The Problem of Diabetes Among African Americans

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Table of Contents

Evaluation Table
Critical Appraisal
References

Evaluation Table

Full APA formatted citationof selected article.	Article #1	Article #2	Article #3	Article #4
Full APA formatted citationof selected article.	Chrvala, C. A., Sherr, D., & Lipman, R. D. (2016). Diabetes self-management education for adults with type 2 diabetes mellitus: a systematic review of the effect on glycemic control. Patient Education and Counseling, 99(6), 926-943.	Cunningham, A. T., Crittendon, D. R., White, N., Mills, G. D., Diaz, V., & LaNoue, M. D. (2018). The effect of diabetes self-management education on HbA1c and quality of life in African-Americans: A systematic review and meta-analysis. BMC Health Services Research, 18(1).	Lagisetty, P. A., Priyadarshini, S., Terrell, S., Hamati, M., Landgraf, J., Chopra, V., & Heisler, M. (2017). Culturally targeted strategies for diabetes prevention in minority populations: A systematic review and framework. Diabetes Education, 43(1), 54-77.	Zhang, Y., Pan, X. F., Chen, J., Xia, L., Cao, A., Zhang, Y., Wang, J., Li, H., Yang, K., Guo, K., He, M., & Pan, A. (2020). Combined lifestyle factors and risk of incident type 2 diabetes and prognosis among individuals with type 2 diabetes: A systematic review and meta-analysis of prospective cohort studies. Diabetologia, 63(1), 21-33.
Evidence Level	I	I	I	I
Conceptual Framework	No framework	No framework	The authors used inductive thematic analysis to develop a conceptual framework and access cultural targeting. The chosen studies were investigated in terms of interventions and categorized into four domains (facilitators, language, location, and message). Each domain had its purpose and impact on diabetic prevention and the results of a systematic review.	No framework
Design/Method	A systematic review was based on the PICOS framing applied for a search strategy within such databases as MEDLINE, CINAHL, EMBASE, PsycINFO, and ERIC. The main headings included “type 2 diabetes”, “self-care education”, “self-management”, and “behavior change” (Chrvala et al., 2016). Inclusion criteria: publication date from January 1, 1997 to December 31, 2013, peer-reviewed journal, and randomized controlled trials as the described designs. Inclusion criteria: articles with the description of diabetes self-management education (DESM) for younger than18 years patients.	A systematic review included the analysis of randomized controlled trials, cluster-randomized trials, and quasi-experimental trials. The Preferred Reporting for Systematic Review and Meta Analysis (PRISMA) guidelines were used as the basis for the chosen method (Cunningham et al., 2018). OVID MEDLINE was the main research database with such keywords as “African Americans” and “type 2 diabetes mellitus”. All potential settings were included where DSCE is an acceptable option. Exclusion criteria: not black populations, type 1 diabetes, interventions not for patients, interventions except DSME, and no HbA1c measurement.	A systematic review contained the results of the search in such databases as PubMed, EMBASE, and CINAHL. Inclusion criteria were the English language for writing peer-reviewed articles and randomized controlled trials or quasi-experimental trials to prevent diabetes, following the PRISMA guidelines. The last update that was appropriate for the analysis was on May 5, 2016 (Lagisetty et al., 2017). Inclusion criteria: the description of the interventions for ethnic minority groups, directed to diabetes and patients older than 18 years. Studies that did not meet these criteria were excluded.	A systematic review represented the analysis of peer-reviewed articles from such databases as EMBASE and PubMed (till April 2019). Inclusion criteria were prospective cohort studies, lifestyle factors (smoking, alcohol, and sedentary lifestyle), and no language restrictions (Zhang et al., 2020). Studies not related to diabetes prognosis, based on other publication types, duplicate publications, and less than 1-year follow up were excluded.
Sample/Setting	120 out of 3095 articles were used; 22947 participants (mean age was 58.5 years) were enrolled.	44 full-text articles and 279 abstracts were reviewed; 14 studies became eligible for the review; 2532 participants (aged between 50-65 years) were involved.	25 out of 34 studies met the criteria; only 4 articles used four domains of culturally tailored intervention. The total number of participants remains unknown.	16 studies with 1,116,248 participants were used for stratified analysis; 10 studies with 34,385 participants were used for meta-analyses.
Major Variables Studied	DSME as an independent variable; A1C level (glycemic control) as a dependent variable.	DSME (delivery, contact hours, and providers) as an independent variable; HvA1c as a dependent variable.	Culturally tailored interventions as an independent variable; diabetes risks as a dependent variable.	Healthy lifestyle as an independent variable; type 2 diabetes incidence is a dependent variable.
Measurement	Pearson’s chi-square analysis to calculate the absolute difference of A1C in control and intervention groups; the Cochran test.	A meta-analysis was used to assess baseline differences; a forest plot was used to generate a weighted mean difference; the Cochran test.	Thematic analysis (no statistical tests) was applied.	Random-effects models; heterogeneity and publication bias tests; forest plots; Begg and Mazumdar rank correlation test; Egger’s test.
Data Analysis Statistical or Qualitative findings	The mean reduction in A1C because of DSME was 0.74 “with a range of 0.6 to -2.50 and a media of -060 versus a mean decrease of 0.17” (Chrvala et al., 2016, p. 937).	“The HbA1c WMD between intervention and usual care participants was not significant: 0.08% [-0.40–0.23]; heterogeneity was high: χ2 = 84.79 (p <.001), I²= 92%” (Cunningham et al., 2018, p. 9).	No tests	56% of participants with the healthiest lifestyle had a low risk of mortality (Zhang et al., 2020).
Findings and Recommendations	DSME was proved to have a favorable impact on glycemic control	Non-significant DSME effect on HbA1c was observed. Changes in the quality of life promoted certain improvements in glycemic control.	There are four critical domains to improve risk factors of diabetes among ethnic minority groups, including facilitators, location, language, and message. Cultural tailoring is a crucial aspect of diabetic interventions for different populations.	It is recommended for people to follow a healthy lifestyle to predict the incidence of type 2 diabetes in regard to their socioeconomic backgrounds and other characteristics.
Appraisal and Study Quality	The worth is statistical significance for delivery mode, engagement hours, and A1C baseline. The strengths are, and the limitations are language and A1C levels as the only factor. The risks are the heterogeneous nature of the intervention and unpredictable behavioral endpoints. The feasibility of DSME is proved by the possibility to control A1C levels, maximize intervention effects, and reduce the risk of complication.	The worth is attention to HbA1c control among African Americans people with diabetes. The strengths are the examination of DSME impact on HbA1c among African Americans and subgroup analysis. The limitations are the heterogeneity of HbA1c results and a small number of studies. The risk of biases in randomization cannot be neglected. In further studies about the effectiveness of education on diabetes, this review could serve as a solid background.	The worth is a better understanding of the effectiveness of diabetic interventions in regard to cultural differences of patients. The strengths include a specific focus on culture and the introduction of domains to evaluate the impact of prevention. The limitations are the use of the English language only and a limited number of randomized trials. The risk is a possible inappropriateness of the four domains to the representatives of new ethnic groups.	The worth includes the possibility of investigating diabetes from an international aspect. The strength is the use of prospective studies and observations to prove the connection between lifestyles and diabetic prevention. The limitations are the lack of information on diabetic microvascular complications, attention to high-income countries, and heterogeneity of healthy lifestyle definitions. The risk is the presence of cultural differences in regions chosen for analysis.
Key findings	DSME interventions may be improved by choice of appropriate methods, providers, and contact time.	No significant effects of DSME on HbA1c among African Americans were observed.	Cultural tailoring in diabetes prevention plays an important role in certain minority groups.	A healthy lifestyle has to be adopted to reduce the risk of type 2 diabetes or predict complications in diabetic patients.
Outcomes	All DSME methods contribute to a reduction in A1C.	It is necessary to continue trials and prioritize the quality of life interventions.	Future studies have to be developed to apply the same domains to new settings and populations.	A combination of lifestyle factors is a chance for people to reduce the burden of diabetes globally.
General Notes/Comments	The impact of new settings and different care providers has to be analyzed through the prism of DSME.	The chosen types of peer-reviewed articles strengthened the quality of findings in this study.	Comparative effectiveness of domains lacks in the study, and the priority of cultural factors has to be recognized.	Diabetes is not a local problem but a public health issue that has to be solved and analyzed from a global perspective.

Critical Appraisal

Taking into consideration the results of the research and the information found in the articles, the problem of diabetes among African Americans has to be identified and discussed at different levels. Regardless of the already made attempts to underline the importance of lifestyle improvements and the impact of culture, people are in need of new interventions and recommendations (Lagisetty et al., 2017; Zhang et al., 2020). Chrvala et al. (2016) and Cunningham et al. (2018) introduce one of the best practices for the populations to control the risks of diabetes, known as diabetes self-management education or DSME. This process aims to facilitate the knowledge, skills, and abilities of people to promote and understand self-care aspects. The worth of DSME is to rely on evidence-based standards and consider patients’ needs with the goals of caregivers.

African Americans, as well as the representatives of other ethnic groups, face certain challenges, questions, and concerns when they hear about diabetes diagnosis. In the majority of cases, people are informed about the main steps and changes. DSME is a common practice that includes diet management, physical exercises, stress control, and monitoring of vital diabetes signs (Chrvala et al., 2016). It is recommended to analyze the guidelines offered by the American Diabetes Association and develop treatment plans as per obtained knowledge. Diabetes is never simple, and diabetes among African Americans is always a serious health problem that requires special attention and care. As a regular intervention, DSME results in decreased glycated hemoglobin levels and improved clinical, psychosocial, and behavioral issues (Cunningham et al., 2018). Diabetic patients learn how to manage this disease and focus on their personal factors like age, race, or gender and choose strategies that meet their needs and are developed as per available resources, caregivers, and other internal and external factors.

References

Chrvala, C. A., Sherr, D., & Lipman, R. D. (2016). Diabetes self-management education for adults with type 2 diabetes mellitus: a systematic review of the effect on glycemic control. Patient Education and Counseling, 99(6), 926-943. Web.

Cunningham, A. T., Crittendon, D. R., White, N., Mills, G. D., Diaz, V., & LaNoue, M. D. (2018). The effect of diabetes self-management education on HbA1c and quality of life in African-Americans: A systematic review and meta-analysis. BMC Health Services Research, 18(1). Web.

Lagisetty, P. A., Priyadarshini, S., Terrell, S., Hamati, M., Landgraf, J., Chopra, V., & Heisler, M. (2017). Culturally targeted strategies for diabetes prevention in minority populations: A systematic review and framework. Diabetes Education, 43(1), 54-77. Web.

Zhang, Y., Pan, X. F., Chen, J., Xia, L., Cao, A., Zhang, Y., Wang, J., Li, H., Yang, K., Guo, K., He, M., & Pan, A. (2020). Combined lifestyle factors and risk of incident type 2 diabetes and prognosis among individuals with type 2 diabetes: A systematic review and meta-analysis of prospective cohort studies. Diabetologia, 63(1), 21-33. Web.

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The Problem of Diabetes Among African Americans

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