Diabetes has been ranked as the fourth killer disease worldwide by the International Diabetes Federation (IDF). According to the World Health Organization (WHO), more than 180 million people have diabetes and the figure is expected to increase to 380 million by 2025. In addition, about 2.9 million people die each year from diabetes. The IDF statistics indicate that the cost of treating and managing diabetes exceeds $ 232 billion and that certain populations are at higher risk of developing the disorder. The African Americans are most affected compared to the whites. Recent prospective studies estimated 2.7 million of all African Americans aged 20 years and above as having diabetes complications (Skelly, et al. 261). Moreover, this group suffers excessively from the complication of diabetes including retinopathy, kidney failure, and amputations.
However, in both whites and African Americans women are more affected than men. The key goal of diabetes management is to control the level of blood glucose. This management involves following a complex, time consuming self-care which involves adherence to meal plan, daily foot care, regular physical activity, insulin administration or oral medications and regular monitoring of blood glucose. However, achieving this goal remains a problem for many people.
The approach to self-care may however vary in accordance to culture affiliations, resources, and functional abilities. This is common for older Africa American women residing in the rural Southeast who apart from managing their diabetes have other challenges such as chronic diseases, poor health and shortage of health providers. In addition, this group has low income and limited resources leading to stress which may interfere with self care. In the United States diabetes self-management education (DSME) has been introduced with an aim of achieving glycemic control thereby preventing or delaying the onset of diabetes complications.
Although the program is structured to provide comprehensive instruction, it fails to address the culture and age-related protocols. This has led to a more individualized approach to diabetes education referred to as symptom-focused approach (skelly, et al. 262).This method guides individuals on how to manage their disease basing on the needs and preferences of different population. The main goal of symptom-focused approach is to educate older African American who has type II diabetes on how to recognize and interpret symptoms so as to make appropriate decision about health care. Individuals are therefore required to take full responsibility in shaping and organizing the nature of their complications to maintain good glycemic control and prevent complications.
The key requirements in management of diabetes are commitment to time, physical and mental energy and knowledge of the disease based on personal experience. The advantage of personal experience of diabetes (symptoms) is that it will help in making informed and right decision about self-care as well as improve diabetes related outcomes. The management and treatment of diabetes is guided by a symptom-focused model. This model engages the patient with diabetes directly connecting the information about self care to a person’s own experience. The model is general, simple, non expensive and can therefore be adapted to a variety of cultures, settings and populations (Skelly, et al. 265).
It has been established that, African Americans are more likely to develop diabetes than whites. This has been associated with low socioeconomic status, physical inactivity and previous family history of diabetes. However, the risk factors that contribute to diabetes may be identified to mitigate the disease in African American during its early stages. A recent research study on diabetes mellitus type II indicated that middle aged African Americans particularly women are at a higher risky of developing the disease than their female counterparts (Brancati, et al. 2253).
However, there is no clear information since earlier investigations has been limited by lack of data on diabetes, designs of study and samples of a typical general population. A community-based study involving middle-aged adults was conducted to compare the risks of incident of diabetes in African Americans and the whites, to explain the excess diabetes risk in African Americans based on racial differences and to compare diabetes-related traits such as blood pressure between whites and African Americans.
The results indicated that, middle-aged African Americans particularly women are at high risk for incident type II diabetes than the whites. The difference is suggested to stem from sex differences between African Americans and whites in adiposity. Additionally, African Americans women are more affected than men. This is contributed by the fact that African American women posses excess risk factor of developing diabetes than men. Racial differences in diabetic state are largely reflected. The African Americans with diabetes suffer from blood pressure and hypertension than their white counterparts. The ARIC study that supports these results are its design, its large population based sample and flexibility to standardization (Brancati, et al. 2256). High risks of diabetes are contributed by genetic factors, shared behaviors and environmental factors.
The above findings are likely to be influenced by differences in socioeconomics status and health behaviors. However, these variables are delicate as they are complex markers for socio-cultural and historical factors in the US. And hence further study involving racial difference should be carried out cautiously. There was likelihood that the method used in this study underestimated the percentages of excess risk explained by diabetes risk factors. The two papers agree to varying levels that diabetes highly affects African Americans than their white counterparts. This has been contributed by factors such as culture, socioeconomic difference, physical inactivity and genetics.
In addition, women are more affected and are at high risks of developing the diabetes complication than men. However, the two papers differ on how the disease should be managed and treated. According to Skelly et al. (263), self-care management should be adhered to. This involves use of a symptom-focused model that calls for self management based on a person’s own experience. The symptom-focused model is economical in number of concepts and well-defined boundaries.
On the other hand, Brancati et al. (2255) carried out a study on diabetes type II in African American and whites. They suggested a method of identifying potentially modifiable risk factors that contribute to the disease as a key way of intervening diabetes at its early stages. Such risks might be prevented through strategies such as weight reduction, dietary modification and increased physical activity.
However, genetics and environmental factors are non-modifiable and hence a limitations in this method. A more advanced investigation based on more novel risk factors that might contribute to excess diabetes risk in African Americans such as gene variants and environmental exposure is recommended. Equal numbers of African Americans and whites should be sampled in the community to get the full insight of racial differences. The geographical distribution or sampling area should be wider enough to lessen the problem of environmental exposure (Brancati, et al. 2257). The symptom-focused model should be tailored to investigate diabetes across racial differences, age differences and groups.
References
Brancati, F., Linda-Kao W. H., Folsom, R., et al. “Incident Type 2 Diabetes Mellitus in African American and White Adults: The Atherosclerosis Risk in Communities Study”. JAMA 283.17 (2000): 2253-2259.
Skelly, H., Leeman, J., Carlson, J., et al. “Conceptual Model of Symptom-Focused Diabetes Care for African Americans”. Journal of Nursing Scholarship, 40.3 (2008): 261–267.