Diabetes Health and Prevention for Asian Americans

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?
Introduction with a problem statement
Type 2 diabetes is a prevalent and growing problem throughout the modern world. The United States especially has seen an increase in type 2 diabetes cases in non-white people. Asian Americans are a notable segment of the American population that develop type 2 diabetes. Intervention strategies aimed at reducing certain markers like HbA1C levels may see improvement if culturally tailored methods are implemented. This essay is aimed at evaluating the effectiveness of a culturally tailored diabetic educational intervention to reduce HbA1C levels among Asian-Americans with type 2 diabetes.
Brief synthesized review.
Racial and ethnic minorities are experiencing a rise in type 2 diabetes cases. “Diabetes is a growing health epidemic in the United States. Racial and ethnic minorities are disproportionately affected by diabetes and associated comorbidities and complications” (Fayfman & Haw, 2017, p. 239). This problem must be addressed. However, because diverse cultures exist within these populations, it can be difficult to formulate and implement an appropriate intervention method. Therefore, the need arises to research if culturally tailored intervention strategies can be more useful and effective at improving certain diabetes markers like HbA1C.
Of the articles researched, a handful demonstrated results that proved such diabetes programs can be effective at improving these markers along with other key markers like psychobehavioral patterns. “…culturally tailored diabetes programs are effective at improving patients’ objectively measured clinical outcomes, in particular A1C levels, and psychobehavioral outcomes. Patients were also highly satisfied with bilingual health care providers and bilingual educational programs” (Joo, 2014, p. 605). In addition, with improvement of specific markers, people within the program detailed their satisfaction with bilingual options for communication. Often immigrants from different cultures experience language barriers when moving and living in a new country. By having bilingual health care providers, the program offers more than one way to offer solutions to the diabetes patients, encouraging better results through better adherence to the program.
Another study for Indian Immigrants with Type 2 diabetes saw marked improved in their HbA1c levels as well as key markers for health like weight and waist circumference through their own culturally tailored program. “While a significant decline in weight and increase in physical activity was observed in all participants, the intervention group lowered their HbA1c and waist circumference significantly as compared to the control group” (Patel, Misra, Raj, & Balasubramanyam, 2017, p. 1). Such effort demonstrates the possibility of tailoring plans to suit the needs of people from different cultures while also providing the parameters for successful compliance and adherence to the treatment plan through bilingual aids and self-reporting measures. Varying cultures have their own means of communicating, dietary habits, and even alternative medicine routes that can also be useful in development of intervention strategies.
Some people from Asian communities like Chinese immigrants for example, have long-standing traditions related to Chinese Medicines that use herbs and tinctures. These Chinese herbal medicines are often imported from China to the United States for alternative treatment options for diabetes type 2 management and management of other chronic diseases. “Recently the US has experienced a growth in the number imports of herbal supplements and other Traditional Chinese Medicines (TCM) to the country as well as the most rapid population growth in individuals who identify themselves as Asian” (Devonish, Singh, Tomkinson, & Morse, 2017, p. 1). If any treatment plan geared towards Asian Americans includes aspects of specific Asian culture like Chinese herbal medicines, this may be a cost-effective and culturally appropriate option, especially for Asian Americans that immigrated from Asian countries like China and were not born in the United States.
Description of the case/situation/conditions.
Asian Americans, especially South Asian Americans are at great risk of developing type 2 diabetes due to their lower muscle mass and higher abdominal fat compared to their European counterparts. Asian Americans can also develop type 2 diabetes at lower BMIs suggesting a need for interventions even when the patients are not technically obese. For example, a South Asian American woman has abdominal fat and a BMI of 23. This BMI would not place her as obese. However, due to her limited muscularity and high abdominal fat, she may be at higher risk for developing type 2 diabetes. Solutions must be made that enabled removal of potential barriers and improve overall health outcomes.
Proposed solutions describing the validity and reliability of the research you have read.
The first solution seems the easiest to implement and provides a clear removal of potential language barriers. Research demonstrated that having a bilingual health care provider enabled patients to adhere better to program guidelines (Joo, 2014). This is because the patient can discuss and communicate with the health care provider openly and without difficulty. Often, when there are language barriers, especially in verbal communication, disconnect may arise, making it difficult to implement protocols for positive health outcomes.
Another part of the solution is introducing herbal alternatives that enable patients to seek treatment options more familiar to them. Herbal medicines are used often in various Asian cultures, especially in China. Providing education on herbal routes may prove useful (Devonish, Singh, Tomkinson, & Morse, 2017). Some potential problems with this is that health care often involves a conventional route and ignores alternative medicine routes. However, alternative medicine is growing in popularity in the United States and may prove useful in cultivating an effective program geared towards Asian populations (Devonish, Singh, Tomkinson, & Morse, 2017).
These two options are easy to implement, effective, and provide an easy means of achieving certain goal objectives as proven in the research. Another potential solution and part of the plan of action that falls in with the bilingual option is educating Asian American patients on maintaining a lower waist circumference by eating less carbohydrates and more protein and fiber. This is something that was covered in one of the studies (Patel, Misra, Raj, & Balasubramanyam, 2017).
Conclusion.
In conclusion, type 2 diabetes is of major concern. Racial and ethnic minorities, particularly in the Asian American community require assistance in combating this growing epidemic of chronic illness. To do so, culturally tailored intervention programs could prove extremely beneficial in several ways. The first is removing language barriers that may exist within the target community. Another is providing alternative medicine options that they may be more familiar with as seen in Chinese herbal medicines. By committing to these actions, health care providers can bridge the gap in effective health outcomes.


References
Devonish, J. A., Singh, S., Tomkinson, E., & Morse, G. D. (2017). Novel Considerations about Diabetes Management Strategies in Chinese Immigrants in America: Possible Corollaries of the Use of Traditional Chinese Medicines. INNOVATIONS in pharmacy, 8(2), 1. doi:10.24926/iip.v8i2.509
Fayfman, M., & Haw, S. (2017). Diabetes in Racial and Ethnic Minorities in the United States: Individualizing Approaches to Diagnosis and Management. Current Diabetes Reviews, 13(3), 239-250. doi:10.2174/1573399812666160926142036
Joo, J. Y. (2014). Effectiveness of Culturally Tailored Diabetes Interventions for Asian Immigrants to the United States. The Diabetes Educator, 40(5), 605-615. doi:10.1177/0145721714534994
Patel, R. M., Misra, R., Raj, S., & Balasubramanyam, A. (2017). Effectiveness of Culturally Tailored Diabetes Interventions for Asian Immigrants to the United States. Journal of Diabetes Research, 2017, 1-13. doi:10.1155/2017/2751980