American Diabetes Association (ADA)
According to Marcial & Graves (2019), 29 million people have been diagnosed with type 2 diabetes mellitus in the United States, while a large proportion of the population remains undiagnosed. It is ranked as the seventh cause of mortality worldwide due to its detrimental results such as organ failure, heart disease, and stroke. The vulnerable and at-risk populations such as Hispanics with diabetes experience hindrances to positive diabetes outcomes. American Diabetes Association (ADA) has specific guidelines for diabetes management, and this is supposed to be applied to the vulnerable Hispanic diabetic population to improve their outcomes considering cultural sensitivity. Self-management is one of the four clinical domains of recommended glycemic control together with nutritional recommendations, lifestyle modification, and obstetric or pediatric diabetes care (Marcial & Graves, 2019).
Methods
I used the CINAHL database in conducting my search since it is more suitable for PICOT studies since it gives detailed information from a variety of resource materials by using various search terms. The search terms I used were: (diabetes type 2 or diabetes mellitus type 2) AND (self-management education or self-care education) AND (Latino or Hispanics). I used Boolean as my search method and filtered my results to sources from current to five years back to provide more recent articles. This narrative aims to review resources that tackle culturally sensitive self-management education in the Hispanic diabetic type 2 population. I chose works of literature that were relevant in my study to examine the problem.
Literature Review
Marquez et al. (2019) focus on understanding glycemic control determinants while considering modifiable glycemic control predictors to improve diabetes outcomes or reduce disparities. This article used other resources to provide a framework and review several articles from the PubMed database related to diabetes and health disparities in the Hispanic population. The Latino population were less likely to engage in daily glucose monitoring and foot checks and were more likely to quit smoking and consuming fruits and vegetables. The Hispanic population had a lower probability compared to other racial groups to engage in self-management education programs. Latino diabetic populations are more likely to take oral antihyperglycemic agents than the use of insulin therapy. Cultural beliefs concerning antidiabetic medications, cost, and neighborhood deprivation were associated with the underuse of antidiabetic medicines. Additionally, patient-provider language concordance has been associated with improved self-management behaviors, patient satisfaction, and glycemic control.
According to Marcial & Graves (2019), the study aimed to improve diabetes care and outcomes in a clinic attending to the Hispanic population. The authors’ method was in two phases; phase I included a 2-hour educational intervention to educate healthcare providers concerning ADA clinical practice guidelines. In Phase II, the guidelines were implemented into practice, and the effectiveness of the interventions was assessed. The chronic care model is integrated into diabetes type 2 and includes self-management support and decision support, which plays a long way to improve glycemic control in the Hispanic diabetes population. This model is used since diabetes is a chronic illness, and self-management is crucial in managing diabetes type 2 in all populations while considering ethnic disparities. The primary care providers’ limited time was a vital factor as to why the Hispanic diabetic population didn’t receive self-management education. Promotion of lifestyle management or modifications and regular assessment of obesity was deemed crucial from the ADA standard guidelines that contribute to positive diabetic outcomes. Knowledgeable healthcare providers are tasked to empower patients to take an active role in controlling their glycemic levels through self-management practices.
Rotberg et al. (2016) aimed at testing the impact of culturally sensitive diabetes self-management practices on improving clinical indicators, risk-reducing examinations, and diabetes-related behaviors in Hispanic populations. A quasi-experimental study was conducted over five years in Hispanics with type 2 diabetes mellitus, and questionnaires and biomarkers were collected as baseline data. Self-efficacious behaviors in chronic illnesses include self-management behaviors, for example, medication adherence, nutrition management, glucose monitoring, and personal behaviors. Behavioral factors related to diabetes self-management include checking blood sugar levels, reducing the risk of complications, physical activities, proper nutrition, and setting goals. These variables showed a drastic improvement in HbA1C levels after follow up when they applied self-care management measures. Spanish culturally sensitive self-management education programs and support and interactive reinforcements play a significant role in controlling glycemic levels and have been proved more productive and complement traditional standard guidelines in diabetes care. These programs should be culturally and linguistically relevant to provide personalized care and improves self-management practices.
Mayberry et al. (2019) studied the importance of self-management in reducing diabetes distress and normalizing hemoglobin type A1C among adults with type 2 diabetes mellitus. Eligible participants with diabetes mellitus type 2 were selected using Electronic Health Records and enrolling out-of-home volunteers willing to participate in patients’ diabetes self-management. A combination of In-home supporters and out-of-home supporters significantly contribute to better self-management practices, lower diabetes distress, and improved glycemic controls, including Hispanic populations. Improved emotional closeness with care partners improved the diabetic outcomes in Latinos. Support within and without the home had a synergistic effect in self-management education programs from willing volunteers making diabetes patients more proactive in the program.
Wagner et al. (2018) studied whether stress management and relaxation as a form of self-management in glycemic controls. The method used was engaging community health workers in delivering self-management education, including stress management and relaxation techniques in Hispanic diabetes patients. Sequencing relaxation techniques such as progressive muscle relaxation activities help shape a healthy lifestyle of Hispanic diabetic populations, thus positively modifying diabetic outcomes. Relaxation techniques such as music are culturally sensitive as it integrates Spanish music which makes them more familiar to their atmosphere and thus leveling HbA1C indicators.
Comparing and Contrasting Articles
The absence of control groups for comparing results was not considered in these articles, which limited the research results and wasn’t comprehensive and inclusive. Some of the questionnaires that were distributed in the studies weren’t completed by the participants. Some participants didn’t finish the study; hence it made it difficult to follow-up on the results, such as biochemical markers, for instance, HbA1C. The controversy in these studies was that the description of medication therapies’ effects wasn’t well established by the Hispanics due to their inability to express themselves well in the English language. Controversies such as negative patient attitudes among selected Hispanic patients resulted from cultural misunderstanding and health disparities such as health insurance. All the above articles were leveled at ensuring that there are culturally sensitive self-management practices such as glucose monitoring, physical activity, and self-examination exercises in normalizing HbA1C levels. All articles selected diabetes mellitus type 2 patients who were willing to participate in the studies, and most of them were Hispanic populations. Wagner et al. (2018) focused on relaxation techniques to control glycemic levels and reduce diabetes stress levels as a self-management practice compared to other studies in the literature review. Some articles differed in their study methods as some reviewed various as their primary method of analysis while others used Hispanic diabetes patients in conducting their studies.
Areas of Further Study
Further research in these articles has failed to illuminate the methods through which health literacy correlates with diabetes health outcomes. Health insurance in influencing diabetes health outcomes hasn’t yet been established in studies, and further research needs to be conducted using this focus. Self-management practices such as physical activity and glycemic controls have been used in controlling HbA1C levels in diabetic clients, and further supporting evidence needs to be done to compare data provided from different healthcare facilities (Rotberg et al., 2016). Other studies should be done on medication use, self-efficacy, and health literacy, acknowledging self-management education in Hispanic populations (Marquez et al., 2019).
Conclusion
In conclusion, diabetes self-management has been proven to be less probable in Hispanic diabetic populations. There is a significant need to integrate self-management education among these populations in primary care (Marquez et al., 2019). Self-management education practices include physical activities, glycemic controls, and blood glucose monitoring, which normalize HbA1C levels in diabetes care. Further studies need to be done on medication use, health literacy, and self-efficacy in determining self-management education practices in controlling glycemic control.
References
Marcial, E., & Graves, B. A. (2019). Implementation and evaluation of diabetes clinical practice guidelines in a primary care clinic serving a Hispanic community. Worldviews on Evidence‐Based Nursing, 16(2), 142-150.
Marquez, I., Calman, N., & Crump, C. (2019). A framework for addressing diabetes-related disparities in US Latino populations. Journal of community health, 44(2), 412-422.
Mayberry, L. S., Piette, J. D., Lee, A. A., & Aikens, J. E. (2019). Out-of-home informal support important for medication adherence, diabetes distress, hemoglobin A1C among adults with type 2 diabetes. Journal of behavioral medicine, 42(3), 493-501.
Rotberg, B., Greene, R., Ferez-Pinzon, A. M., Mejia, R., & Umpierrez, G. (2016). Improving diabetes care in the Latino population: The Emory Latino diabetes education program. American Journal of Health Education, 47(1), 1-7.
Wagner, J., Armeli, S., Tennen, H., Bermudez-Millan, A., & Pérez-Escamilla, R. (2018). Effects of stress management and relaxation training on the relationship between diabetes symptoms and affect among Latinos. Psychology & health, 33(9), 1172-1190.