NRS-441V Capstone Project

Professional Research Project1

Exemplar of Evidence-BasedPractice


Professional ResearchProject

(Student Name)(Grand Canyon University

(NRS 441V:Professional Capstone)



According to documented researches, type 2-diabetes prevalence amongyouths aged between 12-18 years has been on the rise. Most studiesindicate an increase of types 2 diabetes by 25 percent in the lasttwo decades this is due to increase of obesity which result from anincrease in body mass index and abdominal accumulation of adiposetissue. Preventing diabetes among the youth is important becausethere is no specific known treatment for an ailment. Thus, theimportant thing to do for the ailment is to follow all preventivemeasures as advised by the medics. This paper has described themeasure that can be taken to control this ailment. Most schools incollaboration with parent come together to formulate a plan to helpthem put control on diabetes. Example, of measures taken after themeeting, included encouraging exercises and placing control on thetype of food children were allowed to consume.

Keywords: type 2-diabetes, picot, body mass index and obesity

(Problem Statement- Module 1)

Professional Research Project

Type 2-diabetes has over the years increased among children andteenagers, recent epidemiological review claims that at least 8-45%cases of diabetes are type 2. The rise in type diabetes in teenagershas increased in parallel to the alarming increase in number ofteenagers becoming obese. Obesity is considered as a major cause oftype 2 diabetes. In the last 20 years the number of childrensuffering from type 2-diabetes have increased with little being doneto cub the disease.

(Support fromLiterature Review- Module 2)


In his book, Chiha noted that the menace surrounding patients withdiabetes mellitus is an increase of the coronary heart disease bythrice while compared to that of persons not suffering from diabetesmellitus. Furthermore, hypertension was signaled out as increasingthe diseases of the coronary and the renal ailment. On the otherhand, chubbiness which is associated with causing diabetes mellituswas perceived as due to lack of physical exercises. According toBurns and Grove, the medical standards and requirements of patientsmust be considered and adhered to. By this, the number of youthssuffering from persistent ailments and diabetes would be managed.

Also, change of the lifestyle was advised by the two as itcounteracts the disadvantages of diabetes. According to anobservation made, physical exercises of approximately thirty minutesa day lowers the lipid level and elevate glucose ingestion thus onehaving a good cardiovascular health. With this, it was observed thatphysical exercises reduce obesity and the diabetes ailment especiallythe type 2 diabetes. The report also showed that the inactive form oflife and the excessive intake of food have been a contributing factorto obesity. In return, the obesity has been fueling rates ofmetabolic disorder and the diabetes mellitus.

When one is not involved in physical exercises so much, the visceralrapids get concentrated and in return cause oxidative strain,discharge of fatty acids and, amplified rate of metabolic syndromeand irritation which cause an insulin confrontation and the diabetesmellitus.

On the other hand, Garnett undertook a research in the year 2010 andnamed it randomized control trial where he studied the efficiency oftwo controversial lifestyles basing his research on diet intake onthe insulin sensitivity. On another study carried out, it was foundout that the obese youths have an insulin resistance. The OGTT wasused rather than a fasting glucose, and it was found out that itcould be used to detect damaged glucose tolerance in the overweightyouths. After the test, a conclusion was reached upon that this typeof study was efficient as an earlier detection of the disease can beundertaken so as to avert metabolic impediment and cardiovascularailments in patients of diabetes mellitus.

Recent studies shows thatchildren are more prone to type 2-diabetes than the adults especiallychildren from Asian, African and Hispanic descent. The studiesindicated that in every 100, 000 children at least two or one of thechildren suffers from type2 diabetes.

Adolescents between the ages12-18 have been diagnosed with type 2-diabetes, and this has beenproved in a group paper that specializes in EBNP (Evidence-basednursing practice). The aim of the paper is to find the prevention ofdiabetic 11 through decrease in BMI, which has small effects on typeto 2-diabetes. The topic dealing with diabetes type 2 which affectsadolescent, has been discussed in several articles, and review on thesame topic has been carried out in the completed nursing research.


PICOT Question

Out of picot statement, whichtalks about how literature highlight about adolescent ages 12-18years have been affected with type 2 diabetes, a complex question hasbeen formulated. Using elements in the PICO format, importantclinical question are formulated as shown below

 P which representsadolescents between ages 12-18 years old diagnosed with type 11diabetes

 I which represent reductionbody mass index to regulate fasting blood sugar

 C which stand for comparepreventative intervention which is due to the reduction of body massindex in adolescents and ratio between the number of adolescents withincreased body mass index to adolescent diagnosed with type 11diabetes.

 shows how reduction in bodymass index is directly correlated to a reduction of fasting bloodsugar

 T in the PICOT represents thesix months

Articles Used For Review

The group members gatheredseveral articles, and fifteen articles were used for the literaturereview because they were relevant to the research been carried in theproject. According to Burn and Grove important literature, entailssources that are pertinent in providing information needed to study ahighlighted problem in details. The selections of the articles werebased on the quality information related to the PICO question.


According to the research done,there is an indication that there has been an increase in theincidence of T2DM in children and adolescents as opposed in the pastwhere the disease affected adult and old age. The increase of types 2diabetes by 25 percent in the last two decades is due to increase ofobesity which result from an increase in body mass index andabdominal accumulation of adipose tissue.

Out of the data collected by theNational Institute of Health more than two-thirds of men and womenailing from type 2 diabetes in the United States has body mass indexof more than 27 kg/m2. Logically, the risk of diabetes is directlyrelated to the body mass index. Research done by Nurses’ Healthindicates that when body mass index exceeds 22-kg / m2, developmentof diabetes start to increase in women with normal weight. Theincrease in diabetes is due to increase in intra abdomen fat mass,circumference of the waist and the ratio of the circumference of thewaist to the circumference of the hip. Also, there is an indicationthat increases in weight in the young age increases the risk ofailing from diabetes. Men and women, who are aged between 18-20years, and increased weight from 5 to 10 kg are likely to developdiabetes 3 times higher at the age 35 – 60 years compared to thosewho have weight varying between 2kg.

Study indicates that an increasein body mass index between age 18-20 years is an important riskfactor for diseases related to obesity, for example diabetes.Clinical attributes of insulin resistance and prediabetes have beennoticed in most of the adolescents, and this has been indicated inone of the expiration articles. According to Garnett, clinicalinsulin resistance and prediabetes in the pediatric populationexperiencing clinical issues with conclusion from genuine wellbeing.Through proper administration, clinical insulin resistance andprediabetes are reversible or in any situation their spread could bestopped (Garnett, et al. 2010),

Research is done by Tirosh in2011 on healthy men who were young examined and evaluated themwhether they were ailing from diabetes and heart diseases. Theconclusion made from the research was that diabetes result from bothbody mass index and obesity-related diseases. The research showedthat an increase in body mass index between ages 18 – 20 yearsentails an essential risk for obesity-related disorders in midlife.The conclusion from the study shows that the body mass index betweenages 18 – 20 years can be related to type 2-diabetes.

The only demerit about thearticles reviewed was the lack of evidence to show that decrease inbody mass index in adolescents decreases fasting blood sugar. Ideaswere brought up that when a person maintains health and wellness canlead to a reduction of the progress of type 2 diabetes. While theresearch carried out try to show interventions to be used to slow theprogress of type 2-diabetes, the study doesn’t show specificallywhich interventions to use, especially in a reduction of body massindex. Many parents and health providers do not recognize obesity inchildren, and this fact is one of the limitations found in thereviewed articles

The following are the highlightof the information found in the fifteen articles used for the reviewon diabetes among adolescent.

Article 1

The authors of this article areBurns and Grove, and they try to establish a relationship betweentheir body mass index and type to diabetes in the adolescents betweenthe ages 18 – 20 years. The article specializes on determining onreduction of the body mass index can minimize the chances of diabetestype 2 diagnosis. The role and need for carrying out of research innursing and other related fields are defined in this article.Defining in this article, entails a scientific process that canimprove as well as authenticate the available information and to comeup with new ideas that will affects the entire field of nursing. Dueto change in circumstances in the field of nursing, there is a needfor continued research and development of both new and alreadyexisting information and the article has contributed in thisinformation (Burns &amp Grove, 2011).

Article 2

The author of this article isChiha, and his aim is to establish a relationship between type2-diabetes and various cardiovascular diseases. According to theresearch done in this article, coronary arteries which result due tothe formation of waxy substances in the coronary artery may causetypes 2-diabetes, and the waxy substance further lead to clotting ofthe blood in the arteries which lead to blocking in the flow of bloodChiha, et al. 2012). Heart failure can also cause diabetes and theseresults from heart failing to pump enough blood which supposed tomeet all the metabolic processes being carried out in the body.

The article highlights that thedestruction of the internal components of the heart causes diabeticcardiomyopathy which is observed mostly among diabetic type 2patients. This article can be used in the effectively in the field ofnursing. The article has highlighted the way in which type 2 diabetescan cause other health diseases condition, for example, thoseaffecting the heart.

Article 3

In this article, the authorspecializes on the way through which diabetes type 2 could mitigate.One of the ways they recommend is the need for physical exercise asaway of controlling diabetes type 2 (Colberg, et al. 2010). Weightloss can be achieved through physical exercise, and as the researchindicates overweight increases the chance of developing diabetes type2. According to the article, those who have obesity have a highprobability of developing diabetic type 2 condition compared to thosewho do not have. The article encourages people to engage in bothphysical exercise and regulation of diet, for example, reduction ofintake of red meat and increase of intake of grains which are easilyprocessed in the body thus offering the best form of carbohydrates.The research in this article was carried in Minneapolis- St Paulhospital, and this make the information in this article to becredible.

Article 4

According to this articlediabetes type 2 patients suffer from both the antioxidant andanti-inflammatory condition which can be improved through physicalexercise.The article emphasize that one of the factors that promotediabetes type 2 is the inactivity of the body. The article highlightthe important of physical exercise as a mean through which bodymuscles can both use insulin and absorb sugar leading to reducedstrain on the cells that manufacture insulin. The information in thearticle about how the rising of developing type 2 diabetes can beminimize by 30 percent through taking a walk every day for half anhour was borrowed from Nurses’ Health Study and healthprofessional.

Research indicates that passiveactivities, for example, watching television can lead to thedevelopment of type 2 diabetes by 20-% and severe heart condition by15 %. The passive activities, for example, watching television, quickmean of transport and poor eating habit characterizes unhealthypatterns, and can increase the chances of developing type 2 diabetes.

Article 5

The authors of this articlehighlight the use of trial in the research of diabetes type 2 that israndomized. This trial requires people to be allocated randomly sothat they can get clinical intervention study as a mean of bothmeasuring and comparisons of various results from the participantemphasizing on the fact the approach is quantitative. The informationis advantageous to nurse who is in training still because its enablethem to handle cases of the diseases.

Article 6

The author of this articlediscusses how diabetes type 2 affects children at various stages oftheir development. According to the article, the number of childrenwith obesity has increased in the recent past, and this leads toincrease in a number of children with type 2 diabetes. The largenumbers of children found with obesity are between ages 4 – 18years, and the obesity is directly related impaired glucosetolerance. The article recommends that children suffering fromobesity should be given earlier diagnosis to prevent the developmentof type 2 diabetes. The information in this article is important fora person studying medical profession so as to help him or her toreduce the number of children suffering from type 2 diabetes.

Article 7

The authors of this article talkabout talks about the parents as a key contributor to obesity oftheir children at the early stage of their development. Parentbelieves that overweight as a sign of good health in children whoneed to be maintained. The article recommends parents to adaptfeeding habit which reduce the increase of obesity among children.

Article 8

The authors of this article areBialy and Haw, and this article highlights the important of propernutrition and dietetics in controlling the development of diabetestype 2. The nutrient that people observe in the body contains highlevels of glycemic which according to the article it is harmful tothe body if taken excess. According to the article drinks whichcontain high-sugar level lead to chronic inflammation, hightriglycerides and increased insulin resistance. The best drinks tohave instead of sugary drinks are water, tea and coffee.

Article 9

The article states that theoverweight among children relates to their daily lives which may leadto the development of diabetes type 2. The article advocates the useof WAVE screener tool which can determine the level of effects ofdiabetes type 2 among students. The procedure enables the medicalstudents have the ability to relate the various aspects of life tothe development of type 2 diabetes, for example, body weight, dailyactivities and various excesses in life.

Article 10

The authors of this articlediscuss the impact of body mass index on type 2 diabetes. Accordingto the research in this article, people with body mass index above 25percent are likely to fall ill compare to people below the level. Thestatistics collected all over the world differs according to variousraces, for example, a person from Asia with body mass index of 27scores is at a risk of ailing from diabetes type 2.

Article 11

This article highlights the waysin which a diabetic patient can be taken can. The article show hownurses can take care of the diabetic patient through various ways,for example, weight control measures, proper weight and physicalexercises. The other ways of taking care of the diabetic patient areinsulin injection for a patient with high-blood sugar level, andregular blood tests through HbA1c test.

Article 12

The article aims at finding asolution to persons who have developed diabetes. This condition takeslong to manifest itself and occurs when living cells fail, and bodymuscles do not respond to insulin. The article enables students toexperience reality of type 2-diabetes and its impact among people.

Article 13

The authors of the articlehighlight the preventive measures to be used among children andadolescents suffer from the condition, for example, proper diet andweight watching.

Article 14

This article specializes onmitigation of diabetes among pregnant women who have the likelihoodof transferring the disease to the unborn children. The article showshow nurses can take care of pregnant women at their pre – natal andpost – natal phases.

Article 15

This article talks about the wayimproper eating causes diabetes type 2, for example consumption ofjunk foods which have a high level of cholesterol which causesblockage and blood vessels. In the long-run, the blockage inhibitsthe flow of blood thus leading to the development of types 2diabetes.

To sumup on the articles, the research on diabetes type 2 was carried outon patient ages 12 – 18 years. The main intervention, theresearchers, concentrated on is the reduction of body mass index.From the study, both the parents and the nurses should take care ofthe health of young children in order to prevent the development ofdiabetes type 2.

Implementation (From Module 3 Plan)

Controlling Diabetes among Adolescent

Health matters are becoming a worldwide concern where some ailmentsare perceived to as having greater impact on the patient. One of theailments listed in the group of hazardous ailments is Diabetes.Diabetes Mellitus or the type 2 ailment is among the most dreaded.The ailment over the time has been on the rise and posing a difficulttask of dealing with to medics. This is because it requires moreattention for its prevention as there is no specific known treatmentfor an ailment (Henley, et al. 2012). Thus, the important thing to dofor the ailment is to follow all preventive measures as advised bythe medics. One of the preventive measures among the youths in theUnited States of America was coming up with an execution scheme.Those who feel in the category were those of age 12-18 years. Thepurpose of the plan was to lay down all the strategies of dealingwith the disease so as to avoid its spread and contraction in thefuture. Also, this was a step which would avoid the snag caused bythe disease if it is not controlled and in the later stages.

Account of the Predicament

According to rankings done in the United States in the year 2012,Diabetes occupied position seven. According to the report, thepopulation of 9.3% of the American people was diagnosed with thedisease in that year. Also, the report showed that people of age20years and over were only two million. The diabetes ailment wasperceived to be on the rise as in the year 2007 only $174 billion wasused to treat the ailment but in the year 2012 the government used$245 billion. On calculations, the rise in the ailment is perceivedas 41% rise (Centers for Disease Control and Prevention (CDC). 2014).The percentage was given a good concern as it was perceived aselevating the number of never ending and the non-communicableailments.

Theoretical Part of Diabetes

In the United States, there was an increase in concern about thedisease as the largest population affected was that between 12-18years. One of the suspected reasons as to why the ailment was on therise was the genetics of the youths. Some other reasons of thedisease spreading were viewed as the insufficient physical exercisesamong the youths and the inactive behavior which has exposed theyouths to vulnerability of contracting the ailment (Kriska, et al.2013).

The findings were obtained from 699-youths who were suffering fromthe disease and tested 2 years earlier for diabetes mellitus. Also,the youths were found to having a BMI, which was more than 85percent. The study carried out showed that a large number of themodern youth is very inactive thus being venerable of contracting thetype 2 diabetes. The obese youths were advised to be involvingthemselves in more vigorous activities so as to control diabetesmellitus or the type two ailments.


Evaluation (From Module4 Plan)

Coming Up With an Execution Scheme


The scheme of controlling the diabetes was to be put in place afterpermission was granted by several bodies including the parents, theschools and health centers. The plan was to put in place physicalexercises which would be walking for two and a half hours per week.Nutrition also will do a great deal in controlling the situation.After the research, the ailing person will be monitored for acontinuous half a year.

Anticipated Resolution

So as to come up with the good health of youths ailing from diabetesmellitus, physical exercises and enlightening line up were importantso as to elevate production of the youths and reducing further spreadof the ailment. The ailments scheme was to center on the modificationof lifestyles. Some of the ways to control the ailment were listed asdietary therapies, heaviness loses policies, controlling thelifestyle among others. Also, an educational campaign to the youthstelling them the purpose of weight loss was another strategy.

Underlying Principle

A number of researches carried out pointed out the importance ofpolicy allied to the lifestyle outline and physical exercises whichhave indicated elevation of the BMI and weight reduction among theyouths ailing from diabetes mellitus. It was observed that it wasimportant to educate the youth about way of life adjustment.


In the field, there were three ways pointed out for controlling thedisease. The first was pre-design evaluation, design scheme and theaccomplishment. The plan was to be controlled to the finish of itall. Also, it was considered of importance taking into account theculture of the organization and that of the healthcare giver.


For the purpose of laying out a plan, the scheme calls for the humanand machine resources. The human part involves the medics.

Forming an Assessment Scheme

Designing a scheme after execution is very vital as it assist ingauging the results and their effectiveness to the targeted aim. Anevaluation scheme is termed as an article containing all theinformation of the scheme, the control of the scheme and theassessment tactics which are later used to make the appropriateresolution. Evaluation being considered an expensive process and timeconsuming includes processes as the setting up, execution, collectionof information and examination as well as reporting and distribution.

Methods of Evaluation

Some of the ways of evaluation includes outcome and presentationtrials, indicators and the sources of information so as to assist inconvincing information for the assessment scheme. So as to evaluatethe type 2-diabetes deterrence scheme, a survey among the specificgroup should be carried out. This survey should be done with the aimof looking at the alterations in the lifestyles which in return canbe used to avert the diabetes mellitus.

Therefore, the survey is always advisable to be conducted after thepersons carrying it out acquire permission from the institutes,parents and the research partakers. Before the main survey is carriedout, a pre-survey is always advisable to be carried out so as to getthe complete information of the sick people. After this, the ailingperson will regularly be checked for quarter a year so as to indicatean improvement in the health of the patient. On a weekly basis, thehealth of the patient is entitled to be checked.

After the three months of regular checks, the main survey is carriedout where the outcomes are analyzed. The results are then comparedwith those of the pre-survey so as to detect any improvement inhealth and to give some alterations that could be associated to thechanges in health. The alterations are then linked to the targetedaim of the prevention scheme of the diabetes.


Health pointers of the ailing person, evaluation of facts and theattitude concerning the ailment, the ways of averting and treatingthe ailment are the learning variables. These variables are laterbroken into some groups:

Socio-Demographic Distinctiveness

This will cater for the ailing persons’ education, number of years,sex, and ethnicity among others.

Fitness Status

Information contained in this document is the patient’s lab testresults which include the weight, BMI among others. The purpose ofthis is to indicate any important improvement in the patients health.

Routine Pattern and Activities

The information contained in this document include the activeness ofthe patient in physical exercises, food preference, alcohol andtobacco consumption.


To evaluate the patient’s knowledge, the medics pose questions tothe patients concerning the indication of the ailment, ways ofevasion and some obesity allied impediment.


Feelings towards the ailment can be known be asking of questions andpertaining the avoidance and treatment of the ailment.

Educational Tools

After the assessment of the scheme, it is always advisable to teachall the participants who are the ailing persons, the medics and thekey persons in the mission. Results gotten from the assessment arecrucial as they can be used to alter and improve the scheme.

Furthermore, the findings can be used to improve future course ofaction. The ailing person participating in the scheme is alwayspre-educated concerning the ailments and its prevention and cure.Later, an appearance meeting is carried out in the institution withthe aim of enlightening other learners about the merits of heavinessadministration for the rationale of averting diabetes mellitus andchubbiness. Methods which can be used to spread the findings can bethe mass media including the magazines, news papers, the social mediaand usage of emails.

Evaluation gear

So as for the avoidance scheme to be effective, there is a need forappropriate gears to be developed. Among the many gears is thequestionnaire which will be used to carry out the research. Thisdocument is later used as an evaluation gear and can be used to getinformation before or after the survey.

Information on the questionnaires is later used on the patient tofind more from the patient concerning the way of life. Some of thedetails included in the pre-survey can include the patients point ofview of the inactive form of life, improvements due to participationin physical exercises and many other questions. Therefore, all theinformation from the patient concerning diabetes mellitus can becompared with that of the real survey to and the implementationdocument.

Distributing Proof

After the survey has been conducted it’s always advisable todistribute the gained information gotten from the activity. Some ofthe most important things to distribute are the results and thewrapping up of the report. This is perceived as crucial as it willgive a loophole for interventions from other sources and thus fuelingup action from all concerned parties.

With the evident results, it becomes easier to disperse theinformation to the society and the administration thus the healthsystem will use the capital to put off and heal the ailment.

Research findings are later evaluated, and they give the importanceand aims of the diabetes deterrence scheme. Also, the methods used tocarry out the research are written down, and the learning propose andthe precautionary measures. After this, the findings can be inprinted in the journals and the mass media for the purpose ofspreading the details.

Importance to the Nursing Field

It is always advisable to have a team work between the researchersand the medical team as this will give the two parties a platform forpartnership. With this partnership, the perfect practices and ethicsare practiced enhancing the improvement of the patient`s needs. Thisin return place nurses in a better position to build on their work tothe community and far from the centered health system.

Promotional activities of the health team are entirely tied toevidences thus making it crucial in giving out the appropriateinformation and make it accessible to everybody. Furthermore, itassists in scheming for the results and making them meaningful. Muchattention should be based on the conclusions and not only to theanalysis given to the result.


Brownson, R., Ballew, P., Brown, K., Elliott, M., Haire-Joshu, D., &ampHeath, G. et al. (2007). The effect of disseminating evidence-basedinterventions that promotes physical activity to health departments.American Journal of Public Health, 97(10), 1900. Dataretrieved from,on 4th of July, 2014.

Chiha,Maguy.,Njein, Mario., Chedrawy, Edgar G. (2012). Diabetes andCoronary Heart Disease: A Risk Factor for the GlobalEpidemic.&nbspInternationalJournalof Hypertension, 2012(1),1-7, doi: 10.1155/2012/697240.

Colberg,S.R., Sigal, R.J., Fernhall, B., Regensteiner, J.G., Blissmer, B.J.,Rubin, R.R., Chasan-Taber, L., Albright, A.L., &amp Braun, B.(2010).Exercise and type 2 diabetes.DiabetesCare,33(12), e147-e167. doi: 10.2337/dc10-9990

Centers for Disease Control and Prevention (CDC) (2014, June 13). CDC- National Diabetes Statistics Report, 2014 – Publications – DiabetesDDT. Data retrieved from, on 3rdof July, 2014.

Centers for Disease Control and Prevention (CDC), &amp Centers forDisease Control and Prevention (CDC). (2011). National diabetes factsheet: national estimates and general information on diabetes andpre-diabetes in the United States, 2011. Atlanta, GA: USDepartment of Health and Human Services, Centers for Disease Controland Prevention, 201. Data retrieved on 3rd ofJuly, 2014.

DeLemos, E.T., Oliveira, J., Pinheiro, J. P., &amp Reis, F.,(2012).Regular physical exercise as a strategy to improve antioxidantand anti-inflammatory status: Benefits in type 2 diabetesmellitus,&nbspOxidativeMedicine and Cellular Longevity,&nbspdoi:10.1155/2012/741545.

Developing an Effective Evaluation Plan. Atlanta, Georgia: Centersfor Disease Control and Prevention (CDC), National Center for ChronicDisease Prevention and Health Promotion, Office on Smoking andHealth Division of Nutrition, Physical Activity, and Obesity, 2011.Data retrieved from,on 4th of July, 2014.

Garnett, S. P., Baur, L. A., Noakes, M., Steinbeck, K., Woodhead, H.J., Burrell, S., &amp Chisholm, K. (2010, September 24). Researchingeffective strategies to improve insulin sensitivity in children andteenagers-RESIST. a randomized control trial investigating theeffects of two different diets on insulin sensitivity. BMC PublicHealth, 10(575). doi:10.1186/1471-2458-10-575

Goodell, S.L., Pierce, M.B., Bravo, C., Ferris,A., (2008). Parental Perceptions of OverweightDuring Early Childhood.Qualitative Health Research,18(11),1548-1555. doi:10.1177/1049732308325537. Retrieved from

Henley, S., Toburen, A., &ampHowsden, L. (2012). Evidence BasedAdolescent Type 2 Diabetes Prevention. Data retrieved from,on 3rd of July, 2014.

Kramer, M., McWilliams, J., Chen, H., &amp Siminerio, L. (2011). ACommunity-Based Diabetes Prevention Program Evaluation of the GroupLifestyle Balance Program Delivered by Diabetes Educators. TheDiabetes Educator, 37(5), 659–668. Data retrieved from, on 4th ofJuly, 2014.

Kriska, A., Delahanty, L., Edelstein, S., Amodei, N., Chadwick, J., &ampCopeland, K. et al. (2013). Sedentary behavior and physical activityin youth with recent onset of type 2 diabetes. Pediatrics,131(3), 850–856. Data retrieved from,on 3rd of July, 2014.

Makrilakis, K., Liatis, S., Grammatikou, S., Perrea, D.,&ampKatsilambros, N. (2010). Implementation and effectiveness of thefirst community lifestyle intervention programme to prevent Type 2diabetes in Greece. The DE-PLAN study. Diabetic Medicine,27(4), 459–465. Data retrieved from,on 3rd of July, 2014.

Planning and Implementing A Logistics System Design Activity (2009).U.S. Agency for International Development. USAID | DELIVERPROJECT. Data retrieved from,on 3rd of July, 2014.

Teixeira de Lemos, E., Oliveira, J., P`ascoaPinheiro, J., &ampReis, F. (2012). Regular physical exercise as a strategy to improveantioxidant and anti-inflammatory status: benefits in type 2 diabetesmellitus. Oxidative Medicine and Cellular Longevity, 2012.Data retrieved from, on3rd of July, 2014.

Wing, R., Lang, W., Wadden, T., Safford, M., Knowler, W., &ampBertoni,A. et al. (2011). Benefits of modest weight loss in improvingcardiovascular risk factors in overweight and obese individuals withtype 2 diabetes. Diabetes Care, 34(7), 1481–1486. Dateretrieved from, on 3rdof July, 2014.

WHO, (2014). Choosing evaluation methods. World HealthOrganization (WHO). Data retrieved from,on 4th of July, 2014.