Asian Americans and Diabetes

Introduction
The PICOT question is: How does the standard health education to implement patient-specific dietary and lifestyle modifications compare to patients who receive culturally tailored diabetes education and the reduction of mean blood sugar levels among Asian Americans diagnosed for type 2 diabetes 2-3 weeks after education is provided?
Problem Statement
Asian-Americans are the fastest growing ethnic group, yet the exact extent to which this population can effectively treat type 2 diabetes through health education is currently unclear (Hsu, Araneta, Kanaya, Chiang & Fujimoto, 2015). This study aims to address this problem by filling a gap in the literature regarding this issue.
Synthesized Review
Ho, Tran and Chesla (2015) show that it is not a simple procedure to assess what is culturally meaningful among Asian Americans, particularly among the Chinese American population, partly because of a “complex definition of culture that moves beyond just race, ethnicity and language and also focuses on geography, religion, spirituality, biological and sociological characteristics” (p. 39). This complexity extends beyond just Chinese Americans and includes all Asian Americans, as Islam et al. (2015) show in their study of Asian American disparities as compared to other racial and ethnic minority groups in New York City. These disparities make it difficult to determine the extent to which culturally relevant health education material can have an impact on reducing blood sugar levels among the Asian American population that suffers from type 2 diabetes (Jih et al., 2016).
As Jih et al. (2016) point out in their study of educational interventions among Chinese Americans in order to promote health nutrition, print materials were helpful in increasing health knowledge and increasing physical activity among the target population. However, as Islam et al. (2015) showed in their study of diabetes management among Asian Americans, overall Asian Americans were more difficult to manage in terms of moving them to take ownership of their own diabetes management. Islam et al. (2015) found in their sampling of ethnic minorities that among all the various ethnic groups, Asian Americans were the least likely to monitor through self-check their own blood sugar levels. This is problematic because as Hsu, Aranet, Kanaya, Chiang and Fujimoto (2015) showed in their systematic review of the literature available on Asian Americans, this population is growing and its risk of developing diabetes is growing as well, though this population does not meet the criteria for obesity or for being overweight according to the findings of Hsu et al. (2015), which makes it difficult for clinicians to identify possible at-risk scenarios just through an informal assessment. In short, it is important to develop a better method of understanding this diverse population, which has a great deal of different ethnicities within its subset—from Chinese to Japanese to Indian to Filipino Americans: all have their own unique characteristics.
Description of the Case/Situation/Conditions
The different situations examined by researchers in the past 5 years include diabetes management among Asian Americans (Islam et al., 2015), the effect of health education on a specific subset of Asian Americans—Chinese Americans (Jih et al., 2016); the particular risks associated with being an Asian American in terms of diabetes, diagnosis, and mitigation of the risk of onset (Hsu et al., 2015); and the need to better understand the cultures and cultural inputs of Asian Americans (Ho et al., 2015). These situations represent the diverse approaches to the issue of diabetes among Asian Americans and indicate that there is an increasing concern among researchers and health care professionals regarding addressing the problem of managing type 2 diabetes in the Asian American population which is rapidly increasing in the U.S.
Proposed Solutions
Proposed solutions of the studies include: providing literature and conferences for the Asian American population in order to help them lead healthier lives and be more conscious of the role that physical activity and diet can play in managing their diabetes (Jih et al., 2016). Other solutions include understanding more fully the role that cultural understanding plays in helping the Asian American population to obtain the kind of health care it requires, which is especially difficult for health care providers as the inputs of culture are complex, diverse, and hard to identify without guidance (Ho et al., 2015). Hsu et al. (2015) do not offer any direct solutions to the problem of the rising risks of diabetes development among the increasing Asian American population, though they do recommend better screening tools that more effectively measure the appropriate BMI of Asian Americans, since the average BMI used to measure obesity or overweightness of other ethnic populations does not appear to apply to the Asian American population with a view towards identifying those at risk for diabetes. Islam et al. (2015) call for more cultural competency training among health care providers in order to be better able to support the Asian American community in addressing their diabetes management needs. Their findings are in line with those of Ho et al. (2015) who likewise indicate that nurses and health care providers require some form of cultural competency training to better serve the Asian American community and help it to address its diabetes management needs.
Validity of the Research
The validity of the studies varies: the study by Hsu et al. (2015) is a systematic review and the methods employed are not thoroughly discussed; therefore the validity of the study is accepted by the reader without knowing how the researchers set about collecting their data. The study by Ho et al. (2015) describes in general terms its methodology but the extent to which the study actually measures only the variables identified is not guaranteed, so its internal validity is suspect. The study by Isalm et al. (2015) also has a general description of methodology, which gives it a degree of internal validity, and the study by Jih et al. (2016) used a clearly described randomized controlled trial methodology which demonstrated internal validity. This study held the highest degree of validity of the four reviewed.
Reliability of the Research
The consistency of the research and the results would have to be measured against other studies. Of the four, here, the consistency between those which focused on culture was high as was the consistency between those that focused on management and risks within the population. Each of the studies demonstrated reliability.
Conclusion
The research conducted on the Asian American population suffering from diabetes in the past 5 years indicates that more cultural competency training is needed among nurses. It also indicates that this population is at risk of not being managed or diagnosed appropriately. Some new tools for measuring risk indicators are needed.
References
Araneta, M. R., Kanaya, A. M., Hsu, W. C., Chang, H. K., Grandinetti, A., Boyko, E. J.,
... & Onishi, Y. (2015). Optimum BMI cut points to screen asian americans for type 2 diabetes. Diabetes care, 38(5), 814-820.
Ho, E. Y., Tran, H., & Chesla, C. A. (2015). Assessing the cultural in culturally sensitive
printed patient-education materials for Chinese Americans with type 2 diabetes. Health communication, 30(1), 39-49.
Hsu, W. C., Araneta, M. R. G., Kanaya, A. M., Chiang, J. L., & Fujimoto, W. (2015).
BMI cut points to identify at-risk Asian Americans for type 2 diabetes screening. Diabetes Care, 38(1), 150-158.
Islam, N. S., Kwon, S. C., Wyatt, L. C., Ruddock, C., Horowitz, C. R., Devia, C., &
Trinh-Shevrin, C. (2015). Disparities in diabetes management in Asian Americans in New York City compared with other racial/ethnic minority groups. American journal of public health, 105(S3), S443-S446.
Jih, J., Le, G., Woo, K., Tsoh, J. Y., Stewart, S., Gildengorin, G., ... & Yu, F. (2016).
Educational interventions to promote healthy nutrition and physical activity among older Chinese Americans: A cluster-randomized trial. American journal of public health, 106(6), 1092-1098.