Literature Review Table and Analysis

Research Article Chart

Criteria and Defining Characteristics

Article 1:

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, 105S443-S446.

doi:10.2105/AJPH.2014.302523

Article 2:

Islam, N., Zanowiak, J., Wyatt, L., Chun, K., Lee, L., Kwon, S., & Trinh-Shevrin, C. (2013). A Randomized-Controlled, Pilot Intervention on Diabetes Prevention and Healthy Lifestyles in the New York City Korean Community. Journal of Community Health, 38(6), 1030-1041. doi:10.1007/s10900-013-9711-z

Article 3:

Stewart, S. S., Dang, J., & Chen, M. (2016). Diabetes Prevalence and Risk Factors in Four Asian American Communities. Journal of Community Health, 41(6), 1264-1273.

Abstract

After reading the abstract what do you expect to learn from the article?

The differences in how adults of Asian descent manage their diabetes in comparison with other ethnic groups and what this means for clinicians.

What are the best ways for diabetes to be prevented in the New York City Korean health community, given the data already gathered about this community.

What are the major risk factors for getting diabetes

in four major Asian communities and

what does this indicate about lifestyle and prevention?

Introduction: Summarize the following in paragraph form.

· What is the purpose of the study?

· What is the scope of the study?

· What is the rational for the study?

· What is the hypothesis or research question?

· What key concepts and terms are noted?

· Is a review of the literature provided?

The purpose of the study is to determine if there are any advantages or disadvantages in the ways that Asian Americans manage their diabetes in comparison with other ethnic groups. This study can help determine if there’s anything to be learned from this group or if there’s anything that they need to improve upon. The scope of the study was targeted to sampling all racial/ethnic minorities on the diabetes management behavior. The rationale was to ideally find ways that individuals could improve on their diabetes management and essentially save money for the healthcare industry while reducing mortalities. The research question sought to compare how diabetes management practices for Asian Americans compared to other ethnic or racial groups. Management is one of the major concepts defined. There is not a literature review provided.

The purpose of the study is to determine why Asian Americans get diabetes more than non-Hispanic whites and if there’s anything that can be done within lifestyle changes or the greater medical community to thwart this. The scope of the study revolves around the feasibility of a

pilot Community Health Worker (CHW) intervention to make the health related actions better of Korean Americans through the means of a randomized and controlled trial. The main concepts examined in this study were

things like clinical measurements, BMI, health behaviors, self-efficacy, and health access.

A review of literature is not provided.

The purpose of the study is to determine the rate of

Diabetes along with pre-diabetes conditions, and the

Vulnerability to getting diabetes for individuals who

Have BMI indexes higher than 23, in four distinct Asian-

American collectives. The more that clinicians

understand such risk factors the more this condition

will be preventable. It’s also beneficial for the overall

science and healthcare community to understand factors

unique to Asian American communities that have an

influence or risk factor towards diabetes.

The concepts used are things like BMI, along with

hemoglobin A1c (HbAlc), pre-diabetes, and waist

circumference.

A review of literature is not provided.

Methods: Summarize the following in paragraph form.

· What is the population being sampled?

· What data collection procedure is presented?

· What other procedures are described?

The population being sampled are all racial and ethnic minority subgroups that reside in New York City between 2009 and 2012 using Racial and Ethnic Approaches to Community Health (REACH) US Risk Factor Survey Data collected. This gathered over 4400 Hispanic Asian Americans, just under 5000 Hispanics, and just under 3000 non-Hispanic blacks. According to the Islam and colleagues, they harnessed a logistic regression for dichotomous eye exams and linear regression for continuous variable to scrutinize racial distinctions.

Between 2011 and 2012, a complete sum of 48 Korean Americans vulnerable to diabetes residing in New York City (NYC) participated in the research study.

Both quantitative and qualitative data collection methods were used. Participants finished a baseline survey at the three and six month marks. Main outcomes were measured at the baseline, such as the hip-to-waist ratio minimization.

CHWs finished precise logs during phone calls, recording obstacles to healthcare access and in maintaining healthy behaviors. Qualitative interviews were also engaged in after the intervention was complete.

Researchers gathered a sample of just under one thousand

Chinese, Hmong, Korean, and Vietnamese Americans

who all reside in northern California’s Sacramento County.

Their statistics were all collected, measuring their

hemoglobin A1c (HbAlc), height, weight, and waist

size. Whether or not a participant had diabetes

depended on their self-diagnosis or a hemoglobin level

higher than HbA1c ? 6.5%. In this manner, pre-diabetes

was defined as HbAlc 5.7%-6.4%. The researchers

calculated the age-standardized rate of diabetes, pre-diabetes,

BMI and waist circumference higher than standard and

Asian cut-points created multivariable models of the

Connection between diabetes with BMI and waist

Size.

Results: Summarize the following in paragraph form.

· What are the given findings?

· How was data collected?

· Are the findings supported by graphs and charts?

· What does the analysis of data state?

Rates of diabetes prevalence varied distinctively by racial and ethnic groups and there were distinctions within Asian American subgroups. According to Islam and associates, the greatest “..age-adjusted prevalence was seen among Asian Indians (19.0%), Hispanics (16.5%), and Blacks (14.3%), followed by Koreans (10.8%) and Chinese (9.3%).

It is also important to note that differences within sociodemographic traits were noticed across groups for all variables. For instance Asian Indians most likely had college degrees and Koreans were least likely to speak English. The findings are supported by graphs and charts.

The group had an average age of just under 60 and was mostly female; most were unemployed such as retired or married and a homemaker. Seventy-two percent of the sample had a weight issue that was contributing to their diabetes and just over half of the sample had symptoms that indicated they were pre-hypertensive. The qualitative data emphasized the importance of being a Korean speaker in order to properly communicate with the participants. Essentially the data pointed to high amounts of acceptability and efficacy of the intervention and those who participated gave it much positive feedback. There were a few feasibility barriers but nothing that couldn’t be properly tackled with careful planning.

The four ethnic groups that were the main participants

of this study showed significant distinctions in regards

to their

diabetes prevalence, BMI, and stomach size.

Hmong had the greatest rate of diabetes (15.0%, 95% confidence interval [CI] 10.7%-19.4%).

Diabetes and pre-diabetes were most strongly connected

To a BMI greater than 25.

When waist circumference was significantly added to

calculations, BMI impact weakened. Also it’s

important to note that when gender and ethnicity were

taken into account with BMI and waist circumference,

they were not statistically important.

Conclusion: Summarize in paragraph form.

· What is the summary of the study?

· What is the conclusion of the hypothesis?

· What are the questions for future research?

The summary of the study and the conclusion of the hypothesis show the importance of provider-healthcare interventions to improve how well patients engage in diabetes self-care among all Asian American subgroups. The data shows there is a need for culturally and linguistically tailored efforts that promote self awareness and self-efficacy of diabetes self-management. Clinicians need to better engage in encouraging best practices management for these populations and be prepared to clarify issues. The questions for future research really revolve around the possibility of using a bigger sample size and better data collection methods.

Study findings strongly suggest that the CHW model is very useful to this community and greatly helps in encouraging important behavior changes in nutrition and physical activity, along with dietary aspects of diabetes prevention. There still need to be more CHW program evaluations that look at the influence of

Participant results.

Qualitative findings show meaningful data that illuminates the ways in which CHWs can influence health choices. It’s important for clinicians to be aware of the more specific obstacles that immigrant community members face, when it comes to managing and preventing diabetes. This study shows valuable insight into the ways that programs can be adjusted for the needs of minority groups like these, though more research with larger sample sizes, needs to be conducted.

These findings offer meaningful evidence for the

Widespread use of a BMI cut-point of 23 and the

significance of central adiposity as a main vulnerability factor for diabetes in people of Asian descent. This study underscores the sheer

importance of proactive risk minimization activities

for people of Asian heritage.

References

· What are the total number of references used in the study?

· List two of the references used.

8. Halvorsen R, Palmquist R. The interpretation of dummy variables in semi-logarithmic equations. Am Econ Rev. 1980;70(3):474–475.

9. American Diabetes Association. Executive summary: standards of medical care in diabetes–2014. Diabetes Care. 2014;37(suppl 1):S5–S13. [PubMed]

27. D’Eramo-Melkus G, Spollett G, Jefferson V, et al. A culturally competent intervention of education and care for black women with type 2 diabetes. Applied Nursing Research. 2004;17(1):10–20. [PubMed]

28. Mauldon M, Melkus GD, Cagganello M. Tomando control: A culturally appropriate diabetes education program for Spanish-speaking individuals with type 2 diabetes mellitus–evaluation of a pilot project. The Diabetes Educator. 2006;32(5):751–760. [PubMed]

30. Hsu WC, Araneta MRG, Kanaya AM, Chiang JL, Fujimoto W. BMI cut points to identify at-risk Asian Americans for Type 2 diabetes screening. Diabetes Care. 2015;38(1):150–58. [PMC free article] [PubMed]

31. Hsia DS, Larrivee S, Cefelu WT, Johnson WD. Impact of lowering BMI cut points as recommended in the revised American Diabetes Association's Standards of Medical Care in Diabetes Screening in Asian Americans. Diabetes Care. 2015;38(11):2166–2168. 

Synthesis of Research Studies

PICOT: 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?

Subthemes

One of the major subthemes that was uncovered via this research was the extent to which lifestyle plays a role in effective diabetes intervention, prevention and management. Type 2 diabetes is a condition where the potential to prevent it has long been established in the medical community. The key to prevention revolves around intensified physical activity and exercise in combination with improved nutritional habits, particularly with overweight members of communities. Lifestyle interventions, when orchestrated in an organized fashion, have the power to show lasting results for longer periods of time, and help to reduce risk factors. Lifestyle interventions are so powerful because they show the individual the cause and effect relationship between their eating and exercise habits and their health. Lifestyle interventions demonstrate to the individual repeatedly that they have the power to be healthier, and offer a detailed guide for how to achieve more intensified health. Furthermore, with the modernity of science and the advancement of technology, there are more and more manifestations of what a successful intervention looks like and the types of therapeutic interventions available.

Furthermore, the research has demonstrated that lifestyle interventions not only have a high rate of efficiency, but that they are very viable, cost effective options as well that save costs to the greater medical community as a whole. One of the major benefits of lifestyle changes and interventions is that when one individual changes their behavior, it can benefit and impact members of an entire community. No individual is an island: when one individual makes a radical but greatly improve health-related change, it can positively influence so many others in their community. One of the reasons that lifestyle interventions can offer so many doors to success is because they force the individual to engage in lasting behavioral changes and choices. One enlightening aspect that the research demonstrated repeatedly was that “Lifestyle intervention strategies to prevent T2DM should be distinct for different populations around the globe and should emphasize sex, age, ethnicity, and cultural and geographical considerations to be feasible and to promote better compliance” (McLellen et al., 2014).

Another major subtheme that the research articles consistently demonstrated was that prevention for diabetes can be highly effective and a worthy endeavor as well. Prevention is deeply connected to lifestyle interventions, but also contains a component of education that is so crucial and important. Many people who have unhealthy eating and exercise habits, don’t fully understand the very real and very damaging complications that can occur as a result of these habits, and the lasting damage they can do their bodies, along with the grave danger that they can put themselves in.

Finally, the research did indicate that culture played a role in diabetes management and prevention. Many of the participants of this study came from cultures that had influenced how they viewed food, viewed themselves, and had an influence on their habits and ultimately their health. The more researchers were able to understand the culture that a given person had originated from, the more they were able to create tailor-made and relevant interventions. Culture was a significant sub-theme and something that when studied and understood properly, could aid significantly in helping participants to adjust their habits to lead healthier, happier lives.

Research Questions

The research questions addressed by the studies, looked at the problem of diabetes within the Asian populations from a range of perspectives. Some studies looked at the distinctions in the diabetes management in Asian participants when compared to other ethnic groups (Islam et al., 2015). Whereas others looked at prevention, orbiting around the best ways for members of the Korean health community to prevent diabetes (Islam et al., 2013), other studies focused more on the major risk factors in connection with lifestyle that can be adapted to make the most preventative efforts (Stewart et al., 2016). Lifestyle modification being such a profound theme, other studies sought to determine if it could help in the prevention of diabetes in American, Finnish and Chinese populations via interventions in native Asian Indians who had youth on their side, along with lower levels of body fat and more insulin resistance (Ramachandran et al., 2006). Similar studies attempt to determine what the more causative factors of the disease are, and what the main strategies for prevention should be (Ramachandran et al., 2012). At the same time, many researchers understand that it’s still importance to understand the relationship between the level of fasting plasma glucose (FPG) and the rate of diabetes, or combined

 FPG and HbA1c exams (Jeon et al., 2013). Still other studies have a more marked rate of urgency within their research questions, asking how nations around the world can have a more integrated health-approach to engaging in primary prevention of this condition (Yoon et al., 2006).

Research questions that revolve around lifestyle interventions occurred repeatedly, such as research questions that tried to measure the effectiveness of lifestyle interventions with and without metaformin (Diabetes Prevention Program Research Group, 2002) or the role of lifestyle interventions in conjunction with genes (Hu et al., 2011). Lifestyle interventions are such a valid mode of study, that some researchers form their questions in terms of how to best understand the development of diabetes in terms of behavioral science (Wing et al., 2001) or the impact of lifestyle changes that focus exclusively on weight reduction (Bhopal et al., 2014). How problematic lifestyle decisions impact both diabetes and cardiovascular disease in Asian Americans is another point of concern (O’Keefe et al., 2016), (Modesti et al., 2016).

Additional researchers attempt to confront this health concern by looking at the problem with utter specificity. One such research question attempted to see just how well professional healthcare workers were helping patients reach glycemic control in hospitals in Korea, with the mindset that tighter controls might help to minimize the more debilitating complications of diabetes in Korea (Lim et al., 2009). In a comparable fashion, other research teams examined the role of Adiponectin, a substance secreted by fat cells, and sought to determine in what way it plays a role in predicting the manifestation of diabetes in Asian Indians in participants with impaired glucose tolerance (Snehalatha et al., 2003).

Summary of the Sample Populations

The sample populations were all gathered in distinct ways. For example, some researchers used an intense and strategic method to gather their participant group; some researchers sampled exclusively racial and ethnic minority subgroups that reside in New York City between 2009 and 2012 using Racial and Ethnic Approaches to Community Health (REACH) US Risk Factor Survey Data collected. This gathered over 4400 Hispanic Asian Americans, just under 5000 Hispanics, and just under 3000 non-Hispanic blacks (Islam et al., 2013). Other researchers just recruited participant groups of under 100 or sometimes under 50 individuals in size, looking specifically at people who were at risk for developing diabetes (Islam et al., 2015). And still other researchers just gathered a participant group that was made up of a balanced variety of Asian Americans from a host of nations (Stewart et al., 2016) or randomized a group of around 500 men and women with IGT and an average age of 50 years (Ramachandran, et al., 2006). Other studies were intensely rigorous regarding the standards in place for gathering their sample size and made the eligibility criteria dependent on age, BMI, plasma glucose concentration, and fasting state after a glucose load (Diabetes Prevention Research Group) (Snehalatha et al., 2003).

In addition, other studies were exponentially more rigorous, gathering participant groups that were over 5,500 people in size, and selecting these individuals based on their age, gender, height, weight, waist circumference and blood pressure, investigating them all via classic methodologies (Lim et al., 2009). Essentially all the studies as a whole boasted the most diverse and eclectic means of gathering participants: some of them had very broad criteria for selecting participants, others used the most precise criteria list as a means of making sure they had a specific group of people who would provide the most valuable data.

Summary of the Limitations of the Studies

For many of the studies involved in this literature review, the most common limitation was a narrowness in population size. Some of the studies have too small a participant group to offer much more than illuminating conclusions, but ones, which will ultimately require that more research be conducted. Not having a large enough sample size puts all of the research in the danger of perhaps over-estimating its success, and not offering lucid enough breakthroughs on what really needs to be done for the future of diabetes research.

Many of the studies demonstrate the inherent problem of not having a proper control group: control groups allow the research team to make clear conclusions on all changes observed. This is particularly important since many of these studies focus on concrete lifestyle changes that need to occur: having a control group offers a clear point of contrast and comparison. Another major limitation of the studies in question is that very few of them mentioned any stage where there was a follow-up period with the participants involved, so that the long-term success of treatments and interventions could really be determined. This is significant as so many of the studies focused on the lifestyle and behavioral changes that patients needed to undergo in order to manage or treat their diabetes: follow up is crucial with these patient groups.