Sugar Intake and Type 2 Diabetes in African-American Women, Capstone Project Example

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Abstract

In the United States, there are over 23 million people living with diabetes with 95 percent of these people having type 2 (non-insulin dependent) diabetes, and this is particularly true of non-white Americans (Diabetes, Type 2, 2008). According to Smith (2011), it is estimated that African-American women comprise 15 percent of all type 2 diabetes cases in the United States with 12 percent of these cases being African-American women age 20 or over, and this rate increases with their ages. This report examines the association between sugar intake and type 2 diabetes in African-American women, adjusting for age. This report also takes an in-depth look at what diabetes and its risks factors are, what causes it, its prevalence among African-American women, how it can be treated and how it can be prevented. The goal of the research is to evaluate the findings and results of specific analyses in regard to sugar intake and type 2 diabetes in African-American women as they age.

The abstract needs to have summary statements regarding the methods, results and conclusion.  Therefore, it needs to be written last.

Sugar Intake and Type 2 Diabetes in African-American Women

Chapter 1:  Introduction

There are over 23 million people living with diabetes in America and 95 percent of these people have type 2 (non-insulin dependent) diabetes (Diabetes, Type 2, 2008). Additionally, it is estimated that African-American women make up about 15 percent of all type 2 diabetes cases in the United States with 12 percent of these cases being African-American women age 20 or over, and this rate increases with their ages (Smith, 2011).

According to Black Women & Diabetes (n.d.), black women ages 55 and older are affected by diabetes at a rate of 1 in 4, and the disease is the fourth leading cause of death for black women of all ages. It is also noted that almost “50% of Black females born in the year 2000 and beyond will likely develop Type 2 diabetes in their lifetime” (para. 1). The reason for this is linked to African-American women’s level of risk factors for the disease. Statistics show that almost 80 percent of black women have problems with weight and are either classified as overweight or obese, approximately 55 percent of black women do not get regular physical exercise, and many black women have hypertension. These risk factors can result in insulin resistance which causes diabetes (Black Women & Diabetes, n.d.).

Type 2 Diabetes Defined

Diabetes can be managed, and people with the disease can live productive lives, if they follow the treatment, management and medicinal protocols given to them by their doctors, therapists and other healthcare professionals. This is particularly important for African-American women, who tend to be at higher risk for developing the disease and suffering from its complications than are Caucasian women. Lifestyle changes, including taking prescribed medications, are often sufficient for controlling the effects of diabetes and accounts for many people being able to live relatively normal lives with the disease.

Diabetes According to the World Health Organization (WHO)

Chapter 2:  Literature Review

Type 2 diabetes, as it relates to African-American women, is significant at various stages of life which are: (1) the adolescent years, (2) the reproductive years, (3) the middle-aged years, and (4) the elder years.

This literature review is composed of sources that examine diabetes (particularly type 2 diabetes) its causes, its prevalence and treatment options, especially as it relates to African-American women by age group. The correlation of sugar intake to type 2 diabetes in African-American women is also examined. Sources in this literature review range cover a broad range of information about diabetes with an aim to analyze its effects on African-American women, beginning with the causes of diabetes as follows.

What Causes Diabetes?

Obesity is a major risk factor for developing type 2 diabetes and where this used to be a disease of middle-aged people and older, it is now a problem for the youth as well. In this country, particularly, it is apparent that more and more children, teens and young adults are becoming overweight and obese. Consequently, more and more children, teens and young adults are being diagnosed with diseases that used to manifest in later years such as type 2 diabetes. This may be due to young people, overall, being less physically active than in previous years. Being physically inactive plays a role in the incidence of obesity and this can contribute to the occurrence or complication of type 2 diabetes. Consequently, girls are often starting out early with this disease and must deal with its affects through the adolescent and teen years, in addition to their adult years. Moreover, the incidence of obesity affects African-American females disproportionately which leaves them susceptible to developing type 2 diabetes. Following, this literature review reports on how type 2 diabetes relates to African-American women as they age.

Diabetes and Women’s Health Across the Life Stages: A Public HealthPerspective (2001, October). Centers for Disease Control and Prevention.

This literature piece will be used as one of three sources for this report’s methodology, data sources and findings (chapters 3 and 4). It takes an in-depth look at diabetes in African-American women, adjusting for age. The study also highlights the Diabetes Public Health Resource page on the Centers for Disease Control and Prevention (CDC) website which posts a report entitled, Diabetes and Women’s Health Across the Life Stages: A Public Health Perspective (2001). This report shows how diabetes affects African-American females from the adolescent, reproductive, middle and elder years of life, and also a standardized prevalence of the disease as it relates to ages and race within the female adult population in the United States.

Facts About Diabetes and Women

Many people are not aware of the prevalence of diabetes in the United States and unless they or someone they know has the disease, they may not seek to be aware of it. However, as it relates to women, diabetes is something that cannot be ignored because it causes a host of other health conditions and complications that can have an impact on entire families.

One may wonder just how many cases of diabetes are in America. According to Diabetes and Women’s Health (2001), there are approximately 15.7 million people in America with diabetes, and more than half of these people (8.1 million) are women. Additionally, the disease is 2-4 times more prevalent in black women and other minority women, as compared to white women in America.

It is noted that women are more likely to develop heart disease, as a complication of diabetes and they are less likely to survive a heart attack than men with the disease. Also women are more likely to become blind, as a complication of their diabetes and have shorter life expectancies. It is also reported that socio-economic status is a determining factor in whether or not women get adequate treatment and counseling for their diabetes (Diabetes and Women’s Health, 2001). This likely explains why more African-American women are at risk for suffering from diabetes complications. African-American women may be more likely to be uninsured, and therefore, unable to seek proper and thorough medical treatment and preventive measures for diabetes management. This is likely a problem with African-American girls and women who fall within the level of poverty and affects them at each stage of life.

Diabetes in the Adolescent Years of African-American Females

The adolescent years are ages 10 through 17, and although type 2 diabetes was practically unseen in this age group in previous decades, it is becoming a continuous growing problem. This is mainly because of the rise of obesity, which is due to bad diets and physical inactivity in adolescents, particularly girls, and this is especially true among minority groups (Diabetes and Women’s Health, 2001).

Many adults may be able to look back on their childhoods and remember when there only used to be one or two overweight children in their classes, as compared to now where it seems that obese children have become a majority. This is, no doubt, due to increased sugar intakes of children in today’s times. Fast food, soda pops, candy, desserts, processed foods and all types of sugary goodies are readily available to children as is the invitation to sit around instead of moving around. Video games and other electronic devices, the Internet with interactive social sites and cable television are now part of the reason that children get very little physical activity. They do not go out and “play” much anymore which used to serve as excellent exercise, and it helped children maintain their weight and stave off obesity and sedentary-related illnesses and conditions such as type 2 diabetes. More and more children are becoming obese at very young ages and it seems to have become a serious epidemic, particularly with young females in the adolescent age group.

Diabetes in the Reproductive Years of African-American Females

The reproductive years are ages 18 through 44 and according to Diabetes and Women’s Health (2001), there are approximately 1.8 million women of reproductive age living with diabetes in the United States and minority women in this age group are 2-3 times more likely to develop the disease. It is also stated that women with type 2 diabetes, who are in the reproductive year’s stage of life, are more likely to be less educated with lower incomes than women who do not have diabetes. This, again, may contribute to the prevalence statistics of African-American women with type 2 diabetes, because there may be a higher incidence of them that may be more likely to be uneducated and have low incomes than Caucasian women with type 2 diabetes.

Another significant finding of diabetes among women in the reproductive years is the incidence of gestational diabetes (diabetes during pregnancy). According to Diabetes and Women’s Health (2001), gestational diabetes is caused by hormones from the placenta and an estimate of up to 4 percent of women in the United States develop gestational diabetes. Women with gestational diabetes are at a higher risk of pregnancy complications such as preeclampsia which is characterized by hypertension, weight gain and edema. Although gestational diabetes usually resolves after the birth of the baby, women who had it during pregnancy have up to a 45 percent higher risk of having it with subsequent pregnancies, and up to a 63 percent higher risk of becoming a type 2 diabetic. Additionally, it is reported that non-white women are at greater risk of having gestational diabetes (Diabetes and Women’s Health, 2001).

These statistics are due, in part to increased sugar intake of African-American women in this age group, according to (Impact of Sugar-Sweetened Beverage, 2011). However, this will be dealt with in the review of the Impact of Sugar-Sweetened Beverage literature review.

Diabetes in the Middle Years of African-American Females

The middle years are ages 45 through 64 and Diabetes and Women’s Health (2001) reports that type 2 diabetes among African-American women in this age group is at least twice as prevalent than it is in Caucasian women. As mentioned above, women in this age group are likely to be less educated and have lower incomes, and this is likely to be particularly true of African-American women. Also, as with African-American women in the reproductive years, increased sugar intake of African-American women in this age group, according to (Impact of Sugar-Sweetened Beverage, 2011) is largely responsible for the incidence of type 2 diabetes in this age group. This will be dealt with in the review of the Impact of Sugar-Sweetened Beverage literature.

Diabetes in the Elder Years of African-American Females

The elder years are age 65 and older, and according to Diabetes and Women’s Health (2001), type 2 diabetes is most common in elderly women with diabetes, and elderly black women are twice as likely to die from diabetes-related issues than are elderly white women. In addition, they are more likely to suffer from various complications from the disease. It is not likely, however, that black women in this age group have a very high sugar intake, as given the lack of evidence for this found for the purposes of this report.

Age-Standardized Prevalence of Diabetes in African-American Women 

Diabetes affects African-American women differently at various stages of life and the prevalence of the disease, standardized by age is show in the following two figures.

Figure 1 shows which states in America had the highest incidence of minority female (including African-Americans) cases of diabetes between 1996 and 1998. It appears that the states with the highest likely concentrations of African-American female populations (in the hash-marked, dotted and solid red colors) had the highest number of diabetes cases, while the states with the least likely concentrations of African-American female populations (in the solid white color) had the lowest number of diabetes cases.

Additionally, Figure 2 shows the percentage of black females (4^th chart variable) diagnosed with diabetes by age in the United States in 2010. Notice the significant difference as compared to white females (2^nd chart variable).

Given the time span between both of these figures, it is shown that diabetes cases in African-American females are disproportionate, as compared to Caucasian females.

Figure 1: Age-Standardized Prevalence* of Diagnosed Diabetes per 100 Adult Female Population, by State, United States, 1996-1998

Source: Diabetes and Women’s Health (2001)

Figure 2:  Age-Specific Percentage of Civilian, Non-institutionalized Population with Diagnosed Diabetes, by Age, Race and Sex, United States, 2010

Source: Age-Specific Percentage (2011)

Following, the literature review reports on various views about the causes of diabetes and its gender and racial differences. Also, there is in-depth reporting on how sugar intake relates to type 2 diabetes, specifically in African-American women.

Media Centre (2012, September). Diabetes.

This literature work is from the World Health Organization (WHO) website and is based on a fact sheet about diabetes. According to the fact sheet, unchecked and uncontrolled diabetes leads to a condition brought on by elevated blood sugar levels, called hyperglycemia. Over time, serious damage to body systems such as the nervous system and the blood vessels results. People with type 2 diabetes may not even know they have hyperglycemia, so it goes undetected for many years and it is only when complications arise that they find out they have the disease (Media Centre, 2012). In addition to this, prolonged diabetes can cause severe damage to the heart, eyes and kidneys, and it can lead to neuropathy, particularly in the feet, which can lead to foot amputation.

The WHO website outlines some key facts about diabetes such as 3.4 million people passed away from complications of diabetes in 2004, and over 80 percent of these deaths occurred in low- and middle-income socio-economic status levels. It is also pointed out that a healthy diet, regular exercise, tobacco use cessation and maintaining a normal weight are factors in preventing or controlling the disease (Media Centre, 2012).

The WHO website is a resource for people to visit who want more information on diabetes and guidelines for preventing diabetes. The website also gives information about World Diabetes Day which is November 14 of each year. This is significant because there is so much information available that no one should fall victim to the adverse effects of diabetes. Awareness is a key component to prevention.

 Diabetes, Type 2 In-Depth Report (2008). The New York Times.

This literature work thoroughly covers diabetes and both of its forms, type 1 (insulin-dependent diabetes) and type 2 (non-insulin dependent diabetes). However, as it relates to the subject matter of this report, it is most helpful in explaining the nature of type 2 diabetes and how it relates to how the pancreas functions or malfunctions in regard to insulin levels within the body.

This literature explains causes, risk factors, diabetes-related medical conditions, symptoms, testing, and diagnosis. Additionally, lifestyle changes to include suggestions for following medicinal protocol, eating a heart-healthy diet, smoking cessation and regular exercise are highlighted as preventive and corrective measures for managing the disease. As it relates to African-Americans, this literature piece reports that being African-American is a major risk factor for type 2 diabetes.

Additionally, this literature piece goes in-depth into treatment for conditions brought on from diabetes complications such as heart disease, hypertension, foot ulcers, foot amputations, retinopathy, neuropathy, kidney disease and mental problems.

As it relates specifically to women, this literature piece covers specific complications in women with diabetes such as recurrent vaginal yeast infections and drug interaction with birth control pills and diabetes medicines which can decrease the effects of birth control pills. Additionally, diabetic women may go into premature menopause and this can increase heart disease risks.

Since research studies show that excessive sugar intake can contribute to the incidence of type 2 diabetes and also to complications of the disease after diagnosis, it is important to understand how food and sweets play a role in the disease.

Food & Fitness (2012). Sugar and Desserts.

This literature work is an article from the American Diabetes Association that takes a look at how to reasonably include sweets into a meal plan as a way to control weight gain and keep the body at a normal weight range. Considering that being overweight can cause a person to lose track of their sugar intake, this is an excellent way to stave off obesity which can lead to chronic metabolic conditions such as diabetes.

According to Food & Fitness (2012), the notion that sugar causes diabetes is a myth and it is noted that type 1 diabetes is inherited through genetic predisposition and could not possibly be caused by increased sugar intake.

Additionally, consuming excessive sugary drinks is linked to higher incidences of weight gain and obesity, which is a risk factor for developing type 2 diabetes, and this should be limited, according to the American Diabetes Association (Food & Fitness, 2012).  Many Americans have diets that include high sugar intakes as the popularity of sodas, desserts and other sweets is a constant temptation.

It should go without saying that people just need to simply eat less sweets, especially if they are obese, diabetic or borderline diabetic. However, this is something that is not likely, based on the number of people in America who are overweight and have unhealthy eating habits.

The following figure from the Centers for Disease Control and Prevention website show comparisons of a partial history of adult obesity (defined by Body Mass Index – BMI) prevalence by state in America. The statistics are somewhat alarming.

Figure 3: Percentages of Obese (BMI greater than or equal to 30) in U.S. Adults Over a Ten Year Period

As shown in Figure 3 above, the rate of the growth of obesity in America between 1990 and 2010 was consistent and increasing with every year. No doubt, the regular consumption of excess sugar in the American diet is largely to blame, as diets high in sugar contribute to obesity due to added caloric intake.

The highlights of the article focuses on sugar and desserts and mentions the importance of keeping sugar and dessert consumption to a minimum which can include opting for fresh fruit, as opposed to a dessert, to satisfy a sweet craving. As far as what causes diabetes goes, it is not sugar, not directly anyway.

However, consuming excessive amounts of sugar can sometimes happen without notice because so many food and beverage products contain added sugars. The article in this literature review points out the importance of managing sugar intake, to manage weight gain, which can decease the incidence of developing type 2 diabetes.

Moreover, the article states that incorporating small amounts of sweets, on special occasions, into a well-balanced meal plan is acceptable for diabetics to control their diabetes. The article gives advice on diabetes-friendly snacks and gives an overview of the importance of reading nutrition facts labels to help control sugar intake.

This should be true even for non-diabetics as a way to prevent the development of type 2 diabetes. Diets high in sugar may increase one’s risk for obesity and becoming a type 2 diabetic.

Adams, A. (2011, April 8). Does a Diet High in Sugar Increase the Risk for Diabetes? Livestrong.com.

This literature piece is an article on Livestrong.com, a popular health and wellness site whose authors are required to use relevant and reputable sources when writing for the site’s content.

The article reports diabetes is a serious disorder of the metabolism and causes the body’s pancreas to defect as is the case with type 1 and type 2 diabetes. The article also explains how sugar (glucose) affects the body and points out increased sugar intake can come from various types of foods, and not just sweets (Adams, 2011). It is true that many people may think that only foods and drinks that taste sweet will raise blood sugar levels, when in fact, foods that are not sweet like potatoes and other carbohydrates, can cause a rise in blood sugar levels as well. This is why it is important for people with diabetes to be educated and aware of how sugar affects the body and their disease. Without awareness and education, diabetics may not control the factors that could cause serious complications from the disease.

According to Adams (2011), the American Diabetic Association reports that risk factors for diabetes include being overweight, being physically inactive and belonging to a high-risk ethnic group such as African-American. However, studies do not necessarily show that high sugar intake is directly related to diabetes, they do show that high sugar intake increases the risk of obesity and obesity is a risk factor in the development of diabetes, but the research does not show that high sugar intake is directly the cause of diabetes. It is a risk factor. The following literature review takes an additional look at the causes of diabetes.

Diabetes Info. (2011, December 5). Causes of Diabetes.

This literature piece gives a description of what causes diabetes, both type 1 and type 2, according to the National Diabetes Information Clearinghouse (NDIC). It outlines a detailed definition of what diabetes is and the factors that contribute to the occurrence of the disease. Additionally, gestational diabetes is covered on this website and what contributes to its causes.

The NCIC also explains how insulin and glucagon, in the body, are significant factors in regulating normal blood glucose levels as follows: “Glucagon signals the liver and muscle tissue to break down glycogen into glucose, which enters the bloodstream and raises blood glucose levels. If the body needs more glucose, glucagon stimulates the liver to make glucose from amino acids” (Diabetes Info, 2011).

Figure 4

Insulin and glucagon help regulate blood glucose levels

(Diabetes Info, 2011)

The next literature review deals with racial and ethnic disparities with type 2 diabetes, as it negatively affects African-Americans disproportionately.

Black, S. A. (2002, April). Diabetes, Diversity, and Disparity: What Do We Do With the Evidence? American Journal of Public Health, 92(4), 543-548.

This literature work is based on racial and ethnic disparities in the incidence of diabetes in culturally diverse groups. Studies show that diabetes is disproportionately more prevalent in certain ethnic groups which cause various issues that pertain to complications and cost of care.

As it relates to cost of care, the research in this literature piece focuses on diabetes symptoms, complications and cost. It is noted that diabetes accounts for $1 out of every $7 that is spent on medical care in America, and this equates to over $100 billion annually. Additionally, over 3 million annual hospital stays, and 15 million doctor’s visits are due to diabetes (Black, 2002). These are staggering statistics and show the seriousness of this chronic disease and it also shows the disease to be growing at epidemic proportions. No doubt, a large part of the reason these statistics are so high is due to many people not even knowing they have the disease until they begin having symptoms. By then, their conditions are often much worse than would have been expected.

Also, by the time unchecked and undiagnosed diabetes takes its toll, serious damage has already been done to the body from diabetes complications such as vascular disease, leg ulcers, eye problems, nerve problems and kidney disease. It is significant to note that Black (2002) reports that it is estimated that 22 million people in the United States will have diabetes by the year 2025, and approximately 90 percent of these cases will be type 2 diabetes.

As it relates to the topic of this report, Black (2002) states that being African-American, female and in a low socioeconomic class are risk factors for developing type 2 diabetes. There are various reasons for these findings which include unhealthy lifestyle and food choices. However, one of the main reasons that low income African-American females are at high risk for type 2 diabetes is because this group is less likely to have access to adequate healthcare, and therefore, may have proper treatment for their diabetes or pre-diabetes delayed. Additionally, behavioral factors may contribute to African-American women failing to seek medical care for their diabetes or complying with medicinal protocols such as complacency or feeling like they cannot trust doctors or people who work in medical care facilities.

In addition, the diabetes risk increases as people get older and the disease is often more severe in non-White groups such as African-Americans, particularly in African-American women. This may be due to the fact that obesity is typically a bigger problem for women than it is for men.

Recommendations, of the study examined in this review, include empowering high risk groups to control their diabetes with adequate lifestyle changes, medicinal protocols and dietary modifications such as reducing sugar intake, particularly from sugar-sweetened beverage consumption.

Impact of Sugar-Sweetened Beverage Consumption on Black Americans’ Health. (2011).

This literature work is a research brief that explores the consumption of sugar-sweetened beverages (SSBs) and their contribution to added dietary sugar intake of youth and adults in America. Impact of Sugar-Sweetened Beverage (2011) points out that research on this subject “shows that frequent SSB consumption can be harmful because of its contribution to weight gain, obesity, diabetes, dental decay, and other health problems in adults and youth” (p. 1).

The literature also notes that African-Americans are at higher risk for harm from too much SSB consumption because they are more likely to consume too many SSBs on a regular basis. This contributes to excessive weight gain which can lead to obesity-related diseases and conditions such as type 2 diabetes, because with increased sugar in these beverages, comes increased calories and fat grams.

This research brief analysis statistics based on comparisons of African-Americans and Caucasian Americans as it relates to incidences of diabetes, and it analyzes patterns and trends of SSB consumption for African-American youth and adults. The brief shows a comparison of prevalence of SSB consumption, and daily calories consumed from SSB consumption, for black and white adults. The literature further analyzes obesity rates and chronic disease comparisons between blacks and whites, and it also outlines type 2 diabetes statistics for African-American females. These statistics are due, in part, to regular sugar-sweetened beverage consumption.

Methodologies and research findings on the impact of sugar-sweetened beverage consumption on black Americans is shown in Chapter 3.

Palmer, J. R., Boggs, D. A., Krishnan, S., Hu, F. B., Singer, M., & Rosenberg, L. (2008, July 28). Sugar-sweetened beverages and incidence of type 2 diabetes mellitus in African American women. Archives of Internal Medicine, 168(14), 1487-1492.

This literature piece examines the effect of sugar-sweetened beverage (SSB) on African-American women as it relates to their development of type 2 diabetes. The objective of this study “was to examine the association between consumption of sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes mellitus in African American women” (para. 1).

Drinking SSBs such as carbonated soft drinks, artificially flavored drinks, fruit juice with added sugar, sweetened tea and chocolate milk, adds extra dietary calories and can significantly influence the rate of weight gain. This can lead to the incidence and the development of diabetes.

This study was carried out with a progressive follow-up of African-American women participants since 1995 and analyses and results were presented in 2008 (Palmer, et al., 2008). Methodology, data sources, results of analysis and conclusions will be analyzed in a later chapter of this report.

It was concluded with this study that African-American women are at increased risk of developing type 2 diabetes associated with consuming an excess of sugar-sweetened beverages, mainly because of high incidences of obesity and being overweight.

Barclay, L. (2008). Soft Drinks and Fruit Drinks Linked to Diabetes Risk in African American Women.

Findings from the study in this literature piece are in line with typical findings of other studies in this report, and that is the incidence of a link between soft drink consumption and the development of type 2 diabetes. Additionally, the study also focuses on fruit drink consumption as a contributing factor to type 2 diabetes. It is noted that fruit drinks are usually portrayed in the market as healthy alternatives to soft drinks (Barclay, 2008). However, fruit drinks can contain added sugars and calories which can contribute to weight gain and an increased risk of developing type 2 diabetes.

The study examined the increased risk of developing type 2 diabetes for African-American women as it relates to regular consumption of sugar-sweetened soft drinks and fruit drinks, and notes that public awareness about this issue needs to be expanded to include fruit drinks (Barclay, 2008).

It is deceiving to many people who have accepted the marketing tactics of fruit drink companies that promote fruit drink products as being healthier than other drinks on the market. Consumers are largely misinformed about the sugar content of fruit juices and many people fail to read the labeling before they purchase or consume such drinks. The potential risks, particularly to African-American women, are worth more awareness about the link between type 2 diabetes and sugary beverages such as soft drinks and fruit juices. Interestingly, African-American women who consume moderate amounts of other beverages such as coffee and alcohol have been shown to exhibit a reduced risk of developing type 2 diabetes, as noted in the next three literature pieces.

High intake of decaf coffee reduces type 2 diabetes risk in women. (2006). Nursing Standard, 20(52), 14-15.

This literature piece examines the link between decaffeinated coffee consumption and type 2 diabetes onset for post-menopausal women. It is noted that there is an inverse relationship between consuming regular servings of decaffeinated coffee and lower the risk of type 2 diabetes. There are also studies that show evidence that caffeinated coffee also lowers the risk for developing type 2 diabetes, as shown in the next literature review. Comparatively, this suggests that it may not be the caffeine that is the saving ingredient in these results. High intake of decaf (2006) reports, the lower risks may be due to the minerals, phytochemicals and antioxidants contained in both caffeinated and decaffeinated coffee.

The research involved 28,812 post-menopausal women who were evaluated using questionnaires, and out of the total group, only 1,418 new cases of type 2 diabetes were reported over an 11-year period. Findings show that the women who consumed six or more cups of coffee per day were 22 percent less likely to develop type 2 diabetes than those women who did not drink coffee at all (High intake of decaf, 2006).

The next literature review gives additional information about the relationship between regular coffee consumption and type 2 diabetes risks for women, and includes various age groups.

Salazar-Martinez, E., Willett, W. C., Ascherio, A., Manson, J. E., Leitzmann, M. F., Stampfer, M. J., & Hu, F. B. (2004). Coffee Consumption and Risk for Type 2 Diabetes Mellitus. Annals of Internal Medicine, 140(1), 1-9.

This literature review piece focuses on the relationship between regular caffeinated coffee drinkers and their risk of developing type 2 diabetes over a period of time. The study conducted during this research examined long-term coffee consumption and type 2 diabetes incidences of both men and women; however, for the purposes of this report, the women participants are evaluated. Women made up 84,276 of the total participants in the study which was conducted over an 18-year time period. Participants did not have diabetes prior to the start of the study. Study reports show that participants were asked to fill out a questionnaire every 2-4 years as a means of monitoring their coffee consumption and health statuses as it pertained to type 2 diabetes. It is interesting to note that out of the 84,276 women that participated in the study, only 4,085 new cases of type 2 diabetes was reported by the end of the study. Research findings show that caffeinated coffee consumption has an inverse effect on the development of type 2 diabetes (Salazar-Martinez, et al., 2004).

It appears that regular caffeine intake from coffee may be a deterrent in the development of type 2 diabetes. Additionally, although study participants were female, their races were not indicated; however, it is noted that adjustments were made for age, BMI and other type 2 diabetes risk factors (which include being African-American). This correlates with the next literature review which further details the relationship between type 2 diabetes and coffee consumption. The effects of tea and alcohol intake are also assessed.

Boggs, D. A., Rosenberg, L., Ruiz-Narvaez, E. A., & Palmer, J. R. (2010, September). Coffee, tea, and alcohol intake in relation to risk of type 2 diabetes in African American women. The American Journal of Clinical Nutrition, 92(4), 960-966.

This study analyzes the effects of coffee, tea and alcohol intake among African-American women and its connection to type 2 diabetes. With the current rate of rise in the prevalence of type 2 diabetes among American adults, it is reported that African-Americans have higher incidences of developing the disease.

This study’s findings show that moderate caffeinated, as well as decaffeinated, coffee consumption has an inverse effect on the development of type 2 diabetes in African-American women which may actually protect them from developing the disease or cause reversal in the effects of the disease. Although the study reported less consistent findings with tea consumption, it notes that tea is made up of some of the same constituents as coffee and may still have a positive effect on insulin sensitivity (Boggs, Rosenberg, Ruiz-Narvaez, & Palmer, 2010).

Consequently, it appears that people, who are regular coffee drinkers, can actually lower their risks of developing type 2 diabetes. However, the study does not point out whether or not the coffee that study participants drank was black or contained added sugar and creamer. This may have an adverse effect on their findings.

It is interesting to note, however, that the study showed that moderate alcohol intake (4 to 6 drinks per week) is associated with lower risks of developing type 2 diabetes, while heavy alcohol consumption (more than 6 drinks per week) is associated with a higher risk of developing the disease. Additionally, studies show that African-American women are twice as likely as Caucasian women to have type 2 diabetes, and that African-American women are less likely than Caucasian women to drink caffeinated coffee and alcohol (Boggs, Rosenberg, Ruiz-Narvaez, & Palmer, 2010). This may suggest that African-American women may lower their risks of developing type 2 diabetes by consuming moderate amounts of coffee and alcohol as part of their dietary routine, and this was a major focus in the study.

Findings indicated a positive association between moderately increased consumption of caffeinated coffee and alcohol among African-American women and type 2 diabetes over a 12-year period. However, findings showed no association between the consumption of decaffeinated coffee and tea as it relates to type 2 diabetes. However, studies do show a correlation between the consumption of sugar-sweetened beverages and weight gain, and weight gain is a significant risk factor for developing type 2 diabetes. The following literature review piece takes a look at this concept.

Malik, V. S., Schulze, M. B., & Hu, F. B. (2006, August). Intake of sugar-sweetened beverages and weight gain: a systematic review. The American Journal of Clinical Nutrition, 84(2), 274-288.

This literature piece is a review that focuses on the consumption of sugar-sweetened beverages and their contribution to weight gain and obesity, which is a known risk factor for chronic health conditions such as type 2 diabetes.

The review analyzes added dietary sugar intake by Americans and reports this is approximately 15.8 percent of total dietary energy sources for Americans, with the largest source being added sugars in non-diet soft drinks such as sodas, sweetened fruit drinks and tea (Malik, Schulze, & Hu, 2006).

Findings concluded that there is a positive relationship between body weight and sugar-sweetened beverage consumption, and this creates an increased obesity risk in children and adults. There is also an increased risk of developing type 2 diabetes. It is also noted that more education about the effects of sugar-sweetened beverage consumption should be made available to the public and the promotion of healthy beverage consumption (water, low-fat milk and fruit juices with no added sugars) should be increased (Malik, Schulze, & Hu, 2006). It is important to note that many beverage companies advertise beverages such as vitamin water and energy drinks as healthy alternatives; however, these types of beverages contain added sugar.

Based on these findings, the risk of type 2 diabetes as a consequence of regular sugar-sweetened beverage consumption is established, and more in-depth analysis of this subject continues with the next literature review.

Malik, V. S., Popkin, B. M., Bray, G. A., Despr’es, J. P., Willett, W. C., & Hu, F. B. (2010, November). Sugar-Sweetened Beverages and Risk of Metabolic Syndrome and Type 2 Diabetes: A meta analysis. Diabetes Care Journal, 33(11), 2477-2483.

This study examines a correlation between sugar-sweetened beverage consumption and the development of type 2 diabetes. The study indicates sugar-sweetened beverage consumption in the United States has increased more than twice from 1970 and 2006. It is also noted that the added dietary sugars contained in sugar-sweetened beverages are the main sources of increased sugar in the American diet, with drinks that contain added sucrose, high-fructose corn syrup and other added sugars (Malik, et al., 2010).

It is a known fact that regular consumption of sugar-sweetened beverages has become a trend that significantly contributes to weight gain and obesity in America, which is becoming an epidemic. Moreover, the study points out that the sugar-sweetened beverage trend has infiltrated global communities as well. For example, Malik, et al., (2010) reports that “Sales ?gures from Coca Cola’s 2007 annual report show that during 2007, India and China experienced growths of 14 and 18%, respectively” (para. 1). So, not only is the incidence of sugar-sweetened beverage-influenced obesity growing in the United States, it is also now a growing global concern. The sugar-sweetened beverage business is a significant component to the bottom line of many corporations. However, their profit is at the expense of the health of the population.

It is interesting to note, however, that while the study recognizes that regular sugar-sweetened beverage consumption is associated with obesity risks, it did not confirm any quantitative evidence of sugar-sweetened beverage consumption directly related to the actual development of chronic diseases such as type 2 diabetes (Malik, et al., 2010). However, it can be deducted that since there is evidence that obesity is a contributing factor to the development of type 2 diabetes, and regular sugar-sweetened beverage consumption is a contributing factor to obesity, then it is logical to assume that regular sugar-sweetened beverage consumption is also a contributing factor to the development of type 2 diabetes.

A significant factor that contributes to the obesity risk in the consumption of sugar-sweetened beverages is the fact that sugar-sweetened beverages often contain high fructose corn syrup which has a reputation of contributing to negative health conditions. Recent television commercials have defended high fructose corn syrup as being not different that regular sugar (sucrose), stating that the body doesn’t know the difference. However, research shows this to be invalid, as explained in the next two literature reviews.

The following two literature reviews outline how fructose, glucose and high fructose corn syrup contribute to the prevalence of diabetes.

Montonen, J., Jarvinen, R., Knekt, P., Heliovaara, M., & Reunanen, A. (2007, June). Consumption of Sweetened Beverages and Intakes of Fructose and Glucose Predict Type 2 Diabetes Occurrence. The Journal of Nutrition, 137(6), 1447-1454.

This literature review examines fructose and glucose and their role in contributing to type 2 diabetes occurrences. Guidelines from the American Diabetes Association states that moderate amounts of sucrose are acceptable in a healthy diet plan. However, according to Montonen, Jarvinen, Heliovaara & Reunanen (2007), sugars other than sucrose may have different effects on glycemic loads which may contribute to the development of type 2 diabetes.

Sucrose is regular table sugar that is made from sugar cane or sugar beets and is naturally composed of equal amounts (50/50) of fructose and glucose (Parker, 2010). Fructose and glucose are natural sugars such as that found in fruit.

Studies show that the high glycemic index of glucose causes elevates blood glucose levels in the body, when consumed in excess, which is a risk factor for type 2 diabetes. Additionally, excess fructose consumption is linked to weight gain and can negatively affect plasma glucose and insulin levels which are associated with the risk for type 2 diabetes as well.

Sweetened beverages contain any combination of sucrose, fructose and glucose and this includes beverages sweetened naturally such as milk or juices as well as beverages that contain added sugars from processing means. According to Medline Plus (2012), beverages with added sugars often do not contain the natural vitamins and minerals such as in fruits, but they are loaded with added calories instead. In addition, it is important to note that sodas and fruit drinks are not the only beverages that contain added sugar. Vitamin and flavored water as well as coffee drinks, energy drinks and sports drinks are processed with added sugars which increase a person’s total sugar intake. Consequently, sugar adds the calories to a diet but has no other nutritional value and, consumed in large amounts, sugar can cause obesity which increases the risk for type 2 diabetes (Medline Plus, 2012).

As these study findings relate to the subject of this report, African-American women’s sugar intake and type 2 diabetes, it is important to note that the diets of these women may often include flavored water and other sweetened beverages, particularly those beverages that contain large amounts of high fructose corn syrup.

Goran, M. I., Ulijaszek, S. J., & Ventura, E. E. (2012, August 9). High fructose corn syrup and diabetes prevalence: A global perspective. Department of Preventive Medicine, University of Southern California, Los Angeles, CA.

This literature research study evaluates the relationship between high fructose corn syrup consumption and diabetes incidences. The research points out the public health problem of the global obesity epidemic. It is estimated that currently more than 6 percent of the people in the world are diabetic, and that there is a parallel between obesity prevalence and type 2 diabetes. The reason for this is related to Western-style foods that have circulated globally, according to Goran, Ulijaszek, & Ventura (2012).

The Westernized diet largely consists of foods with high levels of sugars, sodium, carbohydrates and processed food items. These types of foods often contain unhealthy additives, such as high fructose corn syrup, which is largely found in sugar-sweetened beverages, among other food products. Studies show that high fructose corn syrup has a much higher dietary fructose content than most people know about. Consequently, with the regular consumption of high fructose corn syrup-containing beverages and foods, the risk of diabetes is increased with the risk of obesity from the added dietary fructose, even more so than from regular sugar (Goran, Ulijaszek, & Ventura, 2012).

According to Parker (2010), a research study done by Princeton University found that high fructose corn syrup was pivotal in significant incidences of weight gain in laboratory rats, as compared to table sugar (sucrose). This was true with equal amounts of total caloric intake of the subjects. In other words, laboratory rats consuming equal amounts of calories had significant differences in weight gain depending on whether or not their diets contained high fructose corn syrup. The rats that were fed high fructose corn syrup had significantly more weight gained than the rats that were fed regular sucrose and not the high fructose corn syrup, and this was true of all of the rats in the study that consumed the high fructose corn syrup, across the board. The study also showed that “In addition to causing significant weight gain in lab animals, long-term consumption of high-fructose corn syrup also led to abnormal increases in body fat, especially in the abdomen, and a rise in circulating blood fats called triglycerides. The researchers say the work sheds light on the factors contributing to obesity trends in the United States” (para. 2).

It is very interesting to note that the concentration of sugar in the solution given to rats receiving regular sucrose was equivalent to what is found in commercial soft drinks. However, the rats fed the solution with the high fructose corn syrup had only one-half the concentration of commercial soft drinks. The lab subjects that were fed the high fructose corn syrup over a long term gain 48 percent more weight that the lab subjects that were not fed the high fructose corn syrup (Parker, 2010). This speaks volumes as to why the obesity percentages and trends shown in Figure 3 of this report show such drastic increases in obesity cases of people in America over the last two decades. According to the Centers for Disease Control and Prevention, only 15 percent the U.S. popular was obese in 1970. Today, approximately a third of the American adult population is considered obese, and this does not include teens and children (Parker, 2010).

The following literature review entry further expands on the link between high fructose corn syrup and type 2 diabetes.

Vikdad. (2012). Diabetes Type 2 and High Fructose Corn Syrup.

This literature piece highlights the correlation between type 2 diabetes and high fructose corn syrup consumption, and identifies high fructose corn syrup as a mixture of glucose and fructose used to artificially sweeten food and beverage products. High fructose corn syrup is mainly composed of fructose and is found mostly in sodas and juice concentrates (Vikdad, 2012).

According to Parker (2010), many products, not just sodas and other sweet drinks, on the market today contain high fructose corn syrup such as pancake syrup, cereals, yogurt, ketchup, mayonnaise, candy, desserts, and even bread. The only way to know if high fructose corn syrup is an ingredient of a food or beverage product is to read the label. A product does not necessarily have to taste sweet to contain high fructose corn syrup. This suggests that, on a daily basis, many people may not even know how much high fructose corn syrup they are consuming and this is a dangerous notion, considering the incidence rates of obesity and diabetes in this country and abroad.

High fructose corn syrup has been linked to various health issue risks, including type 2 diabetes, and is due to the risk of excessive weight gain from regular consumption of high fructose corn syrup-containing products. In addition to excessive weight gain, regular high fructose corn syrup consumption can directly increase the risk of type 2 diabetes because the liver metabolizes fructose into fats which are released into the bloodstream, causing increased lipid levels in the blood. This can result in insulin resistance which is a characteristic of type 2 diabetes development. This is by the same concept that diets high in fat contribute to type 2 diabetes and obesity (Vikdad, 2012).

Parker (2010) reports from a Princeton University study that found there may be a link between appetite, metabolism and gene expression as it relates to excessive amounts of fructose (as contained in high fructose corn syrup) being metabolized for fat production in the body. In contrast, glucose is mainly processed for energy usage or for carbohydrate storage (as glycogen) in the liver and muscles for later energy use.

High fructose corn syrup is an unhealthy additive to food and beverage products which can cause various adverse health conditions, as well as other diabetes health risks. This is particularly true for the consumption of sugar-sweetened beverages and one diabetes health risk it can cause is gestational diabetes, a complication of pregnancy which affects African-American women significantly.

According to African-American Women (2011), although black women are less likely to develop gestational diabetes, those who do develop it have a 52 percent chance of developing type 2 diabetes after pregnancy as compared to white women.

The following literature review entry examines sugar-sweetened beverage consumption as a risk factor for gestational diabetes.

Chen, L., Hu, F. B., Yeung, E., Willett, W., & Zhang, C. (2009, December). Prospective Study of Pre-Gravid Sugar-Sweetened Beverage Consumption and the Risk of Gestational Diabetes Mellitus. Diabetes Care Journal, 32(12), pp. 2236-2241.

This literature piece examines a study on how sugar-sweetened beverage (SSB) consumption habits, prior to pregnancy, directly relate to elevated risks of gestational diabetes among pregnant women, particularly African-American women as African-American women are more adversely affected by diabetes, according to Diabetes and Women’s Health (2001).

The study included 13,475 participants from the United States who were pregnant between 1992 and 2001. The study showed that 860 cases in which the participants developed gestational diabetes. The findings showed that sugar-sweetened cola consumption, specifically, was directly related to the risk of developing gestational diabetes. The women who consumed five or more servings of sugar-sweetened cola per week had a 22 percent greater chance of developing gestational diabetes when becoming pregnant, as compared to the women who consumed less than one serving of sugar-sweetened cola per month. It makes sense that only consuming less than one cola per month is preferable to consuming an average of one serving a day (five or more per week), as it relates to the prevention of developing gestational diabetes in pregnant women. It is interesting to note that this study only reported on sugar-sweetened colas. However, there are many more dietary choices that can contribute to excess sugar intake that may lead to gestational and type 2 diabetes from increased sugar intake from foods, particularly restaurant foods, as mentioned in the next review.

Krishnan, S., Coogan, P. F., Boggs, D. A., Rosenberg, L., & Palmer, J. R. (2010, February). Consumption of restaurant foods and incidence of type 2 diabetes in African American women. The American Journal of Clinical Nutrition, 91(2), 465-471.

This literature piece focuses on efforts to develop a nutritional intervention program for low-income inner-city African Americans with the purpose of reducing the risks of chronic disease, such as type 2 diabetes, for this segment of the population. A research study was done in Baltimore, Maryland with 91 low-income African-American participants (both male and female) between the ages of 18 and 74. Findings of the study showed that the study group, on average, consumed between 2,100 and 2,500 kilo calories per day with fat being approximately one-third of dietary energy intake and sodas being the main source of dietary energy and sugar intake (Krishnan, Coogan, Boggs, Rosenberg, & Palmer, 2010).

Traditionally, the African-American diet largely consists of “soul food” that is often high in calories, saturated fat, sugar, sodium and carbs. Even soul food vegetables can be loaded with added saturated fat, sugar and sodium. Also, the diets of many low-income individuals often lack very many nutritious choices. It is uncertain if this is mainly by choice, by habit or both. Sugary drinks such as sodas, sports drinks and other soft drinks are big sellers in low-income African-American communities. Therefore, African-American women are consuming these types of sugary beverages more often, which means that the effects of the added sugar in their diets causes them to be disproportionately exposed to type 2 diabetes risks.

In addition to soul food, the eating habits of many African-Americans include regular consumption of restaurant foods, particularly fast foods. In African-American communities, along with other unhealthy food choices, this can lead to a daily cycle of unhealthy eating habits which can contribute to weight gain and type 2 diabetes, particularly with African-American women.

According to Krishnan, Coogan, Boggs, Rosenberg, & Palmer (2010), the main objective of the study “investigated the relation of restaurant meal consumption to incidence of type 2 diabetes among African American women with the use of data from the prospective Black Women’s Health Study” (para. 2). It is also noted that the “consumption of restaurant foods, a relatively unexplored factor, is a potential contributor to the increase in diabetes occurrence among African American women” (para. 7).

Study findings indicated an associated risk of type 2 diabetes with regular consumption of restaurant meals such as hamburgers, Chinese food and fried chicken and fish, among African-American women who participated in the study over a 10-year period. The associated risks are due, in large part, to the incidence of a large number of fast food restaurants being located in predominantly African-American neighborhoods.

It is evident that to combat the high incidences of type 2 diabetes among African-American women, food interventions need to be implemented. The next literature review focuses on food-related interventions for African-American women with type 2 diabetes and how this can help reduce the prevalence of the disease in this demographic group.

Sumlin, L. L., & Garcia, A. A. (2012, Mar-Apr). Effects of food-related interventions for African American women with type 2 diabetes. Journal of the American Association of Diabetes Educators, 38(2), 236-249.

This literature is from the School of Nursing, University of Texas at Austin, and it is a systematic review of the effects of diet intervention on conditional factors of African-American women with type 2 diabetes (Sumlin & Garcia, 2012). The African-American community has a culturally-specific diet and their eating habits generally do not conform to heart-healthy diet plans.

The purpose of this research was to meet the challenge of teaching African-American women with type 2 diabetes how to alter their food choices and eating habits to better manage their disease. The focus was on diabetes educators who searched for knowledge on how to help the African-American women in the study make dietary changes more consist with heart-healthy diets. However, little information was found that focused specifically on African-American women (Sumlin & Garcia, 2012).

The study concluded that interventions should be focused on how diabetes educators can help study participants choose suitable alternatives to any foods in their diets that were not good for diabetes management. Targeted interventions aimed at culturally-specific dietary changes were found to be the best route for teaching African-American women with type 2 diabetes techniques for better self-management of the disease (Sumlin & Garcia, 2012). These techniques include modifying eating behavior which is a poorly recognized aspect of why the disease is so poorly controlled in people with diabetes, as noted in the following literature review.

Yannakoulia, M. (2006, Spring). Eating Behavior among Type 2 Diabetic Patients: A Poorly Recognized Aspect in a Poorly Controlled Disease. The Review of Diabetic Studies, 3(1), 11-16.

This literature work deals with nutrition intervention as a necessary part of managing type 2 diabetes. People with diabetes often do not adhere to a proper meal management plan and this often results in the occurrence of complications from the disease. This work focuses on dietary management which includes changing eating habits, planning meals, selecting healthy foods, learning to prepare healthier foods, and controlling portion sizes. Many people overeat on a regular basis and this is particularly precarious in the case of people with diabetes. It is noted that healthcare professionals need to become more aware of diabetic patients’ reasoning for being apprehensive toward dietary management and helping them find a way to cope and be successful with nutrition intervention efforts.

According to Yannakoulia (2006), “Nutritional intervention is an integral part of diabetes management and self-care education, aiming at the attainment and maintenance of optimal metabolic outcomes, the prevention and treatment of medical complications, and the improvement of general health by addressing individual nutritional needs” (para. 2). This is the aim of this study.

It is signficant to note that Yannakoulia (2006) reports that diabetics are less likely than non-diabetics to follow a healthy eating plan and control weight gain. This is interesting, considering that diabetics are more susceptible to adverse affects from being noncompliant with healthy eating and weight control management than are non-diabetics.

The study examines some determining factors regarding the eating behaviors of type 2 diabetics and found that modifying these eating behaviors may be too much “work” for the diabetic. According to Yannakoulia (2006), this is because people with diabetes see the many educational requirements about the disease, the environmental focus, the medicinal requirements, the dietary, psychological and lifestyle changes as difficult to achieve. They must modify their entire lives to accommodate the disease and this often causes barriers to adherence which leads to complications.

Additionally, it is reported that many diabetics feel like complying to the diabetic lifestyle causes loss of pleasure in eating and freedom to do what they want to do. They feel deprived. Also, “Food ingestion is frequently accompanied by feelings of fear, guilt and anger, whereas diet compliance elicits aversive and restrictive attitudes” (para. 8).

Conclusions of this study point out that managing diabetes is mostly behavioral and up to the patient. People with diabetes must take their prescribed medication daily, test their glucose, alter dietary intake and get regular physical activity. Behavioral changes result from consistent meal planning, selection, preparation and portion control as well as being aware of meals while dining out. It is also noted that a significant amount of education and training is necessary for people with diabetes to help them manage their disease and avoid serious complications (Yannakoulia, 2006).

Risk factors of this disease are modifiable in various ways, one of which is to control sugar intake, particulary from sugar-sweetened beverages, as covered in the next literature review.

Hu, F. B. (2010, December). Sugar-Sweetened Beverages as a Major Modifiable Risk Factor for Type 2 Diabetes. CMR Journal, 3(3), 9-12.

This study focuses on the correlation of the consumption of sugar-sweetened beverages (SSBs) and the elevated risks of the development of cardio-metabolic disease, which includes type 2 diabetes, coronary heart disease and metabolic syndrome (Hu, 2010). However, as it relates to the focus of this report, the type 2 diabetes risk is analyzed*.

Hu (2010) reports study findings that showed the consumption of one 12-oz serving of a sugar-sweetened beverage per day could cause a weight gain, in a person, of up to 15 pounds in a year. Additionally, out of 310,819 participants, 15,043 cases were found to have type 2 diabetes. The type 2 diabetes cases in which the participants, who had the highest SSB daily intakes, were 26 percent more likely to develop type 2 diabetes than those who consumed less SSBs on a regular basis.

Figure 5*

Potential Biological Mechanisms Underlying the Effect of 

Sugar?sweetened Beverages on Weight Gain and Type 2 Diabetes Risk* 

*Adapted from Hu (2010), p. 11.

Bhattacharya, G. (2012, February). Self-Management of Type 2 Diabetes among African Americans in the Arkansas Delta: A Strengths Perspective in  Social-cultural Context. Journal of Health Care for the Poor and  Underserved, 23(1), Abstract.

This literature piece is an abstract of a qualitative study that examined type 2 diabetes self-management among African American adults in the Arkansas Delta. The study was conducted using a sample of 31 adults (16 female and 15 male) via an interview process. The participants were evaluated on their awareness of type 2 diabetes and how well they managed the disease (Bhattacharya, 2012). This included asking the participants about their lifestyles as it relates to managing their type 2 diabetes such as whether or not they exercised regularly or adhered to their prescribed diets and medicinal protocols.

It is interesting to note that this particular study found that the participants reported that they did not follow prescribed dietary guidelines, nor did they regular exercise. They reported that the reason they did not do these important tasks to manage their disease was because it did not fit in well with their culture and they reported that eating healthy and exercising was impractical for their lifestyles (Bhattacharya, 2012). This is a dangerous notion, and if the findings of this study are representative of other African Americans, then it is no wonder that statistics show that type 2 diabetes in African Americans is more prevalent than in the Caucasian race. Additionally, the study revealed that the participants were unaware of the seriousness of the disease and they also did not trust the medical system. The goal of the study was to promote culturally-targeted awareness and self-management training among African Americans with type 2 diabetes in the Arkansas Delta.

Self-management is an important factor in combating the effects of the disease and minimizing complications. This is particularly true for African-American women as it relates to sugar intake and type 2 diabetes, not only to combat the disease after it has manifested but also to prevent it from occurring in the first place. The following two literature reviews focus on ways that African-American women can take steps to prevent the onset of type 2 diabetes or manage it once it has become an issue for them.

The Nutrition Source. (2012). Simple Steps to Preventing Diabetes.

This literature piece focuses on necessary steps to take for preventing type 2 diabetes. This is probably the best thing one can do in the case of diabetes, and that is to take steps to prevent the disease in the first place. Granted, there is little if anything, one can do to stave off type 1 diabetes, but type 2 diabetes is caused by preventable factors. This is a truth that, unfortunately, many people don’t know or don’t believe.

The Nutrition Source (2012), points out that type 2 diabetes has become an epidemic, not only among adults, but children and teens as well. Moreover, consequences of this disease have cost the United States more than $116 billion in medical expenditures and at the present rate, diabetes diagnoses in America are projected to triple by the year 2050, and this number is even greater on a global scale.

This literature piece further states how diabetes can be prevented with simple steps that lowers a person’s risk of developing the disease such as (1) controlling weight and weight gain, (2) getting moderate physical activity on a regular basis, and (3) making dietary changes (The Nutrition Source, 2012).

These simple steps can mean the difference in having type 2 diabetes and not having it. It is imperative that more Americans, particularly African-Americans, change their behaviors and lifestyle choices and also to teach these healthy choices to their children. Many Americans have become complacent and refuse to exercise or they have become unaware of their daily caloric intakes. This makes it easy to fall into a habit of this type of behavior and as time goes on, type 2 diabetes develops and many people do not even know they have it until they begin suffering from adverse symptoms of the disease.

The Nutrition Source (2012) reports that a study by the Diabetes Prevention Program found that self-management such as weight loss and physical activity had a positive effect on preventing the development of type 2 diabetes among study participants, as well as glucose control. Again, this is particularly true for African-American women who need to understand how to self-manage the disease. Rahim-Williams, F. B. (2004). African American women with Type 2 diabetes: Understanding self-management. Graduate School Thesis, University of South Florida, Scholar Commons.

This study focuses on self-management of diabetes among African-American women as a high risk group for developing the disease. Self-management factors such as adequate support systems and access to quality healthcare are examined to determine the impact on African-American women and how they manage their diabetes. The study sample included twenty-five African-American women from ages 46 to 87 with type 2 diabetes and a diabetes self-management team made up of various health professionals (Rahim-Williams, 2004).

Self-management of diabetes is important to help prevent complications from the effects of the disease on the body. However, people can become complacent with self-care, and support systems can play a significant role in helping these individuals stay on track with prescribed diabetes management. Additionally, it is imperative that a person with diabetes routinely gets adequate healthcare. This study examines the incidence of adequate support systems and healthcare access for African-American women with type 2 diabetes and how they are affected by having these or not. The study used interviews and surveys to gain information from African-American women in the study about their self-management knowledge, beliefs and behaviors. Findings showed variable differences in self-management behaviors among the participants as it related to glucose control and if they had adequate access to healthcare and support systems. Recommendations of the study included cultural awareness training, removing barriers to healthcare access, improving interactions with physicians and strengthening community and family support systems (Rahim-Williams, 2004).

This concludes the review of the literature for this report that covers research and findings on the correlation between sugar intake and type 2 diabetes in African-American women, adjusting for age. Relevant literature includes reporting on causes, risk factors, comparisons, behaviors, case studies, treatment protocols, self-management information, as well as sugar intake from foods and beverages.

This is written in the format of an annotated bibliography.  You will need to synthesize the sources into a cohesive essay.  Use subheadings to organize.  The reference list belongs after the Discussion and Conclusion.  This is a good start.