Meet the German Diet

The following questions are being edited in compliance with the PBL: Meet the German Diet (MGD) assignment revision which is due 10-20-2018:

1. What would be Jane’s first steps?

ANSWER: Jane’s first step in the compilation of the report is to conduct a literature review that may include the following words/phrases in the search engine: Amish, Diet, Type 2 Diabetes, etc. The literature review should be limited to returns that are a) from medical journals or other refereed sources and b) 5 years or younger in regards to publication date to ensure accuracy and up-to-date information. This information once collected should be share with her writing partner so that they can vet the references together in regards to pertinence to their topic. In the case of partners working together on the literature review, it may be helpful to set up a drop box so that both can contribute literature for review when writing the paper. By doing this, it is also easier to double check and eliminate double entries of the same articles or similar articles.

2. What data would be important? What biostatistics could she apply to the data?

ANSWER: Because the topic is that of why Amish have less incidence of Type II Diabetes, it would be important to ascertain whether or not Amish truly have less Type II Diabetes not only in the geographic area of the country that Jane and Mike work, but also around the United States as well as possibly abroad (the decision to include other countries should be made at the start of the literature review). This could be done through a survey or reviewing established data sets from the state health department. It should be understood however, that the Amish do not commonly use physician’s services, preferring to first try home or natural remedies. Therefore a diagnosis of diabetes could go unmade for quite some time; therefore statistical data may be limited.

Regarding the types of biostatistics that can be applied, it depends on the type of study that is done. According to Savage, Kubs and Groves (Savage CL, 2016), causality determines whether or not there is a cause and effect relationship regarding risk factors and health effects. If one reverses this thought so that instead of looking at what causes diabetes in Amish, the researcher looks at what causes there to be a lack of diabetes in Amish populations, then the causal relationship becomes important. This might further lead to the use of an Ecological model as the best method for examining the German Diet and its effect on Amish populations. This is due to the Ecological Model looking at “groups” as opposed to individuals.

If interested in only determining a) how many Amish have Type II Diabetes at this time, then the learner suggests that it would be helpful to first look at the rate of diabetes that is currently found in this population. To calculate this would require one to have an accurate estimate of the disease in the Amish population (numerator) over the total number of Amish in the area (denominator) as a method of calculating the morbidity. If this is not ideally possible, then it would be helpful to go to Bureau of Vital Statistics (BVS) and pull up the number of deaths attributed to diabetes in Amish populations as the numerator over the total population (denominator) and calculate the mortality rate. Once this information is available it would be easier to decide on the best descriptive statistics to compile. If one is dealing with mortality data, the cross-sectional study would be more helpful as it would give an estimate of the disease within the population at the given time of the mortality data.

In either data set (mortality or morbidity), it is possible to also conduct a cohort study as well as examining relative risk. This is because cohort studies follow a particular or specific population or group of people over a period of time. As it is unlikely that Jan is doing this study for an extended time, this would be reliable if it were conducted as a “prospective study” if studying what is going to happen in the future (morbidity), retrospective (if studying mortality) or historically if for some reason the study is going to be over several years of previously collected data (i.e. BVS data).

3. What will these first statistics tell her?

Initial statistics will tell Jane and Mike the approximate number of diabetic Amish in the area that they are reviewing. But because the data may not be complete in terms of accuracy due to reliance on home/natural treatments, there should be further investigation (N/A, Do Amish Visit Doctors?, 2018).

4. What other information might be helpful?

ANSWER: As with many studies, what is not in evidence is often also very important in understanding a disease process in a population. It would be important to try and identify the home/natural remedies that may be utilized for such symptoms of diabetes as nocturia, weight loss or gain, hunger, thirst and dry mouth (N/A, Early Signs of Diabetes, 2018). Also, one might want to look at medical complaints or home treatment with natural remedies involving 4 out of the 6 symptoms listed above which might point towards diabetes that has not yet been diagnosed.

5. What analytic procedures could they complete with these data?

ANSWER: As mentioned earlier, the Odds Ratio and Rates Ratio could be accomplished by using data from 2 x 2 table. It might also be of interest to compute Incidence if looking at only the immediate data or Prevalence if looking at a longer study or tracking participants over time. Also, Case-Control studies are possible using a 2 x 2 table. If reviewing records, one might also consider a Retrospective or Historical cohort study or if pursuing new and future data, utilize a Prospective study (Savage CL, 2016).

6. What other data might be helpful in completing a report on diabetes in their county?

ANSWER: If only looking at Amish and the incidence of Type II Diabetes in one county, the following should also be examined: health department records of Amish medical visits and reasons, Amish population behavior/habits in the county (use of fast foods, gymnasiums, etc.), historical data on use of medical facilities by Amish in the county or state. The Bureau of Vital Statistics should be consulted to see what the leading cause of death among Amish in the county are. This information may give good information regarding causes of death that could be correlated to possible Diabetes.

7. What would be their findings?

ANSWER: It is hopeful that they would find the number of Amish citizens that have been diagnosed with Type II Diabetes in the County. This in turn could prove to be interesting in regards to the dietary habits and physical activity of the Amish as relates to the diagnosis of diabetes.

8. Is the county in line with 2020 targets for objective D-1?

In examination of the Healthy People 2020 document, Objective D-1 states: Reduce the annual number of new cases of diabetes in the population (N/A, Objective D-1, 2018). If one reviews the scenario, the overall number of cases of Type II diabetes is “increasing” in the county, so therefore (regardless of the fact that the Amish make up a small number of these diagnoses), the answer is no. The county is not in line for showing a decrease in the number of new cases of diabetes.

9. How could this inform the development of interventions?

ANSWER: The information which shows that diabetes is not on the downswing in the County is a strong call for an intervention within the community. Therefore as part of the paper that Jane and Mike are going to write, they should also include their ideas on how to educate the county citizens on the dangers of diabetes, symptoms and available tests that may be done to confirm or rule out a diagnosis of Type II Diabetes. It would also be helpful to those receiving this information to have an idea of where they can be tested (blood glucose and A1C) and what these tests measure. Brochures that could be placed in lobby of physician’s offices as well as the health department would be informative in a private way, allowing the patient to make the decision to broach the topic during their visit, if they feel they have some of these symptoms.

In patients that are diagnosed due to screening as “pre-diabetic”, there should be educational counselling with the patient to try and reverse the process while it is possible. This should be done through close monitoring and regular visits to assist in nutritional counselling and dietary change.

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