Diabetes in Urban African Americans, Research Paper Example

Introduction

Medical therapy has enjoyed some success in the history of their application. One such therapy is proffered here with the goal of serving the African American community living in urban areas. The strategic goal of the therapy is to reduce the risks associated with metabolic syndrome among this demographic. As such, the therapy is intended to work at the community level. Nevertheless, it is incumbent upon researchers to understand some of the pathological implications at least in part in order to determine a specifically targeted therapy protocol. As we move from theory to practice, the role of genetics comes into question. Ultimately, it is practically irrelevant to sufferers of diabetes or those at risk from it.

What is Diabetes?

Diabetes is metabolic condition whereby there is too much glucose in the body (National Diabetes Education Program (NDEP), 2011). There are many forms of diabetes – one specific to pregnant women. Two more are called Type 1 diabetes or Mellitus and Type 2 diabetes, which is more common overall.

Type 1 Diabetes

Type 1 diabetes was once known as childhood diabetes (NDEP, 2011). It is a condition some children are born with and is less prevalent in African Americans at large than the white population. There is no known cure at this time. As such, our discussion here focuses upon Type 2 diabetes.

Type 2 Diabetes

When you have type 2 diabetes, ones metabolism no longer do not handles insulin properly, a condition known as insulin resistance (NDEP, 2011). As such, blood sugar does not get metabolized. As family history plays a key role in this type of diabetes, there appears to be a genetic component, but low levels of physical activity, ineffective eating habits, and too much body fat contribute to the onset of type 2 diabetes. Diabetics typically share certain symptoms including blurred vision, exhaustion, hunger, and rapid weight changes.

Purpose

To assess the magnitude of the problem of diabetes among African Americans in urban areas, researchers have gathered information about the incidence of these criteria. One stark fact is that African Americans have a statistically higher chance of developing diabetes than their white counter-parts (Signorello, Schlundt, Cohen, Steinwandel, Buchowski, McLaughlin, Hargreaves, Blot, 2007). This being true, it is incumbent upon medical professionals to develop a way of reducing the disparity by either increasing the resilience of the population at hand or reducing external factors which impact the trend.

Understandings about the pathology of diabetes are helpful in structuring therapeutic intervention. Thus, one of the aims of the therapy is to reduce the proportion of adults who are obese within the target population (Ford & Giles, 2003). Metabolic syndrome is a highly correlative factor in the incidence of diabetes. As such, one of the aims of the therapy must be to reduce the impact of factors related to constituent conditions. As a traditionally underserved demographic, African Americans are more likely to suffer from metabolic syndrome which contributes to the probability that they are more likely to become obese and thus develop diabetes. It could be that part of the reason our demographic seems to be more susceptible to diabetes is behavioral. Learning to deal with either the genetic or environmental constituencies is necessary for effective prevention and treatment.

Nevertheless, lifestyle habits are known to contribute to the incidence of metabolic syndrome, and thus, diabetes. Education as a form of prevention is the aim of this therapy. The more the target demographic is privy to information about healthy eating habits and physical activity, the more they will be able to make healthy lifestyle choices. Over time, these choices will translate into a lower risk for metabolic syndrome, its consequences in general, and diabetes in particular. This is true despite actual causes.

The stakeholders and partners that will be involved in implementing the therapy are enumerated here. The primary stakeholders are members of the African American community living in urban areas. They have the most to gain by its success. The medical community benefit from the proposed program in at least two ways. The first way is that their rate of positive outcomes will increase with respect to African Americans at risk for diabetes within the population they serve. The other way is that health care professionals will be able to concentrate on other pressing matters with the resources that have been freed up as a result of a lower incidence of diabetes and related illnesses that are part and parcel to the causative factors outlined above. Furthermore, gained partnership from funding agencies such as non-profit organizations that serve the affected community as well as government agencies such as community health departments is normally expected. The overall effect is that the community should experience a reduction in diabetic cases over time.

Review

A review of evidence for other similar diabetes intervention therapies is conducted to substantiate the requirements of the therapy developed here. One study determined the impact and cost-effectiveness of primary care versus community intervention therapies with respect to some of the risk factors associated with diabetes. 542 urban African-Americans with type 2 diabetes who were members of a managed-care organization in Baltimore, MD were divided into two groups for 2 years (Gary, Batts-Turner, Bone, Yeh, Wang, Hill-Briggs, Levine, Powe, Hill, Saudek, McGuire & Brancati, 2004). The control group had normal medical care. The experimental group participated in intensive intervention by a nurse case manager (NCM) and/or community health workers (CHW). The NCM/CHW team performed individual care focusing on diabetes management, complications, and social issues. NCM consultations were conducted annually, and CHW consultations were conducted up to three times per year or more (if necessary). Researchers found that NCM/CHW approach was cost-effective, and it worked to reduce the consequences associated with diabetes for urban African-Americans. As we move toward a universal healthcare, prevention and cost-reduction become as important from the standpoint of community based treatments as actual outcomes.

In another study, researchers studied one hundred fifty-one African American and Latino adults with diabetes recruited from 3 health care systems in Detroit, Michigan (Feathers, Kieffer, Palmisano, Anderson, Sinco, Janz, Heisler, Spencer, Guzman, Thompson, Wisdom & James, 2005). The subjects participated in the Racial and Ethnic Approaches to Community Health (REACH) Detroit Partnership diabetes intervention therapy. The curriculum focused on lifestyle training, and was taught by residents trained to present the material. The aim was to improve diet, physical activity levels, and diabetes self-maintenance. Data was gathered before and after the course to quality-of-life, diet, physical activity, knowledge and behaviors, and hemoglobin A1C. What researchers found was statistically significant improvements in knowledge and behaviors with respect to diet and physical activity. Furthermore, compared to subjects within the same health care community (P=.160), the REACH therapy participants showed statistically significant improvement in A1C levels (P<.0001). This demonstrated the effectiveness of community training therapies aimed at combating diabetes among urban African Americans. The point is that these measures are more or less known to work across the board.

In still another study, the effect of a community therapy aimed at improving lifestyle as a method of intervention was studied (Seidel, Powell, Zgibor, Siminerio & Piatt, 2008). 88 subjects were selected based on their propensity for metabolic syndrome. They were asked to participate in a 12-week lifestyle intervention therapy that taught about healthy weight loss and physical exercise. Over 45% lost up to 5% of their weight and more than 25% lost up to 7%. After 6 months, over 85% and over 65% maintained the 5% and 7% losses, respectively. Over 33% demonstrated improvement in one or more areas of metabolic syndrome, and after 6 months, nearly 75% of them maintained this improvement. After adjusting for age, gender, race, and average number of classes, there was an overall improvement in waist line measures and blood pressure levels overall. These statistics demonstrate the effectiveness of short-term education with respect to diabetes risk factors among African Americans living in urban environments. In cases where it seems where there are both genetic and behavioral components to disease, it is important to take a utilitarian approach especially.

Not only does this evidence demonstrate the effectiveness of the methods employed in mitigating the impact of diabetes in our population of interest, it also helps describe applicability to it. The therapy proposed here is manifold based on knowledge gleaned for previous research. Time-frames and techniques are barrowed from therapies shown to have some success such that hypothetical therapy based on these findings addresses the problem of diabetes among urbanized African Americans. Because we have yet to develop a gene therapy for diabetes, we must do what we can to limit its impact on affected populations.

Proposal

The proposed therapy consists of community training sessions and protocols carried out over a two year period. First, participants are asked to engage in an intensive one-on-one screening with a community nurse to determine their eligibility for the therapy along with an initial consultation about diet, exercise, diabetes management, and metabolic risk factors. Next, they would be asked to participate in a 12 weeks of classes aimed at educating them about the specific, individual changes they can make as a way of mitigating the consequences of both metabolic syndrome and diabetes. For the remaining months, they would attend 2 clinical visits with a nurse and up to 5 in-home visits by community educators to gauge their progress and refresh them about information they learned in the previous sections of the therapy. This seems to help mitigate the consequence associated with the disease.

Specific, measurable objectives are enumerated as a method of tracking the effectiveness of the therapy itself. At intake, participant baselines would be gathered based on waste line measures, metabolic syndrome risks, and quality-of-life measures. These same measures would be replicated at each of the nursing and community educator visits over the subsequent months. This would allow practitioners to monitor the effectiveness of the program within their specific communities.

Conclusion

Certain medical therapies have been shown to be effective in combating some prevalent diseases among certain populations. A therapy aimed at African American communities in urban areas has been developed here. Is that African Americans are more genetically predisposed to diabetes than other demographics, or is it that behavioral components, living conditions, and environmental stress contribute to the overall prevalence of diabetes within their communities? It is known that certain stress hormones such as cortisol contribute to metabolic processes that are associated with insulin resistance when their presence is prolonged for example. The program is pragmatically addressing both. Whether genetic or environmental, the practices reduce the caloric and fat intake of practitioners and increase overall physical activity, both of which are know to reduce stress. The basic goal of the therapy is to reduce the impact of metabolic syndrome on African Americans who have diabetes that live in urban areas. The strategic goal is to help people reduce risk factors among this demographic. The therapy is intended to work at the community level, and it hinges upon research that outlines pathological implications of the risk factors as well as the outcomes of similar such therapies to help combat problem of diabetes among urbanized African Americans.

References

Feathers, J.T., Kieffer, E.C., Palmisano, G., Anderson, M., Sinco, B., Janz, N., Heisler, M., Spencer, M., Guzman, R., Thompson, J., Wisdom, K. & James, S.A. (2005). Racial and Ethnic Approaches to Community Health (REACH) Detroit Partnership: Improving Diabetes-Related Outcomes Among African American and Latino Adults. American Journal of Public Health, 95(9): 1552-1560.

Ford, E.S. & Giles, W.H. (2003). A Comparison of the Prevalence of the Metabolic Syndrome Using Two Proposed Definitions. Diabetes Care, 26(3):575-583.

Gary, T.L., Batts-Turner, M. Bone, L.R., Yeh, H., Wang, N., Hill-Briggs, F., Levine, D.M. Powe, N.R., Hill, M.N., Saudek, C. McGuire, M. & Brancati, F.L. (2004). A randomized controlled trial of the effects of nurse case manager and community health worker team interventions in urban African-Americans with type 2 diabetes. Controlled Clinical Trials, 25(1): 53-66.

National Diabetes Education Program. (2011). The Diabetes Epidemic Among African Americans. Retrieved from http://ndep.nih.gov/media/FS_AfricanAm.pdf?redirect=true

Seidel, M.C., Powell, R.O., Zgibor, J.C., Siminerio, L.M. & Piatt, G.A. (2008). Translating the Diabetes Prevention Therapy into an Urban Medically Underserved Community: A nonrandomized prospective intervention study. Diabetes Care, 31(4): 683-689.

Signorello, L.B., Schlundt, D.G., Cohen, S.S., Steinwandel, M.D., Buchowski, M.S., McLaughlin, J.K., Hargreaves, M.K. Blot, W.J. (2007). Comparing Diabetes Prevalence Between African Americans and Whites of Similar Socioeconomic Status. American Journal of Public Health, 97(20): 2260-2267.