Asian-Americans and Diabetes Treatment

Asian-Americans With Diabetes: Assessing the Intervention

PICOT question: How do Asian-Americans with newly diagnosed type 2 diabetes perceive barriers to implementing dietary and lifestyles changes to reduce A1C levels in the first 3 months after diagnosis?

Evaluation plan

Although Asian cuisines have traditionally been regarded as healthier than Westernized diets because of their high fiber and vegetable content, relatively low levels of sugar, and their emphasis on rice vs. highly sweetened starchy grains, this has been changing in recent years as Asian-Americans adapt increasingly Westernized eating habits (McNeely 2004). In fact, "Asian-Americans are almost twice as likely to develop diabetes as the general population in the United States, and of those who develop the disease, more than 95% are diagnosed with type 2 diabetes," which is strongly correlated with obesity and poor exercise and dietary habits ("Asian-Americans with Diabetes," 2015). Asian-Americans are also more likely to develop type 2 diabetes at relatively lower BMIs than other demographic groups. "At a lower BMI, Asians tend to accumulate more body fat compared to Caucasians" ("Asian-Americans with Diabetes," 2015). Because a healthy body size may be lower on average for Asians this often causes doctors to ignore potential red flags such as elevated weight until it is too late (McNeely 2004). Simply using BMI indexes in a generic fashion for all patient population groups is not ideal.

Methods

The purpose of this study will be to assess the effectiveness of a three-month educational intervention specifically designed to address the needs of Asian-Americans recently diagnosed with diabetes. The emphasis will be on adapting the diet to preferences specifically tailored to Asian-American palates and food selection. For example, for patients that were raised in more traditional food environments, encouraging a shift back to eating as they did when younger might be helpful. For adolescent patients with parents who may have been raised in food-deprived environments that have overcompensated with over-nutrition, family interventions may be required to emphasize what is a healthy body type and to dissociate the connection between food and love. For all patients, the stress will be on reducing BMI and body fat to meet criteria specific to their needs, versus those of a generalized population. Support will be offered regarding weight loss efforts from counselors and personal trainers will offer exercise advice. Goals will be set for patients depending upon individual needs (including age, gender, and degree of physical mobility) but a minimum of 30 minutes of exercise everyday would be the mandatory for each patient, even if only in the form of light walking.

Variables

Counseling will be specifically designed to address patients' cultural needs as they arise. For example, "many Asian patients refuse the initial consultation with a dietitian because they don't understand the role of nutrition in managing their diabetes, and adhere to the traditional view that characterizes physicians as the only experts in treating the disease" ("Asian-Americans with Diabetes," 2015). Discussions about body image and the need for realistic goal-setting regarding weight would be addressed. Nutritional guidance will be given to stress the importance of using nutrition in consort with prescribed medications.

Tools

The intervention will involve patients that have been diagnosed with diabetes within a three-month timeframe. Patients in the experimental group will first submit to a questionnaire about their health status, eating and exercise habits, and also questions to screen for their level of knowledge of the illness and diabetes management. Patients will respond to the Diabetes Self-Management Questionnaire (DSMQ) which is a "16 item questionnaire to assess self-care activities associated with glycaemic control, including items pertaining to glucose management, diet, exercise, and appropriate use of healthcare support (Schmit et al. 2013). This externally-produced instrument with pretested validity and reliability will provide additional context for replies.

The study will deploy a mixed-methods approach. As well as quantitative data, select participants will be interviewed about their perceptions of the degree to which their cultural needs were attended to over the course of the study. This will provide an additional source of data and contextualize the perspective offered by the quantitative component. The control group will consist of Asian-Americans that receive standard diabetes counseling without a culturally specific component.

Assessment

Success will be assessed based upon improved glycemic control, weight and body fat reduction, and improved eating and exercise habits. The diabetes-related knowledge of the patients will also be assessed before and after treatment. Longitudinal data will be collected immediately after the intervention and then at regular three-month intervals over the course of the following year. Given that diabetes is a chronic disorder that must be managed and is never really cured, including long-term assessment is vital. Short-term reductions in weight or short-term blood sugar control are not adequate to help the patient reduce his or her risk from suffering severe long-term health consequences.