The U.S. Hmong population experiences Type 2 diabetes mellitus (T2DM) at disproportionate rates when compared to Non-Hispanic whites (24 percent vs. 10.2 percent). Prior to resettling in the United States after the Vietnam-American War, the Hmong had no concept of diabetes. As a result of this knowledge deficit, the Hmong may be more likely to seek care in an advanced state T2DM disease and after the T2DM has manifested itself in significant disability. This pattern of delayed health care is reflected in hiher than recommended levels of HbAIC (glycosylated hemoglobin-a measurement of diabetes management) found in Hmong patients with T2DM (9.3 to 11.6 percent instead of the recommended <6.5 percent). The delay in care, along with challenges in following recommended Western medical guidelines to manage diabetes, leads to increased burden of disease such as the disproportionate rates of heart disease, kidney failure, loss of vision, and peripheral neuropathy found among the Hmong. To address this health inequity a community based participatory research (CBPR) partnership project was developed to reduce the disease burden of T2DM among the Hmong community. The CBPR partnership's work is informed by a community advisory board. All members of the community advisory board are Hmong in origin and include nurses, nurse practitioners, pharmacists, naturopathic providers, shaman, community leaders and individuals and their family members with diabetes. The CBPR partnership conducted a community needs assessment persons of Hmong origin with T2DM and found that only 13 percent had ever received a foot check, 30 percent reported having a dilated eye exam in the last year, as few as 35 percent had seen a diabetic educator and 38 percent are not aware of their HbAlC status and had not heard the term. Only 20 percent reported checking their blood glucose at least once a day, and 15 percent reported doing any type of exercise or physical activity. In order to address the gaps in recommended diabetes care, the community advisory board proposed four aims for this research proposal: (1) create an effective community-academic based participatory partnership and community advisory board that is inclusive of both Hmong Western and complementary and alternative healthcare providers, (2) determine the effectiveness of Community Healthcare Workers who function as service coordinators, health educators, and healthcare navigators for Hmong community members with T2DM, (3) translate and evaluate the World Health Organization Quality of Life-BREF instrument for care management and biomedical research of T2DM among the Hmong community, (4) conduct a quasi-experiential study to determine if Community Health Workers' services and participation in Qigong (a mediation and exercise program) will improve the quality of life and biomarkers for Hmong community members with T2DM. The continued negative consequence of complications from T2DM in the Hmong community warrants further research into effective community based mechanisms to improve quality of life and health outcomes and for future evidence based translational research.
Type 2 diabetes mellitus is a leading cause of morbidity and mortality among the Hmong community. Undertreated Type 2 diabetes mellitus creates undue burden of disease and financial hardship. The goal of this study is to assist in meeting the Healthy People 2020 objectives (D 2-14) for Hmong community members with Type 2 diabetes mellitus and improve health outcomes.
