Reversing Type 2 Diabetes in African American Women, Research Proposal Example

Background and Significance

Type 2 diabetes is a serious and debilitating disease that impacts many women of all races and cultures, including African Americans. The disease offers many challenging circumstances for those who are affected and impacts quality of life in many ways that cause serious risk and potential harm to their overall health and wellbeing. This problem reflects the need to develop new ideas and strategies to reduce these risks and to provide patients with treatment strategies that will improve disease management over time. This process also demonstrates the importance of understanding the needs of this patient population and to recognize methods whereby the disease could be reversed in some patients. For African American women with Type 2 Diabetes, the threat of long-term complications is a true reality and requires a practical approach to disease management in order to reverse its course and improve overall health as best as possible.

Due to the complexities related to the disease and the complications that often occur in most patients, it is important to determine which factors might be minimized in order to reverse the symptoms and complications related to the disease. This is a challenging circumstance for which the potential exists to reverse its course under specific conditions where medication and lifestyle changes occur that have an impact on overall health and wellbeing; therefore, these issues must be considered. The following discussion will address the impact of Type 2 diabetes on African American females and will consider prior research regarding the disease and how it impacts patient care and wellbeing for this population group. This discussion will evaluate the nature of type 2 diabetes, how it impacts African American women, the potential methods of reversing its course, and the potential barriers to reversal that could continue to impact quality of life in patients.

Understanding of the Problem

In the United States, type 2 diabetes affects one in four African American females over the age of 55, and amputations and kidney failure are two of the most serious complications in this population group (Womenshealth.gov, 2015). One of the factors to consider is socio-economic position (SEP), and the following is known regarding this factor: “SEP may contribute to the development of type 2 diabetes through complex processes involving access to health-care services and information, available healthy foods and places to exercise, economic and occupational opportunities as well as individual lifestyle choices” (Agardh, Allebeck, Hallqvist, Moradi, & Sidorchuk, 2011, p. 2). Many African American women are affected by these conditions due to circumstances beyond their control, and as a result, they face these risks without a clear understanding of how to minimize their risk or even reverse disease progression due in large part to socio-economic status and lack of routine healthcare access for many of these patients (Agardh et.al, 2011). Therefore, it is important to identify some of the tools and resources that are available to support this population in order to recognize the underlying causes of the condition and how it impacts the life span for these women.

Patients with type 2 diabetes may often succumb to poor lifestyle choices and behaviors that influence their wellbeing, and this is associated with a lack of understanding or recognition of prediabetes and how it impacts many women: “A combination of risk factors collectively known as the metabolic syndrome has also shown moderate predictive value in identifying persons at increased risk for diabetes…Known modifiable risk factors for type 2 diabetes include obesity and physical inactivity” (Schellenberg et.al, 2013, p. 543). From this perspective, behaviors that include a sedentary lifestyle may have a lasting impact on the health and wellbeing of patients at an already high risk of diabetes, thereby predisposing them to prediabetes in many situations (Schellenberg et.al, 2013). These findings suggest that the potential exists to modify lifestyle behaviors in order to improve weight loss potential and alleviate obesity, along with an improvement in nutritional habits and an increase in physical activity (Schellenberg et.al, 2013). These lifestyle changes may contribute to a positive impact on wellbeing and the health of patients in this state, thereby increasing the need to evaluate lifestyle interventions as a possible means of reversing type 2 diabetes in some patients (Schellenberg et.al, 2013). Kahn, Cooper, & Del Prato (2014) address the significance of understanding the different elements of care and treatment that impact patients and how this reflects different trends that have evolved over time in managing the disease with an aim at full reversal (Kahn et.al, 2014).

A timely diagnosis of diabetes is critical in understanding the condition and to develop the most feasible treatment strategy for consideration. This process requires a pathogenic understanding of the condition and how it impacts health, along with risk factors such as metabolism and poor insulin development (American Diabetes Association, 2014). However, some experts argue that “Type 2 diabetes has long been regarded as inevitably progressive, requiring increasing numbers of oral hypoglycemic agents and eventually insulin, but it is now certain that the disease process can be halted with restoration of normal carbohydrate and fat metabolism” (Taylor, 2013, p. 1047). Under these conditions, therefore, a reversal of the disease is possible when the appropriate steps are taken to alleviate symptoms through behavioral and lifestyle changes that stimulate weight loss and a return to normal metabolism (Taylor, 2013). McNabb, Quinn, & Tobian (2014) note that type 2 diabetes in African American women is a “silent epidemic” that requires continuous research and evaluation in order to determine if it is reversible with the appropriate strategies in place.

There are a number of factors to consider with respect to the level of risk for African Americans with respect to type 2 diabetes, including but not limited to genetic susceptibility factors, such as single nucleotide polymorphisms (SNPs) that are associated with a higher risk of developing type 2 diabetes in some patients (Cooke et.al, 2012). Prior research indicates that this relationship exists in a number of different population groups, including African Americans (Cooke et.al, 2012). This requires consideration when examining the causes of type 2 diabetes in African Americans and whether or not the genetic risk would prevent a reversal of the disease with the appropriate lifestyle changes or other conditions. The prevalence of type 2 diabetes exists across many generations, particularly in families where the risk is greatest to begin with; therefore, its pathophysiology must be well understood in order to improve the development of treatments and prevention methods that will have an impact on the population as a whole (Nolan, Damm, & Prentki, 2011). From this perspective, it is known that “The clinical management of established type 2 diabetes involves optimum control of factors that cause complications, such as blood glucose and lipid concentrations, blood pressure, bodyweight, and smoking, as well as regular screening for and appropriate management of microvascular (eye, renal, and neural) and macrovascular (coronary, cerebral, and peripheral) complications” (Nolan et.al, 2011, p. 177). This is an important reminder of the issues related to type 2 diabetes that influence patient outcomes and pose a threat to African American women in many ways that are difficult to manage in patients, including the transition to improvements in lifestyle behaviors that impact patient health (Wise et.al, 2011).

Rationale

For African American women with type 2 diabetes, the potential for disease reversal may be prevalent in some patients who commit to significant lifestyle changes and other behaviors that may impact the life span and the existence of the disease. Therefore, it is necessary to consider a potential segment of the female African American population who might fit this profile in order to determine their potential to reverse the disease gradually over time. The potential ability to reverse the disease must be examined in greater detail in order to determine it efficacy, using recommended lifestyle changes as a marker for further analysis and evaluation. This research is relevant because at the level of severity that diabetes currently holds, it is necessary to develop any possible means of understanding the disease and its causes, as well as the potential methods of reversing the condition. This is likely to have a critical impact on patients who have type 2 diabetes, as it reflects the importance of understanding the nature of the disease and its causes in order to promote lifestyle behaviors and other strategies in an effort to reverse the condition whenever possible. This process also requires an evaluation of the following research question regarding this issue: Do lifestyle behavioral changes, such as improved nutrition and physical activity, play a role in the reversal of type 2 diabetes in some African American female patients? This research question is critical to the overall discussion of African American women who have type 2 diabetes and who face the risks associated with the disease.

Conceptual Framework

It is believed that an analysis of the aforementioned research question requires an effective understanding of the different tools and resources that impact African American women with type 2 diabetes and the risks that are associated with this condition. Therefore, it is suspected that when women undertake specific lifestyle changes that may contribute to weight loss and improved health and wellbeing, these factors will play an important role in shaping the development of new ideas and strategies to accommodate patients that have the disease and the possible methods of reversing its course in the designated population. It is believed that patients with type 2 diabetes who qualify may be able to reverse their condition under specific circumstances, depending on other factors that impact their overall health, as well as any other conditions that may exacerbate their diabetes in different ways. These factors must be considered in the development of a research study to address type 2 diabetes in African Americans and the chance of reversal of the disease in some patients.

Research Methodology: Introduction

In order to determine the potential benefits of lifestyle changes for African American females with type 2 diabetes, it is important to address the research question in order to determine whether or not these changes, such as improved nutrition and increased physical activity, play a critical role in the reversal of the disease in some patients. It is suspected that for some patients without a genetic predisposition for diabetes, who are overweight or obese, and who possess other risk factors that predispose them to diabetes, may be able to reverse the condition under some circumstances. The research study will seek to answer this question in order to determine if behavioral lifestyle changes are significant enough to reverse diabetes in some African American females.

Study Design

The proposed study would employ a prospective cohort design, a form of longitudinal study that represents a means of evaluating a specific group of patients over a period of time in order to determine if there are lifestyle changes that may have a lasting impact on patients and the potential reversal of the disease. Therefore, the prospective cohort strategy will evaluate a specific set of lifestyle changes on a group of patients and will determine if they have an impact on regulating metabolism, promoting weight loss, and reversing diabetes in some patients. This prospective cohort approach will require patients to be monitored over a period of time in order to determine the overall efficacy of the interventions and whether or not it is successful in reversing type 2 diabetes in patients.

Intervention

The proposed intervention requires an examination of the different areas whereby lifestyle behaviors may have a positive impact on diabetes, such as improved nutrition that involves reduced carbohydrates, lean meats, and sufficient fruits and vegetables; the elimination of as much sugar as possible from the diet, including sodas; and increased physical activity among the patient population. This intervention will determine if patients respond to these changes and how they are able to manage new lifestyle changes to stimulate weight loss and reverse the disease.

Study Sample

The proposed target population for the study is African American women between the ages of 50-65 who are overweight or obese; who have had type 2 diabetes for at least one year; who have or have not been prescribed oral medication but are not insulin-dependent; and who are willing to commit to a program involving lifestyle changes over a period of nine months to one year. A sample size of 10-12 participants would provide a sufficient number to conduct the prospective cohort study and also determine if the chosen strategy is effective in reversing diabetes in these patients. The study participants will be selected on the basis of the following inclusion criteria: 1) all study participants are between the ages of 50-65; they have had a diagnosis of diabetes for at least one year; 3) they may be on oral medication but to not require insulin; 4) they are overweight or obese; and 5) they are currently receiving routine care from a physician or a clinic for their condition. Recruitment will be conducted through local doctor’s offices and clinics in the form of flyers that explain study and that provide contact information. It is expected that six members of the study will be subject to lifestyle interventions that include increased regular physical activity and improved nutrition, while the other six will only be required to increase their physical activity but are able to eat with dietary restrictions. The independent variables are increased physical activity and improved nutrition, while the dependent variable is the prevalence of type 2 diabetes in these patients.

Data Collection

The proposed study will require patients to be evaluated during their initial participation in the study, including blood glucose testing, height and weight, and other basic values. At three months, six months, and nine months, the same measurements will be taken and recorded, and the values will be analyzed as necessary in order to make determinations regarding the lifestyle interventions that have been employed. Data will be recorded in a password-protected Excel spreadsheet for use only by the researcher.

Data Analysis

The analysis portion of the study will examine the aforementioned data in order to determine its overall efficacy and whether or not lifestyle factors have been influential in addressing the needs of these patients in an effort to reverse type 2 diabetes. Therefore, the data analysis portion must include a comparison of values for each study participant in order to determine if the study has been effective in addressing the chosen research question.  The proposed hypothesis is that patients who undergo the required lifestyle changes will experience a lower level of risk that is evident in their test values and may also reverse their diabetes condition. However, those who do not participate in these lifestyle changes are not likely to experience the same improvements and may continue to face the symptoms and complications of type 2 diabetes.

Human Subjects Research

For this study, a human subjects research protocol will be developed and submitted to the appropriate IRB in order to protect all study participants from any type of risk or harm that may impact their overall health. Once the study has been approved in its final version by the IRB, all persons selected for participation in the study will be required to complete a consent form, which will be kept on file. The researcher will take the steps that are required to protect human subjects from unnecessary risk or harm as best as possible, minus the traditional risks associated with standardized blood testing.

Discussion

It is believed that the study will demonstrate the necessary parallels between the reversal of type 2 diabetes and lifestyle changes; however, this also reflects the need to evaluate the possibility that some patients may not respond to these lifestyle changes in an effective manner. Therefore, it is likely that additional studies would be necessary that would include a greater number of patients in order to determine whether or not these lifestyle interventions have been effective. It is important to consider methods to potentially reverse type 2 diabetes because it is a complex condition with many serious health risks. The disease is a detriment to public health; therefore, it requires patients to examine their own behaviors and to consider how lifestyle changes might make an important difference in the lives of some African American women with type 2 diabetes. This research is of critical importance because the nature of diabetes continues to expand in scope throughout the world, and the affected populations require methods of alleviating the condition through these changes.

References

Agardh, E., Allebeck, P., Hallqvist, J., Moradi, T., & Sidorchuk, A. (2011). Type 2 diabetes incidence and socio-economic position: a systematic review and meta-analysis. International journal of epidemiology, dyr029.

American Diabetes Association. (2014). Diagnosis and classification of diabetes mellitus. Diabetes Care, 37(Supplement 1), S81-S90.

Cooke, J. N., Ng, M. C., Palmer, N. D., An, S. S., Hester, J. M., Freedman, B. I., … & Bowden, W. (2012). Genetic risk assessment of type 2 diabetes–associated polymorphisms in African Americans.Diabetes Care,35(2), 287-292.

Kahn, S. E., Cooper, M. E., & Del Prato, S. (2014). Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future.The Lancet, 383(9922), 1068-1083.

McNabb, W., Quinn, M., & Tobian, J. (2014). Diabetes in African American women: the silent epidemic. Black Women’s Health: A Special Double Issue of Women’s Health: Research on Gender, Behavior, and Policy, 275.

Nolan, C. J., Damm, P., & Prentki, M. (2011). Type 2 diabetes across generations: from pathophysiology to prevention and management. The Lancet, 378(9786), 169-181.

Schellenberg, E. S., Dryden, D. M., Vandermeer, B., Ha, C., & Korownyk, C. (2013). Lifestyle interventions for patients with and at risk for type 2 diabetes: a systematic review and meta-analysis. Annals of internal medicine, 159(8), 543-551.

Taylor, R. (2013). Type 2 diabetes etiology and reversibility. Diabetes care,36(4), 1047-1055.

Wise, L. A., Rosenberg, L., Radin, R. G., Mattox, C., Yang, E. B., Palmer, J. R., & Seddon, J. M. (2011). A prospective study of diabetes, lifestyle factors, and glaucoma among African-American women. Annals of epidemiology, 21(6), 430-439.

Womenshealth.gov (2015). Diabetes. Retrieved from http://www.womenshealth.gov/minority-health/african-americans/diabetes.html