During this, last ten years, in the state of Texas, the prevalence of this practice problem Diabetes Mellitus shows an increased number of population affected and a higher cost for treatment (Johnson, E. P. et al., 2019). The overall percentage of mortality rate in Texas during these last two decades has increased by 2 % in females and 6 % in males due to communicable diseases, non-communicable diseases, and injuries. According to GBD (2018), Diabetes Mellitus ranked in seventh position in the year 1999 and ninth position in the year 2019, and the associated risk factors, which leads to mortality rate are high body mass index, high fasting plasma glucose, high blood pressure, kidney dysfunction, and high alcohol use.
Diabetes Mellitus, a chronic disease that affects multiple systems in patients often gets readmission due to the complications after the initial discharge. Nurses have to use critical thinking and proper judgment to assess the diabetic patients while they are in the hospital to identify the complications and to intervene without delaying the treatment. Nursing care becomes challenging especially with the ic population geriatrics and pediatrics due to the age factor, inability to comprehend the education, memory-related issues (dementia) for the senior citizens, or the language itself. All these factors could become a barrier to do self-management care, which is the most priority education and intervention be done to maintain the targeted glycemic index. Health care Organizations, which has a partnership with the different national diabetic committees takes control of implementing policies and protocols and updates the data of the mortality rate. In Texas, the high mortality rate due to Diabetic Mellitus is because of kidney diseases, septicemia, heart diseases, and stroke. The quality of care be evaluated after a new intervention or a new policy is implemented.
One of the stakeholders who are extremely helpful to identify prediabetes, gestational diabetic, diagnosed diabetic patients are called as Diabetic Prevention Program (DPP) sites. DPP sites emphasize to take data from each county and provide education and preventive techniques towards this practice problem. The DPP considered one of the powerful tool for health care team members to educate and give attention to each county and employers and work partnership (Johnson, E. P. et al., 2019). Another stakeholder identified in the state of Texas is the Diabetic Education Program (DEP) sites. The difference between DPP and DEP is the DEP is a 12-month program including several workshops provided for the patients and does a quarterly follow-up. Every 3 months the patients are checked for the HbA1c and based on the outcome do the intervention and education modifications (Ory, M. G. et,. 2020). Other stakeholders identified are the nurses, patients, family members, ancillary services, health care providers,s, and pharmacists.
Our Organization identified a gap in knowledge in the patients doing self-management care focusing on diet and exercise. After identifying the patients with diabetes and complications of diabetes in the hospital there was, a team implemented which consists of diabetic educators, dietitians, nurse educators, wound care nurses, and dialysis managers. The team members as their role will meet with each patient and implement a plan in collaboration with the patient on self-care management. The feedback was great by the family members because this education provided the patients and the family members to think from a different perspective and helps to understand better and therefore one of the best continuing education topics to be included and explained by the team to the nurses and health care team during the meetings.

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