Type 2 Diabetes among Asian Americans: Effectiveness of a Culturally Tailored Diabetes Education Program

PICOT question: In Asian Americans with type 2 diabetes (P), does a culturally tailored diabetes education program, including patient-specific dietary and lifestyle modifications, (I) reduce A1C levels (O) after 2 months (T) versus a control group of Asian Americans?

Literature Review

According to Nguyen, Fischer, Ha, and Tran (2015), type 2 diabetes mellitus (T2DM) is a growing epidemic in the United States. This is further collaborated by Wang, Wang, and Chan (2013) who observe that the condition is not only a concern in the United States but also across the world. This, according to the authors, is more so the case given that Type 2 diabetes has been associated with multiple complications and comorbidities. Some of the well-documented complications of type 2 diabetes include, but they are not limited to, nerve damage and heart disease.

To demonstrate just how serious the condition really is, Laakso (2010) points out that while it was estimated that a total of 151 million people had diabetes in the year 2000, this figure was projected to grow by almost 50% a decade later. If recent estimates are anything to go by, the number of persons with type 2 diabetes is projected to increase to 552 million by 2030 (Thomas and Ashcraft, 2013). It is for this reason that quite a number of research undertakings have been instituted on the nature, control, and management of type 2 diabetes so as to ensure that adequate strategies are put in place to rein in the condition. Various studies conducted in the past indicate that type 2 diabetes is more prevalent in some demographic groups that in others, with the said prevalence being specifically noted for Hispanic Americans, as well as non-Hispanic Blacks and native Americans (Nguyen, Fischer, Ha, and Tran, 2015). This could be attributed to a myriad of reasons. Laakso (2010) observes that changes in human environment, behavior, and lifestyle have resulted in a dramatic increase in the incidence and prevalence of diabetes in people with genetic susceptibility to diabetes. With regard to changes in environment, Thomas and Ashcraft (2013) observe that Asian Indians, a subgroup of Asian Americans, tend to be at a higher risk of developing the condition. This the authors attribute to the metabolic impact of a westernized diet or reasons based on tissue resistance to insulin (Thomas and Ashcraft, 2013). This, in essence, warrants focused attention to the entire demographic group. In recent times, Nguyen, Fischer, Ha, and Tran, (2015) point out that increasing attention has been drawn to the problem of T2DM among Asian Americans.

As a matter of fact, it should be noted that over time, quite a number of studies have been conducted in an attempt to investigate and examine the claim that Asian Americans have a high risk of type 2 diabetes. Most of the said studies compare the conditions prevalence in Asian Americans in relation to other ethnic formations. In their research piece titled Trends in the Prevalence of Type 2 Diabetes in Asian Versus Whites, Lee, Brancati, and Yeh (2011) come to the conclusion that compared with their white counterparts, Asian Americans have a significantly higher risk for type 2 diabetes, despite having substantially lower BMI. Thomas and Ashcraft are in agreement. In their own words, type 2 diabetes is the fifth leading cause of death in the Asian American population (Thomas and Ashcraft, 2013). However, amongst this general demographic group, the authors point out that Asian Indians are the most afflicted. Others who have reported a higher prevalence of type 2 diabetes among Asian Americans include Alpert and Thomason. The authors note that the prevalence of the condition in this demographic group is largely misunderstood. This is more so the case given the lower BMI levels of Asian Americans in comparison to other demographic groups. More specifically, the authors observe that Asian Americans are not frequently thought of as being obese or overweight...

…one of the nations fastest growing ethnic/racial groups, growing at a rate four times that of the total U.S. population. As it has been pointed out elsewhere in this text, amongst the Asian American group, the Asian Indian subgroup happens to have the highest type 2 diabetes prevalence (Thomas and Ashcraft, 2013). For this reason, the results of this study would come in handy as far as the provision of the relevant information is concerned to aid in not only the formulation, but also the implementation of valid and viable diabetes management strategies and interventions.

References

Alpert, P.T. & Thomason, D. (2016). Metabolic Syndrome: Differences for Asian Americans is in their Body Fat Percentages. Asian/Pacific Island Nursing Journal, 1(3), 70-81.

Bodenheimer, T., Chen, E. & Bennett, H.D. (2009). Confronting the Growing Burden of Chronic Disease: Can The U.S. Health Care Workforce Do The Job? Health Affairs, 28(1), 64.

Ganz, M., Wintfeld, N., Li, Q., Alas, V., Langer, J. & Hammer, M. (2014). The Association Of Body Mass Index With The Risk Of Type 2 Diabetes: A CaseControl tudy Nested In An Electronic Health Records System in the United States. Diabetology & Metabolic Syndrome, 25(2), 93-102.

Herman, W. & Rothberg, A.E. (2016). Prevalence of Diabetes in the United States: A Glimmer of Hope? JAMA, 314(10), 92-107.

Ivey, S., Tseng, W., Kurtovich, E., Lui, B., Weir, R.C., Liu, J., Song, H., Wang, M. & Hubbard, A. (2012). Evaluating a Culturally and Linguistically Competent Health Coach Intervention for Chinese-American Patients with Diabetes. Diabetes Spectrum, 25(2), 93-102.

King, G.L., McNeely, M.J., Thorpe, L.E. & Mau, M.L. (2011). Understanding and Addressing Unique Needs of Diabetes in Asian Americans, Native Hawaiians, and Pacific Islanders. Diabetes Care, 35(5), 1181-1188.

Konchak, J.N., Moran, M.R., OBrein, M.J., Kanduls, N.R. & Ackermann, R.T. (2016). The State of Diabetes Prevention Policy in the USA Following the Affordable Care Act. Curr. Diab. Rep, 16(1), 55.

Laakso, M. (2010). Cardiovascular Disease in Type 2 Diabetes from Population to Man to Mechanisms. Diabetes Care, 33(2), 442-449.

Lee, J.W., Brancati, F.L. & Yeh, H. (2011).…