Assignment: Blood Glucose Control and Cardiovascular Disease Essay

Assignment: Blood Glucose Control and Cardiovascular Disease Essay

Assignment: Blood Glucose Control and Cardiovascular Disease Essay

Cardiovascular Disease (CVD) is the leading cause of death in the United States. The mortality and mortality rates are disproportionately high among the African Americans compared to any other ethnic group. The situation can be attributed to many substantial risks factors such as diabetes, hypertension, and obesity that contribute to the development of CVDs at some point in the life course. However, diabetes has been reported as the leading risk factor for CVDs given that diabetic patients who reports cases of CVDs are 75% higher than non-diabetic patients who report the same cases. Coincidentally, diabetes is as well most rampant among African Americans than other ethnic groups. This makes management of diabetes an alternative way of controlling the risks of CVDs. Monitoring of blood glucose is one of the major techniques adopted by physicians to help in managing diabetes. Since patient education has been widely reported to play a key role in the management and prevention of diabetes, it is an additional advantage to incorporate blood sugar control training in such programs. Therefore, this proposal aims to conduct an education program for male African Americans who are  diabetic as a way of managing diabetes. The patients will be trained once in a week for 6 months on how to control blood sugar. The patients will fill two different questionnaires – before and after the program to generate data that will be used to evaluate the process. Plans for Monitoring of the participants attendance and decline or improvement in diabetic management will be conducted to evaluate the effective and the success of the program.

Cardiovascular Disease (CVD) is the leading cause of death in the United States. Currently, 31.3% of all deaths in the US result from CVDs (Muller et al., 2019).  However, the morbidity and mortality rates of Cardiovascular Diseases (CVDs) are still not proportional within the overall population of the United States.  There is a notable disparity in the prevalence of the diseases among different ethnic groups, genders, and ages. Almost every metric report the African Americas to have poorer cardiovascular health compared to the non-Hispanic whites and any other ethnic group and a higher CVD mortality rate than whites. Among the African Americans and any other ethnic groups, cases of CVDs are more elevated in men than in women.  According to Graham (2015), black African Americans are 30% more likely to die from heart diseases, twice more likely to suffer a stroke, have higher rates of heart failure, functional impairment and death rates from Acute Coronary Syndrome (ACS) and myocardial infarction (MI) among others.

Lockwood et al. (2018) also reported substantially higher prevalence rates of CVDs among Black males (46%) and females (46%) than among White males (38%) and females (32%) and rates of 43% and 29% for Hypertension among adult blacks and whites respectively. The high morbidity and mortality rates associated with CVDs among African American is attributed to substantial risks factors such as diabetes, hypertension, and obesity which contribute to the development of CVDs at some point in the life course (Oguoma et al., 2017). Dinwiddie et al. (2014), reports that the risk factors are determined by gender, education, and nativity. Among the factors, only education can easily be manipulated to confer better health among the higher risk groups. With CVDs and diabetes disproportionately affecting African American male, the priority should be set increasing efforts on providing education to and empowering these patients as a way of managing CVDs. This paper is proposal which applies patient education on blood such control as way of managing diabetes and reducing CVDs risks concurrently.

Problem

It is established that CVDs are the number one cause of death in the United States. The diseases are mostly rampant among the African Americans males. Additionally, diabetes, which is one of the major risk factors of CVDs, is also rampant among this ethnic group. Though the efforts applied to address the situation has generally lowered the prevalence of CVDs in the United States, the diseases are still affecting many people in the country especially African Americans. Most studies give predictions of a possible increase of CVDs and diabetes cases in the United States should the situation failed to be addressed urgently (Muller et al., 2019). Patient education has been proposed as an effective way for managing diabetes. However, the intervention has not been widely implemented to equip diabetic patients with the necessary knowledge on blood sugar control (Mitchell & Hawkins, 2014).

The purpose of this study is to investigate if providing a once per week education to diabetic patients on how to control blood glucose for a six-months period has an impact on blood glucose control and the risk of cardiovascular disease among African American males. This is because diabetes is one of the major risk factors of CVDs. Adopting an approach which will address the problem of blood will lower the occurrence of diabetes which will, in turn, lower the cases of CVDs. Dinwiddie et al. (2014) reported education as the only determining factor of diabetes that can be manipulated to benefit patients. Therefore, the paper tends to establish the impact of this approach. This research will apply a prospective cohort study design to collect data regarding the various factors that put diabetic African American males at risk of cardiovascular disease.

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Male African Americans are disproportionately affected by CVDs because of some risk factors which predispose them to the disease. The literature report poorer cardiovascular health among African Americans compared to the non-Hispanic whites and any other ethnic group and a higher CVD mortality rate than whites. There is a notable disparity in the prevalence of the diseases among

different ethnic groups, genders, and ages. According to Graham (2015), black African Americans are 30% more likely to die from heart diseases, twice more likely to suffer a stroke, have higher rates of heart failure, functional impairment and death rates from Acute Coronary Syndrome (ACS) and myocardial infarction (MI) among others. This condition is attributed to some substantial risks factors such as diabetes, hypertension, and obesity which contribute to the development of CVDs at some point in the life course (Oguoma et al., 2017). Additionally, cases of CVDs are more elevated in men than in women. Some of the notable risk factors to that can be attributed to the prevalence of CVDs among African Americans include diabetes, gender, and ethnicity.

Diabetes is a major predisposing factor to Cardiovascular Diseases (CVDs) even though other factors such as blood pressure, raised serum cholesterol, smoking, and age also play some roles in its development. Diabetes is associated with high sugar levels with the glucose cutoff that defines diabetes is the threshold for microvascular disease such as retinopathy (Muller et al., 2019). According to Muller et al. (2019), the risks of CVDs among people suffering from type 2 diabetic are three times more compared to people without diabetes. Some of these vascular complications include coronary artery disease (CAD), peripheral vascular disease (PVD), retinopathy and nephropathy, and stroke (Huxley et al., 2014). Diabetes contributes to the risks of CVDs because it affects heart muscles and causes both diastolic and systolic heart failure. It is associated with hypertension and dyslipidemia which are known risks for CVDs (Lockwood et al., 2018). Even though the association of the full cardiovascular morbidity and mortality is not fully understood, evidence suggests that hyperglycemia, which the hallmark of diabetes is one of the factors which contribute to the damage of myocardial after ischemic events. High blood glucose caused by diabetes damages nerves that control blood vessels and the heart and blood vessels as well (Huxley et al., 2014). This makes management of blood sugar or blood glucose levels, cholesterol, and blood pressure essential in protecting people from the occurrence of CVDs.

Both the minority and non-majority groups in the United States show clear disparities in the outcomes of cardiovascular diseases. This is due to the health disparities in the country that is determined by race, ethnicity, socioeconomic status, and geography. Ethnic health disparities are caused by the system-related, provider, and patient factors discrimination (Cunningham et al. 2018). Patient-level factors include individual behaviors such as diet and exercise and genetic factors which may predispose victims to poor health risks (Seaborn et al., 2016). Varying sensitivity to patients from different backgrounds and their needs and differences and unintentional bias is among the provider-level factors. Factors such as infrastructure, cultural competency, care, and insurance coverage are among the system-related factors that contribute to ethnic health disparities discrimination (Cunningham et al. 2018). The disproportionate inclination among these factors with different ethnic groups have contributed to higher cases and morbidity and mortality rates of CVDs among African Americans.

African Americans are more likely to suffer from heart failure, stroke, myocardial infarction, and other CVDs. This is because the group suffers from many unrecognized risk factors which therefore go untreated. African Americans have the highest rates of hypertension in the US (Graham, 2015). Cases of high blood pressure and obesity are common among African Americans because of their have higher levels of N-terminal prohormone brain-type natriuretic peptide (NT-proBNP). BNP is a common heart failure predictor discrimination (Cunningham et al. 2018). Additionally, African Americans are less likely to achieve adequate control or receive adequate treatment of risk factors such as hypertension and obesity (Lockwood et al., 2018). Moreover, African Americans are more likely to suffer ACS because of a higher sense of fatigue, abnormal chest pain, sleep disturbances. These ethnic disparities may be attributed to discrimination. Though discrimination may be universal, the marginalized, oppressed, and disenfranchised have historically experienced a disproportionate level of discrimination (Muller et al., 2019). According to the historical and cultural context, institutional and systematic inequality had been created (Lockwood et al., 2018). Those who bore the brunt of these discriminations such as African Americans are more likely to have greater exposure to environmental and personal stresses, disadvantaged social status, and poor access to social resources and material that may address the aftermath of the discrimination (Cunningham et al. 2018).

Gender is another factor which affects the development, manifestation, management, and outcomes of CVDs. However, the exact effects it has on men and women vary and are dependent on other factors such as age, education, and other diseases. Traditionally, there were similar rates for the development of CVDs in both men and women. With time, men became more at risk of low-density lipoprotein (LDL)-cholesterol, higher total cholesterol, and hypertension exposing then to greater risks of CVDs (Muller et al., 2019). However, with advanced age, menopausal women also adopted other risk factors such as smoking, systolic arterial hypertension, high-density lipoprotein (HDL)-cholesterol, diabetes, and triglyceride which expose them to greater risks of CVDs as well.

There is a linear increase in cardiovascular risks and the atherosclerotic process in men as opposed to women. During fertile ages, estrogen protects women from atherosclerosis because they adopt both genomic and non-genomic mechanisms to confer some beneficial effects on the cardiovascular system (Moonesinghe et al., 2019). However, the risks of CVDs increase after menopause. While there are high chances of diabetes in women than men, the elevated levels of LDL-cholesterol enhance more risks of cardiovascular in men than in women. Therefore, cardiovascular risks in female and male genders are disproportionately elevated depending on the prevailing risk factors. According to Moonesinghe et al. (2019), cases of stroke are 60.6% in women.  Annual female deaths caused by CVDs has been more than that of male since 1984. However, when this data is viewed in terms of mortality, the CVDs mortality rate is higher in men than when adjustments are made for age distribution differences (Huxley et al., 2014).

Hypothesis or research (PICOT) question(s) identified

To achieve the objectives of this study, the following hypothesis is proposed guided by the theory that patient education impacts health;

In African American Male, how does providing once a week education over a six-month period on blood glucose control, impacts their risk of cardiovascular disease?

Interventions

Once Per Week Education for Six Months

Various interventions have been adopted to manage diabetes. These interventions include medication, self-care measures, and lifestyle changes. Even though diabetes is a chronic disease, non-pharmacological measures are as well important in managing the disease (Vásquez et al., 2018). Diabetic patients are often required to take specific medication, follow a healthy diet, exercise, and monitor blood glucose and other complications associated with diabetes (Peñalvo et al., 2017). Owing to these complications, better outcomes can be realized only when there an active involvement of the patients in the care process (Mitchell & Hawkins, 2014). Diabetic patients should learn to care for themselves because of the daily challenges associated with diabetes. Therefore, patient education becomes the backbone of diabetes management.

The problem of the high occurrence of CVDs among African Americans is further compounded by the high prevalence of diabetes among the ethnic group. Diabetes being the major risk factor for CVDs as mentioned earlier is very common among African Americans compared to other ethnic groups in the US. According to Mitchell & Hawkins (2014), African Americans are disproportionately affected by diabetes whereby 13% of African Americans age 20 and above suffer from type 2 diabetes while only 7.1 % of their non-Hispanic Whites counterparts suffer the same. Additionally, 7% of African Americans suffer from undiagnosed cases of diabetes. Compared to white, African Americans are 2 to 4 times more likely to experience amputation, renal diseases, blindness due to no or poor management of diabetes and 20% more likely to die from diabetes-related complications (Mitchell & Hawkins, 2014).

These disparities are attributed to low birth-weight, maternal-fetal stress, differences in glucose metabolism, fat distribution, and obesity, customers, cultural food practices, lack of enough neighborhood space for physical activities, low socioeconomic status, poor housing quality, low-quality care, barriers to health care access, limited access to healthy food among other factors (Cunningham et al. 2018). It is reported that cases of CVDs are three times higher in the population suffering from diabetes compared to those are not affected (Bower et al., 2019). As such, by extension, the high prevalence of diabetes among African Americans is a primary factor that contributes to the high morbidity and mortality of CVDs among the ethnic group. Therefore, interventions that lower the cases of diabetes among African Americans are as well contributing towards lowering the occurrences of CVDs.

Being that the cases of diabetes are more common among African Americans, patient education is very important to enable self-care among diabetic patients. This will, in turn, lower the incidence of CVDs. Dinwiddie (2014), reports that CVDs risk factors differ by education, gender, and nativity. Besides, one of the factors which contribute to the elevated case of CVDs and diabetes among African Americans is the mistrust of health caregivers and systems. Other factors which can be addressed by self-care include racial discordance between patients and care-giver and perceived discriminations in medical encounters (Yorke & Atiase, 2018). Therefore, educating patients on blood glucose control is a viable move towards the control of CVDs.

Knowledge gaps

The literature establishes the importance of patient education in controlling diabetes though no explicit application of the techniques to addressing the rampancy of the disease among African Americans. Addition, there is no literature that has taken the approach of managing blood glucose as a way of addressing CVD s among African Americans. Most papers take on holistic approaches in providing education to patient on how to manage diabetes and give less and specific emphasis on blood glucoses control.

Methodology

Participants’ Selection Criteria

The study participant will be selected from a population-based cohort of male African American adults between ages 35 and 65. The participants will have to be diabetic patients seeking treatment in a community health center located in both urban and rural centers. Up to 60 research participants who certified specific eligibility criteria will be recruited for the study. Convenience sampling will be employed for this study whereby any adult diabetic patient attending any assessable hospital will be approached and their eligibility confirmed  before asking them if they can willing join the study so long they are male African Americans. The participants will be randomly approached as they enter a community health center and evaluated for their eligibility and interest in taking part in the study. The purpose of the study will be explained to the patients and in case they are interested, the researchers will make sure that they are male African Americans within the age of 35 to 65 and they are well conversant with the English language. Subsequent tests will be done to ensure their eligibility. The participant will provide their contact informant such as cell numbers and emails for follow up in case of any unexpected events.

Informed Consent

The research will seek the informed consent of the study participants before the study begins. This will be done by drafting an informed consent document which the study participants will be required to sign after reading and understanding the terms of the agreement. Individuals who fail to consent to the study will not be allowed to participate (Ibrahim, Alshogran, Khabour & Alzoubi, 2019)

The Study Procedure

The study will begin by identification and enrolment of the research participants. After ensuring that the candidates are interested male African-Americans with the age limit of 35 to 65 years and the due English fluency, they will be recruited and asked to fill the first survey questionnaire to establish their present status, perspectives, and understanding of the risks associated with cardiovascular diseases and diabetes. Preferable patients will be the ones who check their blood glucose on a daily basis to facilitate the evaluation of the impacts the education will bring. Other diagnostic tests such as lipid profile and electrocardiogram, will be conducted to assess for the presence of cardiovascular disease.

Potential participants will be given an informed consent form to sign. If they consent, the participants will be presented with survey questionnaires that will collect demographic data questions and aspects of health and health behavior such as medical history, family medical history, tobacco use, diet, exercise, risk perception, access to health services, and psychological well-being. They will report their HgbA1C levels prior to the education module. The participants will then be requested to insert the questionnaires in a sealed box to protect their anonymity. They will then be given the program table to be used during the training. Possible changes agreed upon by the participants will be made before they begin the training. The patients will have one session every week. During the period, the patients will be taught the basics of managing blood such as how to control diet, exercise, take blood sugar tests, take and manage medication among other aspects.

To check whether the diet plans are taking effects or not, diabetic patients are required to have a glucose meter at home to test their blood glucose two hours after meals. The recommended levels of blood sugar are 90-130mg/dl in the morning during fasts and less than 180mg/dl after meals (MakkiAwouda, Elmukashfi, & Al-Tom, 2014). Patients will be taught how to monitor these levels and make appropriate medical adjustments on their own.

At the end of the six-month training, the participants who completed the training will be given another six month of evaluation and monitoring before they feel fill a second questionnaire. The questionnaire will try to establish how they are using the knowledge they gained and how it has changed their lives. The hgbA1C levels of the participants will be retested every two months form the onset of the intervention to get the result which can be compared over time. The education will assess the changes in their hgbA1C levels over the time, their rate of admission and readmission and also the incidences of CDVs among the participants.  They will also give comments on the overall nature of diabetes management since the training. The data obtained from these questionnaires and the physician’s evaluation of the patient before, during, and after the training will be used to evaluate the impact of the blood sugar control on the risk of CVDs. risk of CVDs.

Data Collection

The completed surveys of the participants will provide the required data. The HgbA1C levels will be obtained at an interval of two months from the beginning of the training to the end of the six months which follow the intervention and recorded. The questionnaires will answer some of the questions such as patient’s, age, changes in HgbA1C results over a one year period, rates of diabetes related complications (rates of admission and readmissions), ratings of other parameters of the intervention on a scale of 1-5, and the willingness to participate in the proposed project.

Data Confidentiality

The patient will not be required to enter personal information such as names, location, identity numbers and such like in the questionnaires. No personal information except necessary demographic information will be collected in the survey forms or associated with the data from this study to ensure compliance with HIPPA guidelines. After filling the questionnaires, the participants will then be requested to insert the questionnaires in a sealed box to protect their anonymity. Survey documents that might have mistakenly included participant’s names or any other identifying information will be destroyed. As soon as the data is entered into an electronic database, the survey forms will be destroyed.

Anticipated Risks and Side Effects to the Participants

There are no anticipated risks associated with participation in this study. Nevertheless, if participants feel uncomfortable in taking part in the study, they may withdraw at will.

Anticipated Benefits to Participants

There will be no compensation for the research participants. However, the findings from this study will help health providers and the general public to understand how to prevent and lower the risk of cardiovascular diseases among diabetic African American males.

Data Analysis

The survey result will be evaluated using the Likert scale for comparison. The differences between the HgbA1C levels before and after the education program will be compared using t-test. This comparison will determine if there is a difference or not. Pearson’s 2 test will be employed for the analysis of qualitative variables. The ANCOVA will be employed in determining the adjusted effects of the intervention with a p –value of 0.05 indicating a statistical significance of the model.

Summary

Cardiovascular disease is a major cause of death in the United States especially among the African America population which is the most affected ethnic group. Diabetes is a primary risk factor for CVDs and is also common mostly among African Americans. This makes the chances of contracting CVDs double among African Americans. Factors which contribute to these disparities include historical and cultural discriminations, genetic factors, socioeconomic factors among others. Therefore, interventions that can reduce the incidences of CVDs among African Americans should be implemented. Since diabetes is associated with CVDs, controlling it can as well contributed to the management of CVDs. Consequently, blood glucose control comes in handy to manage the disease. Since diabetes management is associated with daily complications and frequent checking of blood sugar levels, patients should be taught how to check and control their blood sugar levels to help doctors with the demanding job, overrides mistrust between patients and caregivers, and to bring more convenience.

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