Physician Assistant Scholarly Project Posters

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  Comparing Rates of Macrosomia and Neonatal Hypoglycemia of Differing Treatment Modalities of Gestational Diabetes Mellitus

  Ashleigh Milbrath

  Gestational diabetes mellitus (GDM) is a known potential complication that can occur during pregnancy. Unmanaged GDM can result in maternal hyperglycemia, which can cause increased neonatal complications, two of which are macrosomia and neonatal hypoglycemia. To prevent maternal hyperglycemia, treatment of GDM typically begins with dietary changes, home glucose monitoring, increased exercise patterns and other lifestyle modifications. However, if maternal hyperglycemia persists after two weeks of maternal lifestyle modifications, there are not current best practice guidelines established for the treatment of GDM. Historically, subcutaneous multiple daily dosed insulin (MDI) has been the gold standard for treatment after lifestyle modification. However, in more recent years oral antihyperglycemic medications, glyburide and metformin, have seen increased use for the treatment of GDM. Additionally, with advancing technology and the development of continuous subcutaneous insulin infusion (CSII), there is discussion regarding which insulin delivery method will achieve more consistent rates of euglycemia to help reduce rates of neonatal hypoglycemia and macrosomia. This scholarly literature review will provide a general overview of GDM, compare treatment modalities (subcutaneous multiple daily dosages of insulin, continuous subcutaneous insulin infusion, metformin and glyburide) of GDM in terms of rates of neonatal hypoglycemia and macrosomia, and compare the safety of differing treatment modalities.

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  Is a Varicocelectomy Beneficial in the Era of Assisted Reproductive Technologies

  Chukwuka Oscar Nnoli

  Clinical varicoceles are the most frequent physical finding associated with infertile men and impaired semen parameters. There is evidence that suggests varicocele repair improves semen parameter and increases the chances of natural pregnancy. Today, varicocele repair is often combined with assisted reproductive techniques (ART) such as intrauterine insemination (IUI), in Vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). In this literature review, data examining whether varicocelectomy before ART leads to improved pregnancy outcomes is reviewed. Current data suggest that there is a significant clinical benefit when correcting a varicocele in oligospermic men before IVF/ICSI. Similarly, men with non-obstructive azoospermia also benefit from varicocelectomy before IVF/ICSI, but not significantly. Furthermore, in couples seeking to use ART to conceive, varicocelectomy may offer improvement in semen parameters and therefore, decrease the level of ART needed to achieve pregnancy.

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  Is a Varicocelectomy Beneficial in the Era of Assisted Reproductive Technologies?

  Chukwuka Oscar Nnoli

  Clinical varicoceles are the most frequent physical finding associated with infertile men and impaired semen parameters. There is evidence that suggests varicocele repair improves semen parameter and increases the chances of natural pregnancy. Today, varicocele repair is often combined with assisted reproductive techniques (ART) such as intrauterine insemination (IUI), in Vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). In this literature review, data examining whether varicocelectomy before ART leads to improved pregnancy outcomes is reviewed. Current data suggest that there is a significant clinical benefit when correcting a varicocele in oligospermic men before IVF/ICSI. Similarly, men with non-obstructive azoospermia also benefit from varicocelectomy before IVF/ICSI, but not significantly. Furthermore, in couples seeking to use ART to conceive, varicocelectomy may offer improvement in semen parameters and therefore, decrease the level of ART needed to achieve pregnancy.

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  Can Early Intervention with Group Therapy or Individual Therapy Improve the Family Dynamic in PTSD Patients?

  Killian Norton

  Post Traumatic Stress Disorder (PTSD) is a mental health disorder that affects an individual directly, while also affecting their family members around them. While PTSD is not directly correlated to the development of Secondary Stress Disorder (STS), PTSD has been shown to lead to increased rates of divorce and mood disorders in children whose parents are diagnosed with PTSD. Children who have grown up with divorced parents, or parents with PTSD, have been shown to have an increased chances of developing mood disorders and risky lifestyle behaviors. The combination of having a parent with PTSD and being divorced would likely increase the odds even further of developing a mood disorder. While there are no set guidelines for the treatment of PTSD, the use of various types of group therapies that include family members has been shown to increase relationship satisfaction. While this type of method is useful, individual therapy or even pharmacological regimens should also be included for best results. Educating family members about PTSD, and what the symptoms look like, can help reduce the increased stress associated with PTSD symptoms. If families are educated properly, divorce rates and mood disorder development among family members can be decreased.

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  Can Early Intervention with Group Therapy or Individual Therapy Improve the Family Dynamic in PTSD Patients?

  Killian Norton

  Post Traumatic Stress Disorder (PTSD) is a mental health disorder that affects an individual directly, while also affecting their family members around them. While PTSD is not directly correlated to the development of Secondary Stress Disorder (STS), PTSD has been shown to lead to increased rates of divorce and mood disorders in children whose parents are diagnosed with PTSD. Children who have grown up with divorced parents, or parents with PTSD, have been shown to have an increased chances of developing mood disorders and risky lifestyle behaviors. The combination of having a parent with PTSD and being divorced would likely increase the odds even further of developing a mood disorder. While there are no set guidelines for the treatment of PTSD, the use of various types of group therapies that include family members has been shown to increase relationship satisfaction. While this type of method is useful, individual therapy or even pharmacological regimens should also be included for best results. Educating family members about PTSD, and what the symptoms look like, can help reduce the increased stress associated with PTSD symptoms. If families are educated properly, divorce rates and mood disorder development among family members can be decreased.

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  Managing Anxiety with Pharmacogenomic Testing

  Ashley Pommer

  Anxiety affects approximately three to seven percent of the United States population, and nearly 50% of the diagnosed patients fail to respond to first line treatment regimens (Boland, Duffy, & Meyer 2018). Traditional first line treatments include medication therapy, cognitive behavioral therapy (CBT), or the combination of both. With such a high initial failure rate, recent studies indicate promising results in managing anxiety with pharmacogenomic testing. Pharmacogenomic testing is allowing providers to prescribe medication based on individual genetic makeup, focusing on how each patient metabolizes certain medications. The purpose of this literature review was to determine if first line methods or pharmacogenomic testing provide patients with more prompt symptom relief. Through a review of several electronic databases and articles, pharmacogenomic testing is yielding promising results in symptom relief, decreasing healthcare costs, and increasing healthcare efficacy. Not only is pharmacogenomic testing promising for anxiety management, it also gives insight to several other medication classes. With this information, pharmacogenomic testing may soon be a screening tool in future medicine.

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  Managing Anxiety with Pharmacogenomic Testing

  Ashley Pommer

  Anxiety affects approximately three to seven percent of the United States population, and nearly 50% of the diagnosed patients fail to respond to first-line treatment regimens (Boland, Duffy, & Meyer 2018). Traditional first-line treatments include medication therapy, cognitive behavioral therapy (CBT), or the combination of both. With such a high initial failure rate, recent studies indicate promising results in managing anxiety with pharmacogenomic testing. Pharmacogenomic testing is allowing providers to prescribe medication based on individual genetic makeup, focusing on how each patient metabolizes certain medications. The purpose of this literature review was to determine if first-line methods or pharmacogenomic testing provide patients with more prompt symptom relief. Through a review of several electronic databases and articles, pharmacogenomic testing is yielding promising results in symptom relief, decreasing healthcare costs, and increasing healthcare efficacy. Not only is pharmacogenomic testing promising for anxiety management, it also gives insight to several other medication classes. With this information, pharmacogenomic testing may soon be a screening tool in future medicine.

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  Provider Suicide

  Amy Quinn

  The purpose of this research and systematic literature review is to determine the risks factors for, the identification of and repercussions of provider suicide. In this review, databases searched included Pubmed, Cochran Database of Systematic Reviews, PsycInfo, National Institute of Health, Medscape and Google Scholar from September 8, 2018 to January 13, 2019. A variety of key terms were used when searching include suicide, provider suicide, suicide, costs of suicide, physician burnout, physician assistant burnout, nurse burnout, doctor suicide, physician assistant suicide, and nurse practitioner suicide. Works chosen for review were published between 1979 and 2018, as the topic has an extended history. Peer reviewed articles including systematic reviews and meta-analysis are included. Editorials were also included for the psychological factors of the topic. The research presented shows evidence that suicide is increased in healthcare providers, especially in women. This is an extremely important topic when considering the number of women entering healthcare. More research still needs to be done to address how suicide also affects all types of providers including nurse practitioners and physician assistants.

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  Provider Suicide

  Amy Quinn

  The purpose of this research and systematic literature review is to determine the risks factors for, the identification of and repercussions of provider suicide. In this review, databases searched included Pubmed , Cochran Database of Systematic Reviews, PsycInfo , National Institute of Health, Medscape and Google Scholar from September 8, 2018 to January 13, 2019. A variety of key terms were used when searching include suicide, provider suicide, suicide, costs of suicide, physician burnout, physician assistant burnout, nurse burnout, doctor suicide, physician assistant suicide, and nurse practitioner suicide . Works chosen for review were published between 1979 and 2018, as the topic has an extended history. Peer reviewed articles including systematic reviews and meta analysis are included. Editorials were also included for the psychological factors of the topic. The research presented shows evidence that suicide is increased in healthcare providers, especially in women. This is an extremely important topic when considering the number of women entering healthcare. More research still needs to be done to address how suicide also affects all types of providers including nurse practitioners and physician assistants.

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  Reducing The Health Care Burden Caused by Undocumented Immigrants

  Juan Carlos Ramirez

  Uncompensated health care and Emergency Department (ED) overcrowding are a national crisis in the United States, and uninsured patients are a major contributor. Undocumented Immigrants (UIs) are a large component of the uninsured patient population.

   The purpose of this study is to evaluate for efficacy and taxpayer value two large-scale potential solutions: Federally Qualified Health Centers (FQHCs), and expanded Medicaid.

   The method of research included a variety of key terms in electronic search databases such as CINAHL Complete, PubMed, and Google Scholar, and only articles published between 2014 and 2018 by peer reviewed journals or gray literature (.gov) were included.

   A Limitation of this study was the inability to conduct a single or limited number of systematic searches of related studies or articles and filter the results using a prescribed set of inclusion or exclusion criteria.

   Data results suggest that while expanded Medicaid does reduce uncompensated health care, it has been shown to increase ED use and overcrowding, at least in the short-term. Therefore, the notion that expanded Medicaid successfully reduces ED overcrowding, was found to be false. FQHCs are a reasonable solution, but there are too few, and relatively unheard of among the target population

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  Comparison of Hemodialysis and Peritoneal Dialysis Outcomes in the Older Adult Patient

  Dane Rasmussen

  The objective of this research and systematic literature review was to determine the dialysis modality of choice for elderly patients with end-stage renal disease. This literature review compared the outcomes of hemodialysis and peritoneal dialysis, which was judged by morbidity, mortality, and quality of life.

  • PubMed, Embase, and DynaMedwere searched using a specific set of keywords and mesh headings. Results of the searches were then filtered to include human-only studies, patients over 65 years old, and published within the last ten years. There were 12 studies that met inclusion criteria and were selected.

  • The studies suggested that there were similar outcomes in elderly patients receiving hemodialysis and peritoneal dialysis. It was concluded that dialysis modality selection should be made on an individual patient basis after first considering each patient’s goals of healthcare, co-morbid conditions, and life experiences. The different dialysis modalities should be discussed between the provider and the patient in detail, and a joint decision can then be made.

  • Lastly, barriers should be identified so that they can be overcome with proper education, counseling, and assistance. These steps will allow the patient to be successful with their selected dialysis modality.

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  Comparing Screening and Treatment of Bacterial Vaginosis and Pregnancy Outcomes

  Stephanie Severson

  • Evidence shows that bacterial vaginosis (BV) can lead to poor perinatal outcomes.

  • The goal of this project is to answer the question of which pregnant patients should be screened for BV and does identification and treatment of BV during pregnancy improve perinatal outcomes.

  • Due to variability in a multitude of factors, a generalized recommendation is difficult to make. Lack of recommendations are largely due to harm of treatment in those who were misdiagnosed.

  • The development of polymerase chain reaction (PCR) has the capability to reduce misdiagnosis.

  • Newer studies have shown benefit of early screening and treatment and the use of clindamycin over the traditional treatment of metronidazole.

  • An online search of PubMed, CINHAL, and Cochrane databases in the past 10 years yielded meta-analyses, systematic reviews, random control trials, and cohort studies. Additional sources found using reference lists. Search terms utilized included; bacterial vaginosis, vaginitis, pregnancy, pregnant, miscarriage, screening, pre-term, and asymptomatic.

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  Comparing Screening and Treatment of Bacterial Vaginosis and Pregnancy Outcomes

  Stephanie Severson

  Evidence shows that bacterial vaginosis (BV) can lead to poor perinatal outcomes.

  • The goal of this project is to answer the question of which pregnant patients should be screened for BV and does identification and treatment of BV during pregnancy improve perinatal outcomes.

  • Due to variability in a multitude of factors, a generalized recommendation is difficult to make. Lack of recommendations are largely due to harm of treatment in those who were misdiagnosed.

  • The development of polymerase chain reaction (PCR) has the capability to reduce misdiagnosis.

  • Newer studies have shown benefit of early screening and treatment and the use of clindamycin over the traditional treatment of metronidazole.

  • An online search of PubMed, CINHAL, and Cochrane databases in the past 10 years yielded meta analyses, systematic reviews, random control trials, and cohort studies. Additional sources found using reference lists. Search terms utilized included; bacterial vaginosis, vaginitis, pregnancy, pregnant, miscarriage, screening, pre term, and asymptomatic.

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  Platelets to the Rescue? A Literature Review of the Safety and Efficacy of Platelet-Rich Plasma for Symptomatic Osteoarthritis of the Knee

  Timothy Simonich

  Osteoarthritis of the knee is one of the most common joint disorders in the United States with rising prevalence due to obesity and an aging population. Regarding non-surgical approaches to management, there has been growing interest in the use of intra-articular injections with Platelet Rich Plasma (PRP).

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  Platelets to the Rescue? A Literature Review of the Safety and Efficacy of Platelet Rich Plasma for Symptomatic Osteoarthritis of the Knee

  Timothy Simonich

  Osteoarthritis of the knee is one of the most common joint disorders in the United States with rising prevalence due to obesity and an aging population. Regarding non surgical approaches to management, there has been growing interest in the use of intra articular injections with Platelet Rich Plasma (PRP).

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  Use of beta antagonists or HMG CoA reductase inhibitors for cardio protection during chemotherapy in oncology patients

  Nichole Streich

  Over the years, oncologists are better able to fight cancer and have increased cancer survival, but we are also finding that these lifesaving therapies can affect the heart and other parts of the body in a negative way. Chemotherapy is excellent at destroying cancer cells, but it also causes collateral damage to other healthy cells. There are certain chemotherapeutic agents that are known to cause cardiotoxicity. Currently we are monitoring the heart function of the patients who are receiving these cardiotoxic drugs prior to starting the chemotherapy as well as during and after treatment. However, there are currently no recommendations for what can be done to prevent the cardiotoxicity. The intention of this scholarly review is to look into the benefits and compelling results in adrenergic beta antagonists and HMG CoA reductase inhibitors to reduce the risk of cardiotoxicity during chemotherapy in oncology patients. The goal of this paper is to look at the research and hopefully conclude that either beta antagonists or hmg CoA reductase are a reliable option to prevent chemotherapy induced cardiotoxicity. An extensive literature review was performed and at this time, there are no concrete benefits of using either a beta blocker or a statin to reduce chemotherapy induced cardiotoxicity. In the research that has been done, there is some evidence of using these agents to protect the heart. More long term studies need to be conducted as well as more precise inclusion terms need to be used, such as the exact chemotherapy regimen or the particular cardioprotective medication that is used in the study. At this time, recommendations to prevent chemotherapy induced cardiotoxicity remains inconclusive.

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  Use of Beta-antagonists or HMG-CoA Reductase Inhibitors for Cardioprotection During Chemotherapy in Oncology Patients

  Nicole Streich

  Over the years, oncologists are better able to fight cancer and have increased cancer survival, but we are also finding that these lifesaving therapies can affect the heart and other parts of the body in a negative way. Chemotherapy is excellent at destroying cancer cells, but it also causes collateral damage to other healthy cells. There are certain chemotherapeutic agents that are known to cause cardiotoxicity. Currently we are monitoring the heart function of the patients who are receiving these cardiotoxic drugs prior to starting the chemotherapy as well as during and after treatment. However, there are currently no recommendations for what can be done to prevent the cardiotoxicity. The intention of this scholarly review is to look into the benefits and compelling results in adrenergic beta-antagonists and HMG-CoA-reductase inhibitors to reduce the risk of cardiotoxicity during chemotherapy in oncology patients. The goal of this paper is to look at the research and hopefully conclude that either beta-antagonists or hmg-CoA reductase are a reliable option to prevent chemotherapy-induced cardiotoxicity. An extensive literature review was performed and at this time, there are no concrete benefits of using either a beta-blocker or a statin to reduce chemotherapy- induced cardiotoxicity. In the research that has been done, there is some evidence of using these agents to protect the heart. More long-term studies need to be conducted as well as more precise inclusion terms need to be used, such as the exact chemotherapy regimen or the particular cardioprotective medication that is used in the study. At this time, recommendations to prevent chemotherapy-induced cardiotoxicity remains inconclusive.

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  Benefits of 3D Breast Tomosynthesis Combined with 2D Digital Mammography in Screening Women for Breast Cancer

  Danielle M. Swanson

  Breast cancer screening imaging options have progressed greatly over the years in sensitivity, specificity, and image quality. According to DynaMed Plus, in 2012 there were 522,000 deaths by breast cancer and 1,677,000 total cases of breast cancer documented (Dynamed, 2018). For years, traditional screening for breast cancer involved 2D digital mammography which obtains two views of each breast. With advances in technology, the use of 3D breast tomosynthesis has become an advantageous addition to routine breast cancer screening protocols at many health care facilities.

  • My literature review of articles was found in PubMed, DynaMed Plus, Cochrane Library, and Clinical Key from the year 2011 and on. The benefits of 2D digital mammography alone, 3D breast tomosynthesis alone, and 2D digital mammography combined with 3D breast tomosynthesis are compared. This study also compares the differences in radiation dose of each imaging option. The research demonstrated that 2D digital mammography combined with 3D breast tomosynthesis offers the lowest recall rates, the highest sensitivity and specificity, and increases the effectiveness of breast cancer screening.

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  Benefits of 3D Breast Tomosynthesis Combined with 2D Digital Mammography in Screening Women for Breast Cancer

  Danielle M. Swanson

  • Breast cancer screening imaging options have progressed greatly over • the years in sensitivity, specificity, and image quality. According to DynaMed Plus, in 2012 there were 522,000 deaths by breast cancer and 1,677,000 total cases of breast cancer documented (Dynamed, 2018). For years, traditional screening for breast cancer involved 2D digital mammography which obtains two views of each breast. With advances in technology, the use of 3D breast tomosynthesis has become an advantageous addition to routine breast cancer screening protocols at many health care facilities.

  • My literature review of articles was found in PubMed, DynaMed Plus, Cochrane Library, and Clinical Key from the year 2011 and on. The benefits of 2D digital mammography alone, 3D breast tomosynthesis alone, and 2D digital mammography combined with 3D breast tomosynthesis are compared. This study also compares the differences in radiation dose of each imaging option. The research demonstrated that 2D digital mammography combined with 3D breast tomosynthesis offers the • lowest recall rates, the highest sensitivity and specificity, and increases the effectiveness of breast cancer screening.

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  Benefits of HPV Vaccination in Adolescent Males

  Budd Theriot

  HPV is the most common sexually transmitted infection in the United States, affecting approximately 75-80% of young adults at some point in their lives, and it is also known to be directly related to several forms of cancer including cervical, vaginal, penile, anal, oral, and oropharyngeal cancer. Vaccination against several high-risk strains of HPV first became available in the U.S. in June of 2006 and has been proven to be effective in creating antibodies against several strains of high-risk HPV, potentially decreasing and preventing more than 30,000 new cases of HPV related cancers each year. Despite this fact, HPV vaccination rates remain low. Although vaccination is recommended for both female and male adolescents, male vaccination rates remain lower than female, likely due to the fact that HPV is most commonly associated with cervical cancer. However; evidence shows that among certain male populations, such as homosexuals, HPV related cancer rates may be as high in males as cervical cancer rates in females, demonstrating the potential impact of HPV vaccination in males. Lack of knowledge, and a perception of a lack of necessity for male vaccination are substantial barriers for achieving targeted vaccination rates. There is evidence demonstrating that proper education, or simply having meaningful conversation with patients, can help to increase patient compliance of receipt of HPV vaccination. Additionally, there is an abundance of unverified information attempting to link HPV vaccination to severe adverse reactions. There is minimal evidence to support such a correlation, but some studies do suggest it. A need for further investigation is warranted.

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  Benefits of HPV Vaccination in Adolescent Males

  Budd Theriot

  HPV is the most common sexually transmitted infection in the United States, affecting approximately 75-80% of young adults at some point in their lives, and it is also known to be directly related to several forms of cancer including cervical, vaginal, penile, anal, oral, and oropharyngeal cancer. Vaccination against several high-risk strains of HPV first became available in the U.S. in June of 2006 and has been proven to be effective in creating antibodies against several strains of high-risk HPV, potentially decreasing and preventing more than 30,000 new cases of HPV related cancers each year. Despite this fact, HPV vaccination rates remain low. Although vaccination is recommended for both female and male adolescents, male vaccination rates remain lower than female, likely due to the fact that HPV is most commonly associated with cervical cancer. However; evidence shows that among certain male populations, such as homosexuals, HPV related cancer rates may be as high in males as cervical cancer rates in females, demonstrating the potential impact of HPV vaccination in males. Lack of knowledge, and a perception of a lack of necessity for male vaccination are substantial barriers for achieving targeted vaccination rates. There is evidence demonstrating that proper education, or simply having meaningful conversation with patients, can help to increase patient compliance of receipt of HPV vaccination. Additionally, there is an abundance of unverified information attempting to link HPV vaccination to severe adverse reactions. There is minimal evidence to support such a correlation, but some studies do suggest it. A need for further investigation is warranted.

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  The Use of DHEA in the Treatment of Depression

  Bryan Tipton

  Dehydroepiandrosterone (DHEA) and its sulfated ester (DHEA-S) are important pre-hormones that also have direct neurohormonal effects on the central nervous system. Over the last twenty years, data have revealed that serum DHEA peaks in a person’s mid-20s and steadily declines throughout their lifetime. In addition, women tend to have lower values than men. This is of note because lower serum values tend to be correlated with increased risk of depression, worse depressive symptoms, and increased risk of relapse into depression. A review of literature concerning DHEA’s age related values, its association with depression, and its use in the treatment of depression was performed. It was found that supplementation with DHEA appears to alleviate the symptoms of depression even though a dose-response relationship nor a clear mechanism have been established. For providers who choose to use DHEA to alleviate the symptoms of depression, they should consider that even the best studies concerning its effectiveness are underpowered, it lacks FDA approval, and, if given as a supplement, may lack any active ingredient. Despite those warnings, the AAPA, CANMAT, and Dynamed all agree that evidence exists as to its efficacy.

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  The Use of DHEA In the Treatment of Depression

  Bryan Tipton

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  Delaying Diabetes in the Native American Population

  Seth Tramm

  Diabetes is a debilitating disease process caused by the body’s inability to control blood glucose levels. With over 30 million diabetics in the United States and another 85 million prediabetics, the effects of this disease are wide-spread and farreaching. Native American/Alaska Native populations have a nearly two-fold increase in prevalence of diabetes when compared to non-native populations. Risk factors for diabetes in all populations include modifiable risks such as obesity, diet, and physical inactivity as well as non-modifiable factors such as age, family history, and ethnicity. Studies have shown that early identification of symptoms, coupled with proper and intentional treatment can delay the onset of diabetes. The purpose of this project is to determine the efficacy of currently recognized bestpractice therapies in Native American patients and to identify barriers to successful implementation of such practices in the Native American population. A thorough review of the available literature shows that research of this topic specific to the Native American population is lacking. However, evidence suggests that the broad, general population recommendations made by the American Diabetes Association in their Standards of Medical Care in Diabetes (2018) will be equally effective in the Native American population when applied objectively. It is also recognized that Native Americans face additional barriers in the effort to identify and treat diabetes. These include geographic, economic, and social factors that inhibit treatment efficacy and ultimately lead to increased morbidity in this population.

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  Delaying Diabetes in the Native American Population

  Seth Tramm

  Diabetes is a debilitating disease process caused by the body’s inability to control blood glucose levels. With over 30 million diabetics in the United States and another 85 million prediabetics, the effects of this disease are wide-spread and far-reaching. Native American/Alaska Native populations have a nearly two-fold increase in prevalence of diabetes when compared to non-native populations. Risk factors for diabetes in all populations include modifiable risks such as obesity, diet, and physical inactivity as well as non-modifiable factors such as age, family history, and ethnicity. Studies have shown that early identification of symptoms, coupled with proper and intentional treatment can delay the onset of diabetes. The purpose of this project is to determine the efficacy of currently recognized best-practice therapies in Native American patients and to identify barriers to successful implementation of such practices in the Native American population. A thorough review of the available literature shows that research of this topic specific to the Native American population is lacking. However, evidence suggests that the broad, general population recommendations made by the American Diabetes Association in their Standards of Medical Care in Diabetes (2018) will be equally effective in the Native American population when applied objectively. It is also recognized that Native Americans face additional barriers in the effort to identify and treat diabetes. These include geographic, economic, and social factors that inhibit treatment efficacy and ultimately lead to increased morbidity in this population.