Diabetes Risks Among Asian Americans

Area of Interest
Asian Americans have the highest proportion of undiagnosed diabetes than any other ethnic group in the United States, by far. According to the CDC (2017), one in every two Asian Americans has diabetes but has never been diagnosed, which is twice the national average. Research even suggests that Asian-Americans are a “greater risk” than other population groups for developing diabetes across the lifetime (Sun, 2015). More Asians have diabetes than any other population group worldwide (Asian Diabetes Prevention Initiative, 2017). However, there are some drawbacks with studying this population group. One is that Asian Americans comprise a vastly diverse group, typically defined as being anyone with origins in South Asia (the Indian subcontinent), East Asia (China, Japan, Korea), and Southeast Asia (Vietnam, Cambodia, Singapore). This means that it may be even more difficult to narrow down causal variables and create culturally appropriate treatment interventions or public health initiatives. Yet given the high prevalence rates, nurses need to pay closer attention to how to help improve access to screenings. The high rates of undiagnosed diabetes among the Asian American population leads to increased rates of unnecessary complications and/or death, healthcare inequalities, and higher overall costs of intervention. Current screening processes are not optimized for this population. More culturally appropriate research is needed too; the vast majority of studies on diabetes prevention or treatment are conducted with Caucasian patient populations (Joslin Diabetes Center, 2017).
The biggest reason why Asian Americans are twice as likely as any other population group to remain undiagnosed is because the symptoms or early warning signs of diabetes are totally different for this population group. The most notable issue is the lower BMI threshold; “Asian Americans often develop type 2 diabetes at a lower body mass index (BMI) than other population groups (National Institutes of Health, 2015).. Most Asian Americans are not overweight, causing doctors and nurses to overlook screenings even though they “may be at greater risk” than other populations (Sun, 2015, p. 1). Therefore, healthcare workers need to routinely screen Asian American patients for diabetes.
Research Question/PICOT 1: Management of type 2 diabetes for Asian Americans newly diagnosed with type 2 diabetes has been problematic (P) because of cultural attachment to Asian food that can aggravate their diabetes. Health education to implement diet and lifestyle modifications are the effective strategies to make Asian Americans eat right type of food (I), which can assist them managing their disease (C) and live the normal life as compared to individuals who only received the standard education (O) within three months (T).
Research Question/PICOT 2: Mandatory screenings (I) for Asian Americans above the age of 21 (P) lead to increased rates of diabetes diagnoses versus unscreened populations (C), causing more health-seeking behaviors (O) within six months (T).
Research Question/PICOT 3: Asian Americans who have been diagnosed with type 2 diabetes (P) who take diabetes management medications (I) have lowered A1C levels (O) versus the control (C) after three months of intervention (T).
Research Question/PICOT 4: Nurses working with Asian American patients (P) who receive cultural literacy and information training (I) will be more likely to screen Asian American patients versus nurses without this training (C), leading to increased diagnoses and better health outcomes (O) after six months (T).
Selected 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 3 months (T) versus a control group of Asian Americans?
PICOT Variables:
Patient Population
Asian Americans
Asian Americans with undiagnosed diabetes
Asian Americans with diagnosed diabetes
Asian Americans with/without diabetes in specific age groups
Asian Americans with/without diabetes according to gender
Intervention
Lifestyle changes including diet
Screenings
Medications
Comparison
No treatments at all
No screenings at all
Only dietary changes and no exercise
Only mediation and no dietary changes
Only dietary and lifestyle changes and no exercise
Outcome
Reduced rates within the population
Symptom management (thirst, etc)
A1C levels
Time
Three months
Six Months
One year
More than one year
Ten Keywords
· Asian Americans (the population group), which should be further broken down into specific cultures including Vietnamese, Chinese, Japanese, Korean, South Indian, etc.
· Type 2 Diabetes (the primary diagnosis)
· Diabetes Screenings (one of the major variables)
· Rates of diagnosis (population health variable)
· Culturally-appropriate dietary intervention (primary intervention)
· Culturally appropriate health literacy and education program (primary intervention)
· Nurse training in cultural literacy (primary intervention)
· Low BMI diabetes (dependent variable)
· Visceral versus peripheral adiposity (Hsu, Araneta, Kanaya, et al, 2015).
· A1C levels (outcome)





References

Asian Diabetes Prevention Initiative (2017). Why are Asians at higher risk? http://asiandiabetesprevention.org/what-is-diabetes/why-are-asians-higher-risk
CDC (2017). Diabetes and Asian Americans. https://www.cdc.gov/diabetes/library/spotlights/diabetes-asian-americans.html
Hsu, W.C., Araneta, M.R.G., Kanaya, A.M., et al (2015). BMI cut points to identify at-risk Asian Americans for Type 2 diabetes screening. Diabetes Care 38(1): 15—158.
Joslin Diabetes Center (2017). Asian Americans and diabetes. http://www.joslin.org/info/Asian_Americans_and_Diabetes.html
McNeely, M.J. & Boyko, E.J. (2004). Type 2 diabetes prevalence in Asian Americans. Diabetes Care 27(1): 66-69. http://care.diabetesjournals.org/content/27/1/66
National Institutes of Health (2015). More than half of Asian Americans with diabetes are undiagnosed. https://www.nih.gov/news-events/news-releases/more-half-asian-americans-diabetes-are-undiagnosed
Sun, L.H. (2015). Why Asian Americans have diabetes but don’t know it. The Washington Post. 10 Sept, 2015. https://www.washingtonpost.com/news/to-your-health/wp/2015/09/10/why-asian-americans-have-diabetes-but-dont-know-it/?utm_term=.372c38a8cecd