Diabetes Management Strategies

This assignment delves into the multifaceted topic of diabetes management. It explores culturally relevant approaches to address the needs of diverse populations, including American Indians, South Asian immigrants, and African Americans. The document examines the role of traditional medicine alongside modern treatments like metformin and insulin analogs. It also highlights the importance of community-based health programs and the challenges faced in achieving optimal diabetes control within minority communities.

Running head: HEALTH CONCERNS OF IMMIGRANT
Health Concerns of a New Immigrant Population
Name of the Student
Name of the University
Author Note

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HEALTH CONCERNS OF IMMIGRANT
Table of Contents
Introduction................................................................................................................................2
Health concerns and health issue of the Indians immigrants in U.S..........................................2
Pharmacological and Treatment Regime for Diabetes...............................................................3
Traditional Beliefs and Practices Associated with Diabetes......................................................4
Culturally based methods to treat Diabetes................................................................................4
How cultural values and traditional practices might affect acceptance and use of prescribed
pharmacological treatments.......................................................................................................5
Evidence based strategy used to control diabetes among AIAN...............................................5
Culturally sensitive strategy used by nurses to treated diabetes................................................5
Conclusion..................................................................................................................................6
References..................................................................................................................................7

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Introduction
Immigrant Indian population in America are twice susceptible in developing type 2
diabetes mellitus in comparison to non-Hispanic group (Centre of Disease Control, 2017).
People with diabetes experiences devastating complications like stroke, blindness and heart
disease. The following report aims to highlight the possible reasons and probable
interventions that must be taken in order to balance this racial and ethnic disparity.
Health concerns and health issue of the Indians immigrants in U.S
South Asians (Indians) are fastest increasing racial or ethnic group in United States
(Jose et al., 2014). The South Asians have high prevalence and early onset of diabetes, type 2
diabetes mellitus (Gany et al., 2012). Type 2 diabetes is recognized as one of the significant
public health problems in American Indian communities for the past 40 years (Weil et al.,
2013). The Pima Indians who are residing in Arizona has highest recorded incidence of
diabetes in the world. The main reason behind this is increase in the insulin resistance among
the Indian immigrants in comparison to that of U.S natives. Although Type 2 diabetes is
traditionally considered as a disease of adults, its rate of occurrence among the children and
youth of Indian immigrants of America is creating an alarming problem (Weil et al., 2013).
According to the American Diabetes Association (2017), 16% of immigrant Indian
population and Alaska Natives in America have highest age-related prevalence of diabetes
among the US ethnic and racial groups. The trend of type 2 diabetes mellitus is mainly
common among the immigrant American Indian females. The reason cited behind this
abnormal body composition, which is characterized by abdominal body fat (American
Diabetes Association, 2017). Other abnormalities among the immigrant Indian population in
America, which increase the predisposition of developing type 2 diabetes mellitus is: insulin

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resistance, higher percentage of visceral fats and subcutaneous truncal fat. Furthermore, the
American Indian immigrant (both female and male have less waist circumferences but
comparable waist-to-hip ratio circumference in comparison to Caucasians and such miss-
proportion further increases the threat of developing type 2 diabetes (American Diabetes
Association, 2017).
Figure: Statistics Published by American Diabetes Association in Relation to Diabetes (2014)
Pharmacological and Treatment Regime for Diabetes
The main pharmacological intervention used for the treatment of Type 2 Diabetes
Mellitus is Metformin. The main cite of action of metformin is liver. Inside the hepatic cells,
metformin acts via reducing glucose output while increasing the uptake of glucose in the
peripheral cells of the muscles. Metformin’s security profile, efficacy and benefic metabolic
and cardiovascular effects make this drug as a potential glucose-lowering agent in type 2
diabetes mellitus (Rojas & Gomes, 2013). Other drugs, which are used for the treatment of
type 2 diabetes in America, include Sulfonylureas and Thiazolidinediones. However,
pharmacological interventions used to treat type 2 diabetes are associated with sudden degree
of side-effects like gastrointestinal malfunction or hepatic malfunction. In order to overcome
with the side-effects of the drugs, insulin replacement therapy is used to treat type 2 diabetes

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mellitus. This therapy mimics the standard mode of insulin secretion where the background
level of insulin is supplemented via high secretion of insulin in order to match with the
glucose load of meal (Zinman, 2013).
Traditional Beliefs and Practices Associated with Diabetes
Traditional belief associated with diabetes prevention is change in diet along with
lifestyle changes. However, Indian immigrants residing in America always not put into
practice the prescribed diet for diabetes the reason behind this lack of proper knowledge and
disease awareness (Wang, Wang & Chan, 2013). Traditional practices among the Indian
immigrants for the treatment of diabetes are the use of herbal medicines. Such herbal
medications are free from side effects and are known to be cost effective (Wang, Wang &
Chan, 2013). However, there lies a substantial similarity in beliefs related with diabetes
management among the American Indians, African Americans and Whites. This similarity
comes in terms of “consequences” and “symptoms” domains in comparison to pertaining
beliefs in relation to “causes” and “medical” management. The socio-economic conditions
influence the beliefs in relation to diabetes than that of the ethnicity (Grzywacz et al., 2012).
Culturally based methods to treat Diabetes
The cultural based methods that is mostly employed by the Indian immigrants
residing in America to treat type 2 diabetes is exercise or lifestyle changes and use of
artificial insulin injection (Wangnoo et al., 2013). However, the patients feel inconvenient in
employing insulin injection therapy due to its interference in eating, daily routine and
exercise. Moreover, the continuing Indian tradition of serving sweet dishes in any cultural or
social occasion along with fasting on specific occasion increases the risk of optimal diabetic
management (Wangnoo et al., 2013). All these further create a barrier towards participation
in the cultural based management of diabetes prevention.

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How cultural values and traditional practices might affect acceptance and use of
prescribed pharmacological treatments
The immigrant Indian population, which falls under the American Indians and
Alaskan Natives (AIAN) has less formal education in comparison to white population. The
majority of them lack higher school education and fall under the poor income group. They
also lack proper health insurance coverage. This social isolation creates a barrier towards the
optimal implementation of type 2 diabetes care plan. AIAN population have higher incidence
of alcohol abuse in comparison to the rest of the US population, another prominent reason
behind negative effect on prescribed pharmacological treatments.
Evidence based strategy used to control diabetes among AIAN
A educational campaign (community-based) in association with family interventions
was found to be effective in changing the thinking perspective of AIAN towards type 2
diabetes management. It is also helpful in generating awareness among the parents and they
are found less likely to provide their children with deserts and are more likely to promote
breastfeed their infants up to 6 months of age. Evidence based studies have also highlighted
the efficacy of providing diabetes education in a culturally competent manner to the AIAN
population. Such programs will lead to higher level of patient satisfaction and retention
information (Copeland et al., 2013).
Culturally sensitive strategy used by nurses to treated diabetes
In order generate awareness and proper education in type 2 diabetes and its
management, the nurses are required to act as educator. According to American Diabetes
Association, the health educators (nurses) need to be mindful towards the cultural tradition
and customs while recognizing the socio-cultural challenges (Lagisetty et al., 2017). The
culturally tailoring intervention must cover four specific domains like language, facilitators,

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location and messaging (text-message). Such culturally competent diabetes management
program has been shown to provide improved patient behavior, knowledge and health status
(Lagisetty et al., 2017).
Conclusion
Thus from the above discussion it can be concluded that proper culturally competent
intervention along with educational program must be undertaken in order to control increase
incidence of type 2 diabetes among the immigrant population (Indians) in US. Such
intervention programs must be actively designed by the physicians in association with trained
nurses.

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References
American Indian/Alaska Native Programs. (2017). American Diabetes Association. Retrieved
28 January 2018, from http://www.diabetes.org/in-my-community/awareness-
programs/american-indian-programs/
Copeland, K. C., Silverstein, J., Moore, K. R., Prazar, G. E., Raymer, T., Shiffman, R. N., ...
& Flinn, S. K. (2013). Management of newly diagnosed type 2 diabetes mellitus
(T2DM) in children and adolescents. Pediatrics, 131(2), 364-382.
Gany, F., Levy, A., Basu, P., Misra, S., Silberstein, J., Bari, S., ... & Leng, J. C. (2012).
Culturally tailored health camps and cardiovascular risk among South Asian
immigrants. Journal of health care for the poor and underserved, 23(2), 615-625.
Grzywacz, J. G., Arcury, T. A., Ip, E. H., Nguyen, H. T., Saldana, S., Reynolds, T., ... &
Quandt, S. A. (2012). “Culture” in Diabetes-Related Beliefs among Low-and High-
Education African American, American Indian, and White Older Adults. Ethnicity &
disease, 22(4), 466.
Jose, P. O., Frank, A. T., Kapphahn, K. I., Goldstein, B. A., Eggleston, K., Hastings, K. G., ...
& Palaniappan, L. P. (2014). Cardiovascular disease mortality in Asian
Americans. Journal of the American College of Cardiology, 64(23), 2486-2494.
Lagisetty, P. A., Priyadarshini, S., Terrell, S., Hamati, M., Landgraf, J., Chopra, V., &
Heisler, M. (2017). Culturally Targeted Strategies for Diabetes Prevention in Minority
Population: A Systematic Review and Framework. The Diabetes educator, 43(1), 54-
77.

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Rojas, L. B. A., & Gomes, M. B. (2013). Metformin: an old but still the best treatment for
type 2 diabetes. Diabetology & metabolic syndrome, 5(1), 6.
Wang, Z., Wang, J., & Chan, P. (2013). Treating type 2 diabetes mellitus with traditional
Chinese and Indian medicinal herbs. Evidence-Based Complementary and Alternative
Medicine, 2013.
Wangnoo, S. K., Maji, D., Das, A. K., Rao, P. V., Moses, A., Sethi, B., ... & Kesavadev, J.
(2013). Barriers and solutions to diabetes management: An Indian perspective. Indian
journal of endocrinology and metabolism, 17(4), 594.
Weil, E. J., Fufaa, G., Jones, L. I., Lovato, T., Lemley, K. V., Hanson, R. L., ... & Nelson, R.
G. (2013). Effect of losartan on prevention and progression of early diabetic
nephropathy in American Indians with type 2 diabetes. Diabetes, 62(9), 3224-3231.
Zinman, B. (2013). Newer insulin analogs: advances in basal insulin replacement. Diabetes,
Obesity and Metabolism, 15(s1), 6-10.