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Introduction
Becoming agents for social change is a crucial goal for DNP-prepared nurses. The development of culturally sensitive prevention and teaching interventions has become a promising approach to the prevention of lifestyle-related conditions, including type 2 diabetes (T2D). This problem selection paper explores T2D in Hispanic Americans and specifies the direction for further research suitable for intervention development.
Person, Place, and Time Characteristics
Being the largest minority in the U.S., Hispanics in diverse age subgroups experience higher T2D-related risks than non-Hispanic whites. In the U.S., Hispanic children develop diabetes up to five times more often than their racial majority peers (Aguayo-Mazzucato et al., 2018). For adult U.S. citizens, the race-based difference in T2D incidence exceeds 80%, with individuals’ positive obesity status, educational attainment level lower than a high school diploma, and a yearly income lower than $75.000 increasing Hispanics’ risks even more (Aguayo-Mazzucato et al., 2018). Diabetes prevalence also varies between this population’s subgroups, with the highest T2D incidence rates for U.S. citizens originating from Mexico and Puerto Rico (13.9% and 14.8%, respectively) (Smith-Miller et al., 2017). A recent genome-wide association study in Hispanic/Latino U.S. citizens has shown a positive link between ancestry rather than European and T2D risks (Chande et al., 2020). As for time, between 2012 and 2017, the costs of diabetes treatment for the U.S. healthcare system increased by 26% (Aguayo-Mazzucato et al., 2018). Increases in the number of low-income Hispanic diabetes patients have also played a critical role in the growth.
The Problem’s Significance
The HP2020 objectives and the “who, where, and when” of the problem highlight the significance of developing new, focused, culturally sensitive T2D prevention programs for Hispanic Americans. The group is projected to triple in size, becoming 20-29% of the U.S. population by 2050, which, considering this cohort’s current prevalence of T2D, could make the financial burden of diabetes management almost unbearable (McCurley et al., 2017). Aside from economic effects, the failure to prevent T2D in Hispanic Americans will affect mortality; in Mexico, many U.S. Hispanics’ country of origin, diabetes is already recognized as the most prevalent cause of death (Aguayo-Mazzucato et al., 2018; McCurley et al., 2017). The lack of adequate programs also leads to increases in non-lethal complications of T2D, including eye disease, CVD, amputations, and other consequences, resulting in corresponding budget-related effects (Aguayo-Mazzucato et al., 2018; McCurley et al., 2017). T2D prevention in Hispanics aligns with three diabetes-focused HP2020 objectives, including D-16.1, D-16.2, and D-16.3 (Office of Disease Prevention and Health Promotion, n.d.). The objectives deal with motivating lifestyle changes in high-risk populations for T2D, including fostering healthier physical activity patterns, weight loss attempts, and decreased fat/caloric consumption.
Preliminary Research Question
The preliminary research question focuses on the value of culturally sensitive lifestyle-focused T2D prevention interventions compared to disseminating generalized prevention recommendations and patient toolkits in Hispanic adults with prediabetes. In uninsured prediabetes Hispanic populations, the dissemination of diabetes toolkits and metformin (in patients with HbA1c levels exceeding 6.2%) has been shown to promote the normalization of fasting blood sugar levels (Botah-Oduro & Talley, 2021). As for culturally tailored approaches to T2D prevention, there are promising programs based on literacy modification techniques, healthier alternatives to traditional Hispanic recipes, and experiential learning (McCurley et al., 2017). Exploring the question through literature review methods will support developing a multi-component culturally sensitive teaching program for adult Hispanic patients with prediabetes in the U.S.
Conclusion
Finally, the current prevalence of T2D in U.S. Hispanic adults creates the need for focused disease prevention interventions. Cultural sensitivity and patient/community education that explains and demonstrates the adaptation of general lifestyle change recommendations to Hispanic Americans’ culture and philosophy might be the key to achieving HP2020 objectives linked with diabetes. The author will further explore culture-focused T2D prevention strategies to propose a feasible teaching program for Hispanic adults with prediabetes.
References
Aguayo-Mazzucato, C., Diaque, P., Hernandez, S., Rosas, S., Kostic, A., & Caballero, A. E. (2018). Understanding the growing epidemic of type 2 diabetes in the Hispanic population living in the United States.Diabetes/Metabolism Research and Reviews, 35(2), 1-35.
Botah-Oduro, O., & Talley, M. H. (2021). Evaluating interventions to delay the progression of prediabetes to type-2 diabetes mellitus in an uninsured Hispanic population. Journal of the American Association of Nurse Practitioners, 33(8), 661-666.
Chande, A. T., Rishishwar, L., Conley, A. B., Valderrama-Aguirre, A., Medina-Rivas, M. A., & Jordan, I. K. (2020). Ancestry effects on type 2 diabetes genetic risk inference in Hispanic/Latino populations.BMC Medical Genetics, 21(2), 1-14.
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.
Office of Disease Prevention and Health Promotion. (n.d.). 2020 topics & objectives: Diabetes. Web.
Smith-Miller, C. A., Berry, D. C., & Miller, C. T. (2017). Diabetes affects everything: Type 2 diabetes self-management among Spanish-speaking Hispanic immigrants.Research in Nursing & Health, 40(6), 541-554.
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