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Diabetes in Lake County,


By Ashley Gran
Amy Neveau
Lisa Thornburg
Wendy Ackel
The United States Census Bureau in July, 2014 estimated Lake County to
have a population of 11,341. Median household income is $30,656
compared to Michigan's median income of $40,200.

The number of people per primary care physician (PCP) in Lake County is
5,749. The state of Michigan has 1,246 per PCP.

The population of Lake County rates 28.3% poor general health compared
to Michigan at 17.2%.

(District Health Department #10, 2015).

There is inadequate fruit and vegetable consumption at 83% and 18.1% of the
population often does not have enough to eat.

Those with a chronic condition of diabetes is high at 14% compared to local District
Health Department # 10 at 10.2%.

Poverty for all ages is at 31% in 2013 compared to Michigan at 17%.

Overweight and obesity are closely related to diabetes. The population is

overweight at 35.1% and those classified as obese are at 35.4%

(District Health Department #10, 2015).

Contributing factors
Social and economic factors affecting health are ranked at number 82. The
ranking is based on 82 counties. The factors related to diabetes are poverty,
education and unemployment.

Health behaviors are ranked at 79. This includes obesity, food environment
and physical activity.

Clinical care is rated number 77. This includes lack of health professional to
the population, uninsured and the need for diabetic monitoring.

Overall one in ten people have diabetes and one in five are over the age of 55.

(District Health Department #10, 2015).

Community health Improvement plan
The District Health Department #10 developed a plan to help the community
of Lake County.

Progress was made in poverty, access to preventive care, promotion of

healthier lifestyles and behaviors and creation and maintenance of healthy

Call to action for overweight and obesity

Enhancement to trails and parks

Food policy council, community health and chronic disease prevention

coalition have been developed
(District Health Department #10, 2015).
Problem Statement
Problem statement:
Adults of Lake County, Michigan are at a higher risk of acquiring type II
diabetes related to inactivity and poor diet as demonstrated by an increase
in the number of people who fall into the obesity category from the health
profile chart book for 2014 and for 2015.

(District Health Department #10, 2015).

(District Health Department #10, 2014).
Population Evaluated

We are looking at the residents of Lake County, MI because they

have a higher rate of deaths associated with type II diabetes than other
counties in district 10 of Michigan. (District Health Department #10,
Causative Factors
There are many risk factors for type 2 diabetes such as age, race,
pregnancy, stress, certain medications, genetics or family history,
high cholesterol and obesity. However, the single best predictor of
type 2 diabetes is overweight or obesity. (Obesity Society, 2015).
In 2014 the reported percentage Residents that were classified in the
obese category was 31.3%. (District Health Department #10, 2014).
In 2015, that percentage increased to 35.4%. (District Health
Department #10, 2015).
If we can decrease the number of residents who are overweight or
obese then we can in turn reduce the number of people who are
diagnosed with type II diabetes.
Health Indicator Changes
There are several health indicators that should change if residents
are able to lose weight.
These indicators include but are not limited to:
A decrease in the percentage of residents in the overweight and
obese categories
A decrease in the percentage of residents in the no physical
activity category
An increase in the fruit and veg 5x/day category
A decrease of the percentage of residents with diabetes

(District Health Department #10, 2015).

Community Assessment
Estimate the impact of a disease
1 in 2 adults with diabetes is undiagnosed
Lake County death rate higher than State of Michigan
Access to Healthy Food Options and Health Care
Rx for Health in Lake County Prescription from physician
that is filled at a local farmers market
Health Care access increased over last year
Obesity and Physical Inactivity Estimates
The Live Well Campaign Collaborative effort to promote
healthier lifestyles
Be Specific. What is the behavior that I will change?
Be Measureable. How often will I do this?
Be Attainable. I will not try to change too much at one time.
Be Relevant. If I become healthier and lose the extra weight, my
diabetes will be manageable/improved.
Be Time-bound. I will set my goals and start on Monday.
*Have a backup plan - If it is raining, instead of walking outside, I
will walk indoors on the treadmill at work.
*Reward yourself for achieving goals I will treat myself to the
movies if I follow my plan for an entire month.
Primary Prevention
Access to Health Education Classes
Education on Risk Factors
Reduction of Sedentary Behaviors
Ideal Body Weight Maintenance
Physical Activity
No smoking
National Diabetes Prevention Program (NDPP)
Secondary Prevention
Lake County Classes Offered
Diabetes PATH Manage and Take Control
A Matter of Balance Increase Activity Levels
Behavioral Counseling
Healthy Food Options and Education
Environment Improvement
Improved Park access
Community Center activities

The ultimate goal for this community project is to improve the health of
residents in Lake county, Michigan. Lake county has a higher rate of diabetes
compared to other counties in Michigan.

By implementing evidence based interventions based on SMART objectives,

the desired outcomes are to decrease the percentage risk of diabetes in

In order to assess whether the desired outcomes were achieved, the results
from nursing interventions must be evaluated.
Evaluation is the process of collecting and analyzing information to
assess the effectiveness of the plan in action for future planning efforts
and to improve and implement health promotion programs to provide
positive outcomes for communities. (Harkness & Demarco, 2016).
Evaluation is essential to understand whether a quality improvement
activity is accomplishing planned goals, whether goals and actions are
ultimately improving the health outcomes of the population, and what
adjustments are necessary. (AHRQ, 2008).
The six steps in the evaluation process:
Engaging stakeholders-those planning and directing the program and
Describing the program
Focusing and evaluation design-identifying the purpose of the evaluation,
methods, roles and responsibilities.
Gathering credible evidence
Justifying conclusions-when consensus is reached and evidence gathered is
Ensuring use and sharing lessons learned
(AHRQ, 2008)
Intermediate Outcomes:
Achieve and maintain a healthy weight
Obtain glucose levels in the target range of 70-110
Keep Hemoglobin A1c levels below 7%
Keep blood pressures below 130/80Keep cholesterol below 200 mg/dl
Monitor Long Term Outcomes:
Prevention of diabetes-related complications
Tracking incidence and prevalence of blindness, kidney failure, amputations,
and cardiovascular disease.
(District Health Department #10, 2015).

Evaluation of patient education programs: How to do it and how to use it (1996, p. 86-93).
American Diabetes Association. Retrieved from http://journal.diabetes.org/
Diabetes Care Quality Improvement: A Resource Guide for State Action (2008). Agency for
Healthcare Research and Quality (AHRQ). Retrieved from http://archive.ahrq.gov/
Area Agency on Aging of Western Michigan. (2016). Lake county classes. Retrieved from:
Hughes, K., Morse, J. (2015). District health department #10: 2015 annual report.
Retrieved from: http://www.dhd10.org/images/AnnualReportFY15compressed.pdf
District Health Department #10 Behavioral Risk Factor Survey. (2014).Health profile
chartbook 2014, Lake County. Michigan Behavioral Risk Factor Surveillance
System.Retrieved from: http://dhd10.org/files/Chartbook_2014_Lake.pdf
District Health Department #10 Behavioral Risk Factor Survey.(2015).Health profile
chartbook 2015, Lake County. Michigan Behavioral Risk Factor Surveillance System.
Retrieved from: http://dhd10.org/images/Lake_Chartbook__2015.pdf
Obesity Society. (2015). Your weight and diabetes. The Obesity Society. Retrieved from:
International Diabetes Federation. (2015). Diabetes: Facts and figures. Retrieved from:
Schulze, M.B., Hu, F. B. (2005). Primary prevention of diabetes: what can be done and
how much can be prevented? Annual Review of Public Health 26, p. 445-467. DOI: