Degree Name

Master of Science in Nursing (MSN)

Document Type

Major Paper


School of Nursing




Clinical Practice Recommendations and Evidence-Based Guidelines for Integrated Care were used to evaluate a diabetes management program for persons with serious and persistent mental illness in an integrated primary and behavioral health care center in New England. A simple random method was used to select a sample of 25 medical records of patients with diabetes and at least one mental illness. Data on seven diabetes content areas offered to patients and biophysical measures of weight, body mass index (BMI) and Hemoglobin A1C were collected via retrospective electronic chart reviews. Results showed the center focused on nutrition and exercise education, offered to 90% and 85% of patients respectively. Other education areas, including medications, self-monitoring of blood sugar, foot care, dental care and smoking cessation were offered to 5%-40% of the patients. An unexpected finding was noted, in that most participants (65%) gained weight despite focused nutrition and exercise education. The BMI was consequently elevated at a median level of 35, identified as obese. In spite of the weight and BMI increase, 65% of the patients had well controlled diabetes with an A1C below 7.The finding may be attributed to compliance and personalized diabetes medication regimen. Keeping all appointments did not improve biophysical measures: 67% of those who kept all appointments gained weight and increased A1C from base line. The unexpected results underscore the complexity and confounding nature of factors influencing diabetes in this population despite measures to improve health outcomes.