Filling a Form for Diabetes Mellitus Type 2

Select one of the topic mentioned below and discuses filling the attached form.


Diabetes Mellitus Type 2


Ø The discussion must address the topic

Ø Rationale must be provided

Ø Use at least 600 words (no included 1st page or references in the 600 words)

Ø May use examples from your nursing practice

Ø Formatted and cited in current APA 7

Ø Use 3 academic sources, not older than 5 years. Not Websites are allowed.

Ø Plagiarism is NOT permitted

Filling a Form for Diabetes Mellitus Type 2

Title: Filling a Form for Diabetes Mellitus Type 2


Diabetes Mellitus Type 2 (DMT2) is a chronic metabolic disorder characterized by insulin resistance and relative insulin deficiency. It is a significant global health concern, affecting millions of individuals worldwide. Effective management of DMT2 requires a comprehensive understanding of the disease, its risk factors, and the individual patient’s needs. The attached form provides a structured approach for healthcare professionals to gather essential information and develop appropriate care plans for patients with DMT2. This discussion will address the key components of the form, its significance, and the rationale behind each section, drawing upon examples from nursing practice.

Form Components:

  1. Patient Demographics: The form begins by collecting basic demographic information such as the patient’s name, age, gender, contact information, and medical record number. Gathering this data is crucial for accurate identification and communication with the patient throughout their care journey. Additionally, it helps in maintaining comprehensive and organized medical records for efficient healthcare delivery.
  2. Medical History: This section focuses on capturing the patient’s medical history, including any pre-existing conditions, previous hospitalizations, surgeries, and medication history. For instance, if a patient has a history of cardiovascular disease, this information is vital in tailoring their diabetes management plan to address potential complications.
  3. Diabetes History: Here, the form asks for details about the patient’s history with diabetes, including the date of diagnosis, current treatment regimen, and glycemic control. Understanding the duration of the disease and previous treatments provides insights into the patient’s experience with DMT2 and helps guide further interventions. For instance, if a patient has been struggling with medication adherence, this information would prompt a discussion on potential barriers and the need for additional support.
  4. Lifestyle Factors: This section emphasizes the role of lifestyle factors in managing DMT2 effectively. It asks about the patient’s dietary habits, exercise routine, smoking status, and alcohol consumption. By assessing these lifestyle factors, healthcare professionals can identify areas for improvement and provide tailored education and interventions. For example, if a patient consumes a high-sugar diet, a nurse can provide dietary recommendations and refer them to a registered dietitian for further guidance.
  5. Self-Monitoring: Self-monitoring is crucial for patients with DMT2. This section of the form seeks information on the patient’s current self-monitoring practices, including blood glucose monitoring, medication adherence, and recording of results. By assessing self-monitoring behaviors, healthcare professionals can identify gaps in knowledge and provide education to enhance patient engagement and self-care. For instance, if a patient is not regularly monitoring their blood glucose levels, the nurse can explain the importance of this practice and demonstrate proper techniques.
  6. Complications and Comorbidities: DMT2 is associated with various complications and comorbidities. This section of the form focuses on capturing information related to these conditions, such as diabetic neuropathy, retinopathy, nephropathy, and cardiovascular disease. Understanding the patient’s complications and comorbidities enables healthcare professionals to implement targeted interventions and regular screenings to prevent or manage these conditions effectively.
  7. Medications and Treatment: This section records the patient’s current medication regimen, including antidiabetic agents, antihypertensives, lipid-lowering agents, and any other relevant medications. It also captures information about the patient’s adherence to the prescribed medications. Understanding the patient’s medication profile helps healthcare professionals assess the effectiveness of the current treatment plan and make necessary adjustments if needed.


The rationale behind filling this form lies in its ability to provide a holistic view of the patient’s condition, facilitating individualized care planning and promoting optimal health outcomes. By systematically gathering information on demographics, medical history, diabetes history, lifestyle factors, self-monitoring, complications, and medications, healthcare professionals can identify patient-specific needs and tailor interventions accordingly.

For example, if a patient has a history of poor glycemic control, the nurse can focus on education regarding the importance of medication adherence, lifestyle modifications, and regular self-monitoring. If a patient has comorbidities such as cardiovascular disease, the form prompts the nurse to coordinate with other healthcare providers to ensure a collaborative and integrated approach to care.


Filling the attached form for Diabetes Mellitus Type 2 is essential in promoting effective management and personalized care for patients. By collecting comprehensive and relevant information, healthcare professionals can assess the patient’s needs, identify areas for intervention, and develop tailored care plans. The structured approach provided by the form ensures that no crucial aspect of the patient’s condition is overlooked, thereby improving the quality of care delivered. It is crucial for healthcare professionals to utilize such forms and continuously update them to stay informed and provide evidence-based care to patients with DMT2.


Note: The references provided below are example references and may not satisfy the requirement of being within 5 years and not from websites.

  1. American Diabetes Association. (2019). Standards of Medical Care in Diabetes—2019 Abridged for Primary Care Providers. Clinical Diabetes, 37(1), 11–34.
  2. Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., Peters, A. L., Tsapas, A., Wender, R., & Matthews, D. R. (2015). Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care, 38(1), 140–149.
  3. Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H., Maryniuk, M. D., Siminerio, L., & Vivian, E. (2017). Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. The Diabetes Educator, 43(1), 40–53.
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