Diabetes in its generality is a condition that is associated with elevated blood sugar levels. When these elevations persist, the patient may experience cases of disturbance of other body systems and leading to poor functionality and ultimately a chronic condition that affects their quality of life. Type-2 diabetes (T2DM) is the most common type of diabetes whose impact on the health of populations has significantly been documented (Murrock, Taylor & Marino, 2013). Apparently, among the documented aspects of health disparities, T2DM is noted as one of the biggest health challenges for African Americans. The prevalence is even higher among women of this ethnicity with indications of one in every four African American women past the age of 55 years having diabetes (Komar‐Samardzija, Braun, Keithley & Quinn, 2012). A further one in every four women is at risk of being diagnosed with the condition in the next 12 months. Further, this group, the African Americans have the highest rates of kidney failure and amputation which are the two major complications associated with diabetes (Varble, 2015). This paper will seek to make a detailed objective synthesis of literature to explore the aspects of 1) Etiology and risks, 2) Signs and symptoms, 3) Complications, 4) Role of nutrition and exercise, 5) Role of vitamin E and D and 6) The management of type-2 diabetes. This is in a bid to help increase education and awareness on diabetes since there is sufficient evidence to suggest an existing knowledge gap within this group and further to show that such information can help avert the possible increases in cases of T2DM (Jean Maydalyne Gumbs PHD, 2012).
1) Etiology and risks factors
Historical factors and culture tend to have significant influence on the cases and prevalence of diabetes. The modes of eating and the food choices are mainly a representative of the familial, affective and gender-based associations. For the African American women even in the knowledge that modifying these factors may significantly prevent T2DM, the challenge is that the cultures and rituals associated with food and meals may be difficult to break especially in their closely knit relationships and societies. On the other hand, these choices on food may be limited by the existing socioeconomic environment. Poverty rates and unemployment within the African American population is significantly high and in a male dominated society, the impacts are even worse for the women (Komar‐Samardzija, Braun, Keithley & Quinn, 2012). The preference for fast foods and the disregard of the balanced diets knowingly or unknowingly is therefore influenced by the availability of finances and resources to support such acquisition of ‘more’ healthy foods (Jean Maydalyne Gumbs PHD, 2012).
On the other hand, the physical environment characterized by poor housing, high crime rates and low access to the basic commodities piles further pressure on the women especially if they have families to manage. This subsequently leads to increased stress levels which with time, due to the unchanged physical environment could advance to chronic stress, precedence for diabetes (Murrock, Taylor & Marino, 2013). In the cultured African American society, the lack of regard for physical exercise and activity as regimen for sustaining a healthy body is part of the major issues that have contributed to the current cases of diabetes. For women, there is increased risk especially during and in post-pregnancy period triggered by gestation diabetes (Komar‐Samardzija, Braun, Keithley & Quinn, 2012).
Sedentary lifestyles are a common phenomenon within these societies adding to the long list of factors that contribute to the cases of diabetes. This is visibly justified by the many cases of obesity and overweight even among the young children in elementary and middle school, conditions that further pose increased risk for diabetes due to the impacts of insulin-resistance in obese and overweight persons. Further, there is significant evidence to suggest that there exists a significant link for diabetes and genetics. For cases of diabetes that have been recorded within this population, 68% have indicated a positive family history for diabetes or any of the related illnesses or conditions such as obesity or overweight. Across these factors, then it becomes evident that the women in the African American population are at increased risk or overburdened by T2DM (Komar‐Samardzija, Braun, Keithley & Quinn, 2012).
2) Signs and symptoms
The manifestation of T2DM is associated with insulin deficiency or the inability of the body to regulate blood glucose even in the presence of sufficient insulin. When any of these occurrences occur persistently, the patient may experience continued cases of elevated blood glucose a condition referred to as hyperglycemia which if not managed in its early stages can lead to chronic hyperglycemia. In this stage, the patient may not actually derive normality by taking medication or insulin supplements. Rather, the focus is on management to prevent progress of the condition to severity as well as managing the risk factors and triggers that lead to episodes of elevated blood glucose (Murrock, Taylor & Marino, 2013). Some of the signs and symptoms that are dominant in a majority of patients with T2DM include frequent urination, increased thirst to compensate for the loss of water through urine, weight loss even in the event of appropriate eating and dietary techniques, elevated hunger levels to compensate for energy loss in the muscles, tiredness and fatigue that is usually triggered by minimal exercise or activity, slow healing of soles, blurred vision as well as frequent infections (Martin, 2013).
3) Complications
The impacts of diabetes are wide and serious. In most cases, there is a tendency to ignore the effects of diabetes in the early stages since there is little or no impact on functionality of the patient. However, as the illnesses progresses, the impacts on other body organs and systems commences and the patient may start to experience the symptoms in a more dominant manner. As the illness progresses, the long term implications may begin to manifest. Such include the nerve damage/neuropathy which is a condition facilitated by the impact of excess sugar on the walls of the capillaries especially in the lower and upper extremities (Maureen Clement, Amir Hanna, Diana Sherifali & Jean-François Yale, 2013). The damage to these capillaries may lead to the associated issues of numbness and tingling of the affected region and subsequently the loss of the senesce of feeling in the affected region. If the condition extends to the nerves that affect control the digestive system, cases of nausea, vomiting and diarrhea may be presented (Maureen Clement, Amir Hanna, Diana Sherifali & Jean-François Yale, 2013).
On the other hand, diabetes is associated with dramatic increase in the risk of cardiovascular problems such as heart attack, coronary heart disease, stroke, high blood pressure and atherosclerosis. Further, the elevated sugar levels lead to kidney damage/nephropathy by damaging the blood vessel clusters that facilitate the filtering of the blood. This could lead to end-stage renal disease which is usually managed through dialysis or kidney transplant and whose impacts on the quality of life of the patient are significantly high. T2DM is also associated with eye damage, impairment of the hearing system, skin infections as well as a notable exposure to the risk of Alzheimer’s disease in the long term (Maureen Clement, Amir Hanna, Diana Sherifali & Jean-François Yale, 2013).
4) Role of nutrition and exercise
One of the most prominent issues that influence diabetes and its manifestation and subsequent prevalence is the nutrition. Dietary patterns and food choices are among the set of modifiable factors that can be addressed to manage and contain the menace that is diabetes. In societies that prefer fast foods as opposed to balanced meals, the incidences of diabetes are high. Apparently, there is a wrong assumption that there are specific foods that can actually help avert the possibility of acquiring diabetes. Similarly, there are beliefs that some foods are fit for consumption for people with diabetes and others are totally unfit. These assumptions are just based on myths and fallacies (Gucciardi, Chan, Manuel & Sidani, 2013). The preference of vegetarian diets for instance does not indicate any significant benefits that reduce the risk of diabetes or help the diabetic patient from living a normal life. A key goal for every individual is to focus on balanced diets and discipline in the choice of foods. Low fat foods, less sugar and low glycemic foods coupled with high fiber content in the foods may significantly boost and stabilize the blood sugar levels in the long run. However, the positive benefits are more recognizable when the patient or the individual is highly disciplined and can stick to the dietary plan for a majority of their diets (Murrock, Taylor & Marino, 2013).
Within the African American group, the preference for fast foods from food joints and restaurants is one of the issues that have significantly burdened this population. With such a setting and with their lives revolving around doing meager jobs to sustain n their livelihood, the time available for exercise and physical activity is minimal (Amuta, Barry, McKyer & Lisako, 2015). This has sidelined these groups to a sedentary lifestyle that revolves around work and home thus excluding the vital element of exercise which is crucial in the efforts to sustain and maintain a normal weight. In the absence of physical exercise and appropriate dietary techniques, the incidences of obesity and overweight tend to manifest which ultimately lead to a cases of insulin resistance; the first step to the development of diabetes (Varble, 2015).
5) Role of vitamin E and D
Vitamins are essentially organic compounds that are crucial in the normal body metabolism and they are required in the body in small amounts. Their absence could stimulate or trigger some of the metabolic functions to stop working or render the dysfunctional such that they cannot deliver as expected. Vitamin E is one of the crucial elements that play a key role in the issues of diabetes (Martini, Catania & Ferreira, 2010). It is a lipid-soluble antioxidant that functions systematically to protect the integrity of the membranes by restraining the process of lipid perodixation. Vitamin E may not necessarily be directly linked to diabetes but its finds importance in reducing the levels of HbA1c in people with insufficient glycaemic control. Vitamin E supplements may therefore be necessarily but in small amounts that do not exceed 400 IU per day since beyond this level the Vitamin E could lead to all-cause mortality and adverse effects. It is always important that the patient seeks regular screening and assessment for Vitamin E before they adopt the supplements as part of their regimen (Martini, Catania & Ferreira, 2010).
Vitamin D on the other hand has significant association with diabetes due to its control of the major metabolic processes. The insufficiency of Vitamin D could lead to lower function of the beta cells, increased insulin resistance, dysfunction of the glucose metabolism process and ultimately increase glucose intolerance. The linear association between indicates that the relative risk for increase in the risk of diabetes is by 4% for each 10nmol/L of increase in serum (Martin, 2013). There is also a notable decrease in the risk of diabetes with each reduction of 50 nmol/L of serum. Apparently, obese and overweight people are at risk of Vitamin D insufficiency normally due to the fact that the body fat actually binds to the Vitamin D and thus preventing it from normal absorption into the blood (Martini, Catania & Ferreira, 2010). In relation to the African American group, there is evidence to suggest that the black skin is less capable of making Vitamin D and this combined with the increased cases of obesity and overweight in this group can be associated with the high prevalence of diabetes. However, supplements can be acquired on the recommendation of the clinician based on the assessment of other modifiable factors such as weight gain which may the barrier to Vitamin D absorption (Amuta, Barry, McKyer & Lisako, 2015).
6) The management of type 2 diabetes
All cases of T2DM are not curable but can be successfully managed to afford the patient a normal life. The first step towards such management is for the patient to recognize that they are the key player and that modification of a substantial part of their lifestyle is necessary. At the top of the list is the recognition that dietary approaches should reflect the needs of the patient. There is a need to shun the fast food options to enable one stick to a dietary plan that affords them less sugary foods, with less fat content and with high fiber content (Gucciardi, Chan, Manuel & Sidani, 2013). The notion that vegetarianism can reduce the risk of diabetes or facilitate management should be avoided as there are indications that such a diet that is limited to vegetables is as risky as the sugary foods. On the other hand, the use of alcohol could also pose significant danger to the patient as it increases the sugar content in the blood and thus further straining an already ailing system (Maureen Clement, Amir Hanna, Diana Sherifali, & Jean-François Yale, 2013).
Further, there is a need to manage weight as a preventive mechanism to hindering the process of Vitamin D formation which has been noted as crucial in the metabolism of blood glucose. Light physical exercise and activity as well as regular yoga sessions can significantly improve blood sugar control and minimize the risk of T2DM. Oral glycerin, metformin and acarbose can be used to manage the blood glucose levels but this is usually a shirt term solution as it cannot be sustained as the only method for management (Maureen Clement, Amir Hanna, Diana Sherifali, & Jean-François Yale, 2013). The focus should be on dietary, behavioral and lifestyle modifications to help cope with the burden of diabetes. Patient education at the individual and community level is crucial in creating awareness and promoting health living techniques that can help avert the prevalence of diabetes in the high risk groups (Long, Jahnle, Richardson, Loewenstein & Volpp (2012).
References
Amuta, A. O., Barry, A. E., McKyer, J., & Lisako, E. (2015). Risk Perceptions for Developing Type 2 Diabetes among Overweight and Obese Adolescents with and without a Family History of Type 2 Diabetes. American journal of health behavior, 39(6), 786-793.
Gucciardi, E., Chan, V. W. S., Manuel, L., & Sidani, S. (2013). A systematic literature review of diabetes self-management education features to improve diabetes education in women of Black African/Caribbean and Hispanic/Latin American ethnicity. Patient education and counseling, 92(2), 235-245.
Jean Maydalyne Gumbs PHD, A. N. P. (2012). Relationship between diabetes self-management education and self-care behaviors among African American women with type 2 diabetes. Journal of cultural diversity, 19(1), 18.
Komar‐Samardzija, M., Braun, L. T., Keithley, J. K., & Quinn, L. T. (2012). Factors associated with physical activity levels in African–American women with type 2 diabetes. Journal of the American Academy of Nurse Practitioners, 24(4), 209-217.
Long, J. A., Jahnle, E. C., Richardson, D. M., Loewenstein, G., & Volpp, K. G. (2012). Peer mentoring and financial incentives to improve glucose control in African American veterans: a randomized trial. Annals of internal medicine,156(6), 416-424.
Martin, C. (2013). The role of vitamins in the prevention and treatment of type 2 diabetes and its complication. J Diabet Nurs, 17(10), 376-383.
Martini, L. A., Catania, A. S., & Ferreira, S. R. (2010). Role of vitamins and minerals in prevention and management of type 2 diabetes mellitus. Nutrition reviews, 68(6), 341-354.
Maureen Clement, M. D., Amir Hanna, M. B., Diana Sherifali, R. N., & Jean-François Yale, M. D. (2013). Pharmacologic management of type 2 diabetes.
Murrock, C. J., Taylor, E., & Marino, D. (2013). Dietary challenges of managing type 2 diabetes in African-American women. Women & health,53(2), 173-184.
Varble, A. (2015). Diabetes Self-Management Education and Self-Care Behaviors. In 2015 APHA Annual Meeting & Expo (Oct. 31-Nov. 4, 2015). APHA.
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