabetes. The focus group meetings will take place twice on every week and the various group members interviewed by a diabetic specialized doctor.

The focus groups will also be trained on ways of preventing and controlling type 2 diabetes. They will then get back to the communities in the Mississippi state and get research on data relating to the prevalence and information on diabetes mellitus of type 2 in Mississippi.

Observation

Observational case studies will be carried at the various locations in Mississippi State. Some of the locations where observation will be done include the entry points of the various hospitals in Mississippi, the various shopping centers and schools. The cases of type 2 diabetes and its complications will be noted down and the extent to which the complications have reached will also be recorded for qualitative data analysis.

Data analysis

The various approaches to data analysis will be deployed to evaluate the data gathered during the research phase

a)      Qualitative  data analysis

b)      Quantitative data analysis

Qualitative data analysis

Comparisons and contrasts will be evaluated from the various observational points, the direct interviews and the focus group interviews. Analysis will then be carried out to evaluate the distribution of cases of type 2 diabetes and complications resulting from diabetes mellitus of type 2. The earlier formulated hypotheses will be tested for their viability and nullity after the evaluation and analysis of the data collected from the observational methods. Some of the qualitative methodology approaches that will be used include the constant comparison theory

Quantitative data analysis

This will involve the evaluation and in-depth analysis of data extracted fro the questionnaires. The various comparisons and contrasts will be evaluated with regard to the cases of diabetes mellitus of type 2 in Mississippi State. The distribution and variations in distribution between the various locations in the Mississippi state will be evaluated and conclusions drawn from the above evaluations.

Evidence supporting program efficacy

The measure of successfulness of a project is solely dependent on the implementation of similar projects in different locales (Jack 1983). A similar project was implemented in New York during 2008 by the New York Department of health and mental hygiene. Before the implementation of the diabetes control program, cases of diabetes type 2 and its complications were very prevalent in the state of New York.  The research indicated that majority of the population in New York did not know any information concerning type 2 diabetes and its complications. Over 70000 people living in New York had Diabetes and almost 30000 people had no idea that they had diabetes. Research also indicated that more than 100000 had poorly controlled diabetes and were at risk of diabetic complications such as heart attacks, blindness, and failures in the kidney, stroke and amputations of the body parts. It also noted that diabetes type 2 is epidemic in New York and all over the country due increased obesity levels. It also indicated that over the last 15 years, cases of diabetes had doubled in New York ().The diabetes control program in New York advocated for policies that were aimed at managing the lifestyles of people living in New York with the goal of preventing and controlling diabetes type 2 complications.

The outcomes of the control program was that the prevalence of diabetes mellitus of type 2 in New York reduced significantly over a short period of time. Periodical data collection in New York continue to indicate that the prevalence of type 2 diabetes continue to decrease significantly. The awareness level of the population regarding to type 2 diabetes increased and majority of the population in New York are more conscious towards their lifestyles such as their eating habits and smoking habits.

Basing on the above research and drawing analogies to the New York Diabetes control program, on assumption that the project will be well received well by the people of Mississippi; the project will be able to realize its goals and objectives.

Program evaluation

The program evaluation phase will involve a systematic data collection method, analysis of the collected data and using available information to evaluate the efficiency of the Mississippi Diabetes prevention and Control Project. The program evaluation will be based on both qualitative and quantitative evaluation. The program evaluation paradigm that will be used to evaluate the efficiency of the program is the positivist approach. The program evaluation will be divided into the following phases:

a)      Doing evaluation

The evaluation process will be carried out all stages during the program’s development cycle. It will entail assessment of the project’s cost and efficiency, evaluation of the program’s outcome, assessment of the how the project is being practically implemented and assessment of the need for the project.

Needs assessment

The needs assessment will examine the target population that the project is intended to be implemented to see whether there is a problem that the project intends to provide solution for. This will involve recognition and analysis of the actual problem in Mississippi that the project will be trying to address. Some of the perspectives that the needs analysis will put into consideration include what category of people are being affected by type 2 diabetes, how widespread is type 2 diabetes in Mississippi and measurable effects of diabetes in Mississippi.

Accessing the outcome

The outcome evaluation will be used to measure the casual effects of the project on the target population. It will involve an evaluation to determine if the project will accomplish its postulated goals and objectives. Impact analysis will involve comparison in the cases of type 2 diabetes and its complications between different periods of time in order to determine the magnitude of the improvement per given time.

Process evaluation

This will entail an analysis to evaluate how the project will be implemented. The evaluation will be used to determine if critical project components that are necessary for its success are implemented in the program. Some of the parameters that will be used to determine process analysis include an analysis if the people of Mississippi are receiving the intended services, if the staff is adequately qualified in their undertakings. Process analysis will be carried periodically to monitor effective implementation of the program

 

 

 

 

 

Efficiency evaluation

The cost-benefit analysis will also be carried out to evaluate the efficiency of the project with regard to cost. Comparison will be drawn between the benefits and cost of the program.

 

b)      Determining causation

Determining causation will involve an analysis of to determine if the project will be causing changes that will be observed during the research. Causation will be based on impact analysis of the outcomes of the program once implemented.

Budget

 

 

Project summary

The goal of this proposed program is primarily to reduce cases of type 2 diabetes and its implications and increase the awareness of type 2 diabetes among the people of Mississippi particularly the African American community. The Mississippi diabetes prevention and control project was motivated by the need to reduce diabetic complications and death cases as a result of type 2 diabetes. To achieve this goal, the program will initiate new methodologies aimed at increasing public awareness of the risks of diabetic complications, sensitizing the public on ways to check their dietary habits and advising the public on the importance of exercising the body in regulation of the body glucose to combat type 2 diabetes. The anticipated outcome of this program is the reduction in cases of type 2 diabetes, incidences of diabetic complications and a reduction in deaths that are as a result of diabetes in Mississippi. The project will increase the public’s awareness of the preventive measures to combat diabetes mellitus of type 2.

References

 

 

Andrew L.W. (1997). Managing the patient with type II diabetes. Sudbury: Jones & Bartlett Learning.

Barrett T.G (September 2001). Best Practice & Research. Clinical Endocrinology & Metabolism.Retrirved from http://dx.doi.org/10.1053%2Fbeem.2001.0149 accessed on 2010 October 30, 2010.

Brian J. Welch, MD and Ivana Zib.  Clinical Diabetes. Retrieved from http://clinical.diabetesjournals.org/content/22/4/198.full accessed on 29th October 2010.

Centers for Disease Control and Prevention (CDC) (November 2004). MMWR. Morbidity and Mortality Weekly Report 53 (45): 1066–8. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5345a2.htm accessed on  October 30, 2010.

David E. D, Terry Z. (2005). The Type 2 Diabetes Sourcebook.  New York: McGraw-Hill Professional.. 

Farrell J.B, Deshmukh A, Baghaie A.A .(2008).  The Diabetes Educator. Retrieved from http://dx.doi.org/10.1177%2F0145721708323100  accessed on October 30, 2010.

Gwen H. (2007).Providing Diabetes Care in General Practice: A Practical Guide to Integrated Care: London: Class Publishing Ltd.

Jack K.(1983). A theory of qualitative methodology. In R. M. Emerson

Contemporary field research. Prospect Heights, Ill.: Waveland.

Knowler W.C, Barrett-Connor E, Fowler SE, et al. (2002).The New England Journal of Medicine. retrieved from http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1370926 accessed on 29^th October 2010.

Manfred G.(2005). Prevention of type 2 diabetes. New York: John Wiley and Sons.

Mark N. F, Mary A. B(2008)Type 2 diabetes mellitus: an evidence-based approach to practical management. New Jersey: Humana Press.

quantitative research. Newbury Park, Cal.: Sage Publications.

Robert P. Gephart (1988). Ethnostatistics: Qualitative foundations for

Rolka D.B, Narayan K.M, Thompson T.J, et al. (2001). Diabetes Care. Retrieved from http://dx.doi.org/10.2337%2Fdiacare.24.11.1899 accessed on 2010 October 30, 2010.

Steven .L, Richard D.(2008). Management of Type 2 Diabetes Mellitus: A Practical Guide.Sydney: Elsevier Health Sciences. 

 

 

.