Epidemiology: Type II Diabetes in Hispanic Americans

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Table of Contents

Introduction
Population Health Problem of Interest
Study Question
The Most Appropriate Design
Relevant Assumptions and Tenets Supporting Design Selection
Health Data Resources
Conclusion
References

Introduction

Achieving DNP preparedness requires sound skills in proceeding from research question formulation to hypothetical research design selection activities. The last assignments have specified type II diabetes in Americans of Latin American/Spanish ancestry as the epidemiological issue of interest. This paper builds upon the previous discussions by exploring diverse research designs’ applicability to the problem and identifying the types of health data resources that might be useful in research.

Population Health Problem of Interest

The scientific community has recently recognized the epidemic character of type II diabetes in Hispanic Americans. In adult Hispanic Americans, the condition’s incidence exceeds that of the total U.S. population by 80%, with the greatest risks experienced by citizens of Puerto Rican and Mexican origin (Aguayo-Mazzucato et al., 2019). Disease incidence in these groups exceeds 14%, contributing to the financial burden on the U.S. public health system, which has grown by more than 25% recently (Aguayo-Mazzucato et al., 2019). The existing compartmental models feature diverse contributors to the epidemic, including wage levels, educational attainment gaps, peculiar sequence variants of SLC16A11 and HNF1A genes common in individuals of Latin American ancestry, and genetic contributors to insulin resistance patterns (Aguayo-Mazzucato et al., 2019). Increased consumption of carbohydrates and saturated fats, the value of simpatia, family meal traditions, and the lack of culturally adapted prediabetes education could promote the epidemic (Aguayo-Mazzucato et al., 2019; McCurley et al., 2017). Some factors, such as culture-specific nutritional preferences and rituals, are modifiable with teaching interventions, making lifestyle variables a promising area in diabetes prevention efforts.

Study Question

Despite extensive epidemic research, the best lifestyle-focused diabetes prevention methods in the Hispanic population of the U.S. are unclear. Although positioned as the future of addressing the diabetes epidemic, culturally adapted lifestyle modification interventions require further experimental studies with more male participants and analyzing patient feedback (McCurley et al., 2017). The following question has been selected: in Hispanic American adults with prediabetes, does exposure to a culturally-tailored nutrition guide versus non-culturally-specific prediabetes diet information decrease type II diabetes incidence within a 1-year timeframe?

The Most Appropriate Design

Experimental research with randomization has been chosen as the most appropriate study design for addressing the knowledge gap specified above. The study would involve recruiting a representative sample of adult Hispanic Americans with prediabetes diagnosis (blood sugar levels between 5.7% and 6.4%) with the group’s sex ratio approaching 1:1 to address the issue of male underrepresentation in the previous RCTs of culturally-tailored interventions mentioned by McCurley et al. (2017). The participants will be randomly assigned to exposure to general prediabetes dietary recommendations or a set of recommendations tailored to the Latin diet (cooking methods and product selection advice), and diabetes incidence levels will be measured and comparatively analyzed one year after the intervention.

Relevant Assumptions and Tenets Supporting Design Selection

Internal Validity and Bias

The rationale for choosing experimental design stems from validity and accuracy differences across the existing designs. Firstly, experimental research, especially clinical trials, outperforms descriptive and analytical designs, including ecological, cross-sectional, case-control, and cohort longitudinal studies in terms of relative validity, which has direct implications for results’ generalizability (Friis & Sellers, 2021). Considering the recognition of diabetes in Hispanics as a true epidemic, outcomes’ transferability to wider epidemiological contexts is crucial for rapid improvement at the national level (McCurley et al., 2017). Secondly, as the tenets of experimental design, replicability, randomization, and variable manipulation reduce the risks of exposure measurement errors and deficiencies in scientific accuracy, including recall bias in case-control research, cohort studies’ proneness to selection bias, and cross-sectional designs’ weakness in establishing causal links (Cubillos et al., 2017; Friis & Sellers, 2021). With that in mind, experimental research seems relevant to the problem.

Applicability Considerations

From the perspective of applicability, experimental research is an optimal choice. Being aimed at large-scale comparisons, ecological designs would be suitable only if culturally adapted nutritional recommendations were a standard of prediabetes care (Friis & Sellers, 2021). Case-control research is more applicable to rare conditions with long latency periods, whereas cohort studies are suitable for issues with multiple outcomes of interest and exposures occurring naturally, which is not the case of lifestyle modification (Friis & Sellers, 2021). Cross-sectional designs capture disease prevalence data, making them more suitable for insufficiently studied conditions (Friis & Sellers, 2021). The prevalence of type II diabetes in Hispanic Americans is well-established, and the search for inexpensive prevention methods is in the limelight. By emphasizing prevention, the question also exceeds the scope of descriptive epidemiology or studying disease frequency variations over time and depending on demographic/geographic variables. With reduced selection biases, experimental designs are the most suitable for exploring exposures and treatments of interest comparatively to improve standard care practices for widespread conditions, such as type II diabetes and prediabetes (Friis & Sellers, 2021). These differences between the designs’ applicability limits explain the final choice.

Health Data Resources

Potential Resources

Selecting the right health data resources is essential to epidemiology studies’ success during both the preparatory and research stages. Friis and Sellers (2021) specify a multitude of helpful sources, including high-quality epidemiological studies from professional databases for healthcare specialists, such as PubMed and MEDLINE, and the website of the National Center for Health Statistics (NCHS). All three options would be helpful for the major assessment study, allowing for a literature review and intervention planning endeavors based on the best practices in adapting nutrition education curricula to Hispanic citizens’ typical food choices.

Strengths and Weaknesses

The resources above possess their strengths and limitations that require discussion. PubMed is an authoritative and reliable database focused on healthcare research, which adds to the search results’ relevance (Friis & Sellers, 2021). With its modes, including basic search, advanced search, and MeSH, it offers flexibility in search string complexity. As the main database of the National Library of Medicine, MEDLINE possesses similar advantages, for instance, availability, regular updates, and customizable search boxes (Friis & Sellers, 2021). There can be limitations since not all PubMed searches contain links to articles’ full-text versions, and MEDLINE does not index many source types aside from journal articles, thus omitting multiple conference papers. As for the NCHS, its benefits are accessibility, accuracy estimates, and data on large-scale diabetes-related trends by race, age, and poverty level (Friis & Sellers, 2021; Jackson et al., 2020). Regarding limitations, despite being a national source, the NCHS does not provide information on non-demographic variables, including lifestyle/social variables of type II diabetes patients. Only national diabetes registries, such as the Diabetes Collaborative Registry, offer these details (Bak et al., 2021). Despite the limitations, proper search strategies would maximize the resources’ effectiveness.

Conclusion

Finally, studying the role of lifestyle interventions’ cultural adaptation in diabetes prevention is important for battling the diabetes epidemic in U.S. Hispanics. Experimental designs would be suitable for the preliminary question due to the predictive power and applicability to widespread conditions requiring improved standard care guidelines. Diverse data resources, including medical research databases and national statistics agencies in the healthcare field, can promote the hypothetical study’s success.

References

Aguayo-Mazzucato, C., Diaque, P., Hernandez, S., Rosas, S., Kostic, A., & Caballero, A. E. (2019). Understanding the growing epidemic of type 2 diabetes in the Hispanic population living in the United States. Diabetes/Metabolism Research and Reviews, 35(2), 1-40.

Bak, J. C., Serné, E. H., Kramer, M. H., Nieuwdorp, M., & Verheugt, C. L. (2021). National diabetes registries: Do they make a difference? Acta Diabetologica, 58(3), 267-278.

Cubillos, L., Estrada del Campo, Y., Harbi, K., Keyserling, T., Samuel-Hodge, C., & Reuland, D. S. (2017). Feasibility and acceptability of a clinic-based Mediterranean-style diet intervention to reduce cardiovascular risk for Hispanic Americans with type 2 diabetes. The Diabetes Educator, 43(3), 286-296.

Friis, R. H., & Sellers, T. (2021). Epidemiology for public health practice (6th ed.). Jones & Bartlett Learning.

Jackson, M. C., Dai, S., Skeete, R. A., Owens-Gary, M., Cannon, M. J., Smith, B. D., Jabra, R., Masalovich, S. E., & Soler, R. E. (2020). An examination of gender differences in the National Diabetes Prevention Program’s Lifestyle Change Program. The Diabetes Educator, 46(6), 580–586.

McCurley, J. L., Gutierrez, A. P., & Gallo, L. C. (2017). Diabetes prevention in US Hispanic adults: A systematic review of culturally tailored interventions. American Journal of Preventive Medicine, 52(4), 519-529.

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