Type 2 Diabetes in African American Women, Research Paper Example

Introduction

Type 2 Diabetes is directly related to obesity. Two out of three Americans are categorized as obese. These numbers have caused an epidemic of massive proportions in the United States. More than 50 million Americans are obese and have been diagnosed with Type 2 Diabetes; more than 41 million Americans are obese and in the developing stages of Type 2 Diabetes (Rosenzweig & Hamdy, 2005). Of those diagnosed with Diabetes, the majority consists of African American women. This portion of society is at a high risk of developing Type 2 Diabetes at some point in their lifetime. In order to develop a change in this pattern, Americans are urged to implement healthier diets, exercise more regularly, and educate themselves on the causes and effects of Diabetes. This paper will examine the cause of Type 2 Diabetes among African American women and support the findings with peer-reviewed literature. Based on research findings, the paper will offer recommendations to successfully educate at-risk portions of society about the causes of Diabetes and offer solutions to prevent the spread of this chronic disease.

Population

In 2010 the American Diabetes Association reported that African American women are at a greater risk of being diagnosed with Type 2 diabetes than White women. Type 2 Diabetes results from the body’s inability to produce adequate amounts of insulin. Nearly 50 million Americans are affected by this disease; that includes nearly 12 percent of African American women (National Organization for Women Foundation, 2002). Research data indicates that one in four African American women over the age of 55 have Type 2 Diabetes. These high numbers are attributed to the fact that African Americans carry a gene which gives them a decreased glucose tolerance. As a result, they are more susceptible to Diabetes and related issues such as blindness, kidney failure, and limb amputations. Another reason for the increased risk of Type 2 Diabetes among African American women is an increased rate in obesity. African American women aged 25 to 75 are more obese than White women of the same age group. Obesity is risk factor for Diabetes (National Organization for Women Foundation, 2002).

Nearly 20 percent of all African Americans over the age of 20 have been diagnosed with Diabetes. These people are at an increased risk of cardiovascular failure as a direct result of Diabetes (Centers for Disease Control and Prevention, 2011). In fact, two in three people diagnosed with Diabetes die from cardiovascular complications or stroke. That means that adult Diabetes patients are four times more likely to die from heart disease than adults without Diabetes. In addition to the increased risk of heart failure among Diabetes patients is the increased risk of high blood pressure. Seventy percent of adults diagnosed with Diabetes have also been diagnosed with high blood pressure (Centers for Disease Control and Prevention, 2011).

The risk of severe implications such as heart disease and amputations due to Diabetes among African American women have increased. In the last three decades, the death rate among African American women with Diabetes have risen by nearly 24 percent. The major cause of death has been heart disease  (American Diabetes Association, 2011). In addition to an increased rate of heart disease, African American women diagnosed with Diabetes are also more likely to be victims of lower limb amputations. These amputations (usually of a toe or a foot) are due to Diabetic neuropathy. This is a complication of Diabetes where nerve damage results in burning sensations, and numbness or weakness of the feet. This puts the patient at an increased risk of foot damage which could lead to infection and eventual amputation  (American Diabetes Association, 2011).

Behavioral Dimensions

The American Diabetes Association (ADA), labels Diabetes as a self-managed disease. It is therefore the responsibility of the patient to administer proper day-to-day care. Patients can significantly reduce the effects of Diabetes by implementing a healthy diet, regular exercise, and taking Diabetes medication as directed by a doctor. These simple lifestyle changes will reduce blood glucose levels, blood pressure, and cholesterol (American Diabetes Association, 2011). Keeping these three factors within their target ranges will significantly reduce the risk of heart disease in patients diagnosed with Type 2 Diabetes. A desired target level for blood glucose is less than seven percent; for blood pressure it is less than 130/80 mmHg; and for cholesterol it is less than 100 mg/dl. These reduced levels will reduce the patient’s risk of heart disease and thereby improve quality of life (American Diabetes Association, 2011).

Melkus et al. conducted an 11-week study to determine the effects of Diabetes education and coping skills training on African American women diagnosed with Type 2 Diabetes. The three-month study compared the effects of self-management training to typical Diabetes training among 109 African American women aged 38 to 58. The study showed that both methods of Diabetic care had a positive impact on the patients. Both groups showed an improvement in lipoprotein cholesterol levels, blood pressure levels, and blood glucose levels. However, the emotional state of patients in the self-management training group improved significantly. This improvement resulted in an overall improvement in health (Melkus, Chyun, Vorderstrasse, Newlin, Jefferson, &Langerman, 2010). The study concluded that all types of Diabetes care are beneficial to patients, but when patients are responsible for their own well-being, the lasting effects of their improvements have a positive impact on their emotional state.

Psychosocial Dimensions

A 2004 study conducted by Agardh et al. showed that psychosocial factors and socioeconomic factors play key roles in the development of Type 2 Diabetes. Psychosocial factors are defined as limited freedom in the workplace and decreased sense of coherence. Socioeconomic factors refer to heredity, physical activity, and smoking. The study confirmed a link between Type 2 Diabetes and a lower socioeconomic position. Also, the study found a link between glucose intolerance and a lower social position based on the participant’s profession. The study also found that a person who is in a professional position where he or she has limited freedom to come and go is at a higher risk of developing Type 2 Diabetes (Agardh, et al., 2004). This means that employees who are ranked lower on the company scale are at a higher risk of becoming sick. Psychosocial factors such as depression and hopelessness are direct derivatives of the lower company position. These employees often receive a lower-income, are less active, smoke more, have more stress, and are socially isolated. The results of these factors are increased blood pressure and weakened cardiovascular health. These factors often snowball to become Type 2 Diabetes. In fact, the study showed that people with higher psychosocial-related issues and who are on a lower socioeconomic scale are 48 percent more likely to develop Type 2 Diabetes (Agardh, et al., 2004).

Amoako, Skelly &Rossen (2008) support these findings and argue that African American women over 50 in a low socioeconomic environment are at greater risk of developing illnesses related to Diabetes than women in a higher socioeconomic environment. Lack of resources and comorbid conditions reduce these women’s abilities to gather information about self-care activities (Amoako, Skelly, &Rossen, 2008). As a result, they develop an uncertainty about the disease and adjust poorly to its rigorous requirements. The study showed that women who received regular interventions from health professionals were more likely to adjust more successfully to the disease. Regular input from health professionals had a positive impact on the wellbeing of 68 women in the study. These women participated in increased exercise routines and administered self-care more effectively. The psychosocial adjustment proved to be beneficial to Diabetes patients (Amoako, Skelly, &Rossen, 2008).

Environmental Dimensions

Krishnan, Rosenberg & Palmer (2010) determined that socioeconomic status is directly linked to Type 2 Diabetes in African American women. Lower-income levels and limited education in conjunction with lower levels of neighborhood socioeconomic standings put African American women at an increased risk of developing Type 2 Diabetes. The study found African American women who lived disadvantaged neighborhoods had a higher frequency of insulin resistance syndrome. The development of Diabetes in these women was attributed to adverse housing conditions, but that levels of education and family income did not affect the possibility of developing Diabetes (Krishnan, Cozier, Rosenberg, & Palmer, 2010). In other words, education and income were not major determinants in the development of Diabetes; instead, the conditions of the neighborhood in which these women lived played a larger role in the development of the disease. The study confirmed that the negative influences of living in disadvantaged neighborhoods make African American women more susceptible to Diabetes (Krishnan, Cozier, Rosenberg, & Palmer, 2010). The researchers attribute these findings to the fact that African Americans who reside in lower-income neighborhoods tend to have less healthy diets than African Americans who live in more affluent neighborhoods. This is true because higher-income neighborhoods are often surrounded with grocery stores and supermarkets that reflect the income of the neighborhood. As a result, lower-income neighborhoods have fewer supermarkets and therefore limited selections of healthy foods. Additionally, lower-income neighborhoods have little to no recreational facilities such as tennis courts or gyms. This limits residents’ opportunities to exercise. Also, safety concerns in lower-income neighborhoods often limit outdoor activities (Krishnan, Cozier, Rosenberg, & Palmer, 2010). The risk of Type 2 Diabetes among African American women can therefore be determined by the neighborhoods in which they live. Income levels and levels of education play minor roles in the risk of developing Diabetes.

On an abstract level, anthropological evidence indicates that African American women are at an increased risk of developing Type 2 Diabetes because of their culture. In African American culture views eating as a cultural ritual that holds both meaning and importance to the sustenance of the culture. Liburd (2003) argues that food communicates history and social status. In a situation where money is absent, food is often viewed as quantifiable capital (Liburd, 2003). The author argues that culture is innate in a person’s biological structure and because one cannot divorce from one’s biological makeup, one has to take active steps to change behavior. Doing so will result in healthier lifestyles. In other words, although African American women are burdened with the cultural implications of eating rituals, they are urged to actively improve those conditions in order to preserve their health  (Liburd, 2003).

Prevention

Liburd (2003) proposes that health care providers play a more active role in educating target audiences about the risk factors involved in unhealthy diets. Without eliminating the sense of community often associated with food in the African American culture, at-risk persons should re-create eating rituals to promote health. Doing so will result in healthier bodies, minds, and souls; and subsequently reduce the risk of Type 2 Diabetes in African American women  (Liburd, 2003). Martin (2005) attributes eating rituals of African Americans to higher rates of obesity. The author therefore suggests a change in the eating rituals of African American women. Similar to Liburd, Martin (2005) proposes a ‘Diabetes prevention nutrition program’ which is culturally sensitive (Martin, 2005). A culturally sensitive nutrition program implies that it should consider traditional recipes and foods of African Americans but implement it in a healthy manner. The ‘Eat Well, Live Well’ nutrition program does just that. It is a diet plan aimed specifically at African American women with the intent to prevent Type 2 Diabetes. The program was tested in a study and more than 80 percent of the participants agreed that it was both culturally sensitive and healthy. One key component of the program is the elimination of fried foods. Because African Americans eat more fried foods and high-fat foods than any other ethnic group (Martin, 2005). The program convinced participants to reduce fat intake and avoid fat as a seasoning.

Similar to this study, Samuel-Hodge et al. conducted a study which showed that a church-based education program was effective in reducing the risk of Type 2 Diabetes among African American women (Samuel-Hodge, et al., 2006). The program was designed to be culturally sensitive, yet adamant about effective lifestyle changes to reduce the risk of Type 2 Diabetes. During the course of the study several participants quit smoking and more than 60 percent took active steps to improve diet and increase exercise. This study confirms that community-based programs that maintain the cultural integrity of an ethnic group is likely to bear positive results in the prevention of chronic diseases (Samuel-Hodge, et al., 2006).

Antoher method to prevent the increase of the disease among African American women is to improve the conditions of lower-incomeneighborhoods  (Krishnan, Cozier, Rosenberg, & Palmer, 2010). This means more options for safe exercise. Public parks and community projects have proved successful in similar past attempts. Keyserling et al. (2002) found that clinics aimed at specific cultures (such as African American women), will increase physical activity. A study which involved 219 participants found that active involvement from a community-based clinic improved the exercise schedules of participants. Participants were motivated by the community involvement of the clinic and showed improvement despite income, education levels, or neighborhood conditions. This gives evidence that African American women in disadvantaged neighborhoods have an opportunity to improve their health, regardless of their environmental circumstances (Keyserling, et al., 2002).

Public Health Policy Implications

Based on the research collected for this paper, health policies may be beneficial in the prevention of chronic diseases; specifically Type 2 Diabetes. It is the responsibility of public health agencies to monitor community health and determine health problems. It is also the responsibility of public health agencies to develop public policies based on previous findings and to ensure that all communities have access to affordable health care. These health care services refer to disease prevention services as well as clinics (Albright, 2007). Certain states are proactive in identifying at-risk groups and offering services to treat those diagnosed with Type 2 Diabetes. For instance; the California Department of Health Services implemented the Diabetes Program. This program allows health care professionals to collect data from various counties to determine how many people have been diagnosed with Diabetes, or display symptoms without proper diagnoses. The program utilizes population-based survey tools to measure the spread of Diabetes. The New York City Department of Health and Mental Hygiene mandated clinics to report patient data as it pertains to Diabetes. Collected data will be stored in a government-based registry. The purpose of this mandate is to determine the severity of Diabetes in the area and offer subsequent services to treat the affected population (Albright, 2007).

Public policies with regards to Diabetes are wide-ranging. For instance, it includes insurance coverage for Diabetes materials. Currently, 46 states offer some form of coverage of supplies and related education. These policies also include factors such as school-based policies. These policies refer to the assurance that school-going children will have safe environments in which to follow treatment plans successfully (Albright, 2007).

Although many health care policies on Diabetes are in place, more is needed to effectively approach the growing problem of Type 2 Diabetes among Americans in general. One way would be to integrate health care systems into communities. Doing so would address the environmental factor which is a major contributor to the risk of Type 2 Diabetes among African American women. A study conducted in Los Angeles found that health care systems aimed at certain African American and Latino communities had a positive impact on the health of community members. These improvements increased when paired with nurse-directed care. Among the improvements were more regular eye examinations by patients as well as more foot examinations. In the event where nurses assisted health care providers in community clinics, patients developed an eagerness to improve their health. Regardless of the socioeconomic state of the community, patients were increasingly more enthusiastic about their quality of life (Albright, 2007).

Another area of concern with regards to public policy on Diabetes is the lack of involvement from the National Academy of Sciences. The Academy is directly responsible for WIC (the Special Supplemental Nutrition Program for Women, Infants, and Children). This program distributes food vouchers to more than eight million disadvantaged families in the U.S. these food vouchers were developed in 1974 and based on a specific-food plan. However, nutritional research has changed significantly over the past three decades and it is therefore essential that the National Academy of Sciences revise the food plan so that disadvantaged families may have access to healthier foods. This will reduce the problem of obesity and its unpopular cousin Diabetes (Rosenzweig & Hamdy, 2005).

Successful public policies therefore have a significant impact on the wellbeing of community members. Focusing on three basic principles (diet, exercise, and education on Diabetes), public health policies could contribute to substantial changes in the development and prevention of Type 2 Diabetes.

Bibliography

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Albright, A. (2007). The Public Health Approach to Diabetes. American Journal of Nursing, 107(6), 39-42.

American Diabetes Association. (2011). African Americans & Complications. Retrieved May 22, 2011, from Living with Diabetes: http://www.diabetes.org/living-with-diabetes/complications/african-americans-and-complications.html

Amoako, E., Skelly, A., &Rossen, E. (2008). Outcomes of an intervention to reduce uncertainty among African American women with diabetes. Western Journal of Nursing Research, 30(8), 928-942.

Centers for Disease Control and Prevention. (2011). The Diabates Epidemic Among African Americans. Atlanta, GA: U.S Department of Health and Human Resources.

Keyserling, T. C., Samuel-Hodge, C., Ammerman, A. S., Ainsworth, B. E., Henríquez-Roldán, C. F., Elasy, T. A., et al. (2002). A Randomized Trial of an Intervention to Improve Self-Care Behaviors of African-American Women With Type 2 Diabetes. Diabetes Care, 25(9), 1576-1583.

Krishnan, S., Cozier, Y. C., Rosenberg, L., & Palmer, J. R. (2010). Socioeconomic Status and Incidence of Type 2 Diabetes: Results From the Black Women’s Health Study. American Journal of Epidemiology, 171(5), 564-570.

Liburd, L. (2003). Food, Identity, and African-American Women With Type 2 Diabetes: An Anthropological Perspective. Diabetes Spectrum, 16(3), 160-165.

Martin, J. (2005, October 5). Diabetes prevention programs built around Afrocentric culture successful in changing dietary behavior of African-American women. Retrieved May 22, 2011, from wustl.edu: http://news.wustl.edu/news/Pages/5871.aspx?at

Melkus, D., Chyun, D., Vorderstrasse, A., Newlin, K., Jefferson, V., &Langerman, S. (2010). The effect of a diabetes education, coping skills training, and care intervention on physiological and psychosocial outcomes in black women with type 2 diabetes. Biological Research for Nursing, 7-19.

National Organization for Women Foundation. (2002, September 10). African American Women and Diabetes. Retrieved May 22, 2011, from nowfoundation.org: http://www.nowfoundation.org/issues/health/whp/whp_fact16.html

Rosenzweig, J., &Hamdy, O. (2005, August 13). The obesity and diabetes epidemic. Retrieved May 22, 2011, from The Boston Globe: http://www.boston.com/news/globe/editorial_opinion/oped/articles/2005/08/13/the_obesity_and_diabetes_epidemic/

Samuel-Hodge, C. D., Keyserling, T. C., France, R., Ingram, A. F., Johnston, L. F., Pullen Davis, L., et al. (2006). A Church-based Diabetes Self-management Education Program for African Americans With Type 2 Diabetes. Preventing Chronic Disease, 3(3), A93.