What Are the Health Effects of Type 2 Diabetes for the Elderly Asian People Living in England?

Contents

1 Statement of findings

1.1 Overview of the study

2 Strengths and Limitations

3 Question Context:

3.1 Significant to the area of study

3.2 Relevance to the area of study

3.4 The legal policy to the question

3.5 The practice issues associated with the question

4 Methodology

5 Results

6 Thematic Discussion and Recommendation

7 Conclusion

8 Appendices

9 Reference

10 Feedback of progress review

1 Statement of findings

Over four million people have diabetes in England according to WHO. It is a very common disease especially amongst the south Asian communities living in the UK. In 2030 diabetes, will be the 7^th leading cause of death (World Health Organisation, 2016). South Asians are the 2^nd largest ethnic minority group of people living in UK, accounting for over 4% of the population in England. Thus, this population are at the uppermost risk of developing type-2 diabetes (Holt, 2012). South Asian people are origin of Bangladesh, Sir Lanka, Pakistan, India and Nepal (Gholap et al., 2011).

Review of the leading cause of TD2 in the elderly Asian people living in the UK is that diabetes has a life changing impact, it creates cataracts easily in the eyes of the sufferers causing blindness, it carries increase risks of heart disease, kidney failure, feet ulcer leading to limb amputation and damage to the bodies nerve systems (Gillies et al., 2007; Atkins, 2016).

Risk perceptions and health effects is understood and interpreted differently by different communities. Involving individuals attitude, feelings, beliefs and judgments as well as the broader social and cultural dispositions they adopt towards their benefits and hazards. Studies have shown some south Asian people believe in scientific approach in treating the body with the Ayurvedic medicine, perceptions of external health responsibility were seen to be very important but there was a sense of helplessness with what the individual could do to remain healthy (Macaden and Clarke, 2010).

From the year 1996, the number of patients with diabetes has more than doubled. It is known to be the fastest growing health threat and an urgent public health issue. It is estimated that over five million people in England will have diabetes if urgent changes are not made soon (Diabetes UK. Known diabetes, fight diabetes, 2017). Henceforth, it is vital to create awareness to prevent and reduce TD2 among the south Asian people living in England (Bellary, 2008).

According to the annual Health Survey for England diabetes is the prime health treatment. The elderly Asian community has high chances of suffering from diabetes as people from Asian countries are stated to have the poorest health conditions (Nation Statistics NHS, 2017).

Studies in considering the scarce evidence for a possible age-depended influence of HbA1C levels on mortality, as the mortality rate of TD2 themes at high risk of cardiovascular disease (CVD), therefor, significant changes on how TD2 is managed and underlining the necessity of findings whether age-specific treatment is vital (Nicholas et al., 2013).

By making changes to lifestyle and successfully managing to control the disease can transform the quality of life for the suffers of TD2 (Claydon et al., 2009)

1.1 Overview of the study

Diabetes is a fast-growing and a life changing disease for the nation. Especially for the south Asian population as they have a much higher prevalence of T2D (Macaden and Clarke, 2006). This project overviews the research question of “what are the health effects of T2D for the elderly Asian people living in England?” and the aim in finding the strategies in preventing, reducing and controlling the health effects of T2D. This projects is as follow starting with the statement of findings, strengths and limitation, question context, methodology followed by the results and thematic discussion with recommendation and finally conclusion.

2 Strengths and Limitations

The biggest strength of this project has been my family support. Being a mother of three children, working part time and studying at the same time has been a challenge for me in managing my time but I overcame that by making a time plan and by trying my best to follow the steps on my compilation plan from the progress review. Furthermore, the support of my husband, children and family has been a great strength to keep me going through the stressful moments of meeting deadlines.

Other strengths have been using the ABS journal articles, as recommended by the lecturer. ABS journals are useful for the fact they are better ranked published articles, which had reliable and accountable information related to my research question. Also, using online resources search engine like google schooler and the BREO platform, both have been a strength as there are highly-rated and academically creditable journals and book related to my study.

Strength whilst using mixed methods of secondary research has helped me to gain better knowledge of my question and it has been less time consuming. Wider readings of secondary data provided more accurate and straightforward information of statics, figures and quantitative numbers, which has helped me to break down my study.

Limitation of accessing some journals as it was not available for free. I didn’t have the funds to help me buy journals and books, though I got student finance support, it is something I will have to pay that back.

Following the compilation plan I made in my progress review has been a challenge as finding the correct journals that are bases on my research question and aim. Barrier of limiting myself to review the elderly south Asian people living in the UK has been a challenge and time consuming. Furthermore, identifying literatures that are related to my research question was also a big challenge, however, having the supervisory sessions with our lecturer and sharing knowledge with my peers has been a strength to overcome that.

Coming from the Asian background helps to understand the literature reviews more as I could relate to it at some personal level, furthermore, I have senior relatives who have T2D and my mum has recently been diagnosed with T2D, understanding and getting confirmation from them of certain information I gathered from the wider readings has been a strength.

3 Question Context

The reason that led me to settle on the question is for the fact diabetes is a very common disease in England. According to the recent reports, over 3.8 million people are suffering from diabetes (NHS, 2017). Therefore, it is essential to make public more aware on the health effects diabetes have, especially in the Asian communities as they are the largest number in being diagnosed with T2D in England (World Health Organisation, 2016).

3.1 Significant to the area of study

Diabetes is a life changing chronic disease that has a negative impact on sufferer’s health & life (Diabetes UK. Known diabetes, fight diabetes, 2017). Furthermore, the question is more significant to me is because my mum has recently been diagnosed with T2D and I would personally like to gain more knowledge and understanding about what the health effects are of T2D and how it can be well managed effectively.

3.2 Relevance to the area of study

The research question is relevance to the area of my study because there is a large hypothesis of south Asian living in the UK, of having greater prevalence of T2D, which is due to the fact they have increased influence of becoming insulin resistance to certain environmental factors, including the adoption of inactive lifestyle and obesity (Barnett et al., 2006).

3.4 The legal policy to the question

In association to the research question, there are a vast number of legal, policy put in place by the UK government. The Preventing Diabetes Parliament UK legal policies through which the government published strategies in 2011 for the Department of Health to implement “Healthy Lives, Healthy People: a call to action on obesity in England” policy. It is a strategy to achieve a reduction in obesity, overweight and calories intake by 2020.

The Department of Health has 2 major programmes to tackle inactivity and obesity, by implementing (1) social marketing programs in 2009 like the ‘Change4life’ which aims to encouraging regular physical activity and healthy eating. (2) Program of voluntary pledges between government, some charities and industry, to which many food businesses have agreed the action on calories reductions by labelling calorie on their menus (Gov.uk, 2017).

There is the nationally funded agency Medical Research Council (MRC) provides clinical guidance and support researchers across the medical sciences, hospitals and in universities, to help improve human health (Kaleebu et al., 2014).

Diabetes UK has Strategies to take action to lower risks with the support of the health care services, joining the 8-week weight loss programs. Furthermore, there is the NHS diabetes prevention programs and pharmacological intervention available through GP. Who also provide educational programs on healthy eating along with help to reduce weight and prescribed medication to keep sugar levels in control (Diabetes UK, 2017).

There is also the National Institute for Health and Care Excellence (NICE). They provide national advice and guidance to improve health, they mentioned type 2 diabetes as a chorionic lifelong disease affecting the bodies never system and other major organs of the body. There are currently more than 4 million diabetic people and over 500 thousand that have T2D are unaware of it (NICE.org.uk, 2017).

The UK government legislation is set to start in April 2018 on the tax for sugar usage on sweetened drinks. There will be two bands, a higher one for drinks with more than 8g per 100ml and one for soft drinks with more than 5g of sugar per 100ml. Ministers hope it will help tackle the nation’s obesity problem. Which is one of the leading cause of T2D. Many companies have already begun to take action on cutting the amount of sugar they use to make their drinks (UK pushes ahead with sugar tax, 2016).

UK’s greater prevalence of T2D in south Asian people has gone up susceptibility in developing insulin resistance due to certain environmental factors (Barnett et al., 2006). To control the health effects of type 2 diabetes in the Asian community, a UK community based programme has been launched helps reduce the mortality & morbidity of T2D in south Asians through a fresh approach to management of lifestyle changes (Simon, 2014).

3.5 The practice issues associated with the question

South Asian community T2D management is poor although they have the highest burden of T2D in the world. Practice issues related to the research question is significantly the communication and language barrier with the health care professionals. Understanding and receiving diabetes education was an issue.

There were issues such as lack of willingness to take part in self-management with physician’s guidance. Other practice issues of misconceptions on the components of the diabetic diet and adopting a diabetic cultural diet tailored to south Asian diet was a barrier.

Diabetic patients raised lack of knowledge and understanding about diabetes medication management, and concerns about the long-term side effect of the medications (Sohal et al., 2017)

The psychological Health Belief Model (HBM) 1950’s attempts to understand and explain a person’s health behaviours. This is done by focusing on the attitudes and beliefs of individuals for example taking on recommendation of implementing a healthy lifestyle and controlled weight can prevent T2D. There are other models such as the self-management theory, self-regulation theory, self-determination theory, social-learning theory (Universiteit Twente, 2017).

4 Methodology

The purpose of this research is to find answer to what the health effects are of T2D. The proposed research was originally conducted by reviewing 18 articles, then narrowing down to the six key secondary literatures. The final six was identified by finding the most related based on the research review, the most respected, academically and credible rated also focusing on the literatures that used mixed methods data collection. Furthermore, papers that only did the primary research only the UK was selected.

Using the search engine of google schooler and the UoB BREO online platform, with the terminology ‘literatures of English language’, ‘elderly south Asian’, and ‘In the UK’. To widen the search use of the Boolean operator with key words like, ‘EFFECTS’, ‘AFFECTS’, ‘WHAT’, ‘OR’ and ‘IS’ has helped to combine the review question and widen the search. Resulting with finalizing the six key papers listed on the table below.

However, modification of the search was done by using the ‘Critical Appraisal Skills Program’ (CASP). Considering the three broad issues from this tool;

• Are the results of the study valid?
• What are the results?
• Will the results help locally?

Using this tool was very beneficial because it helped to break down the question and make sense of cohort study.

The six final selected papers are as follow:

Paper	Title of the Six key papers	Author	Year
	Type 2 Diabetes and Cardiovascular risk in the UK South Asian community	Barnett et al.	2006
	Risk perception among older South Asian people living in the UK with type 2 diabetes	Macaden and Clarke	2006
	Pharmacological and lifestyle intervention to prevent or delay TD2 in the people with impaired glucose tolerance	Gillies et al	2007
	Prevention of type 2 diabetes in British Bangladesh: qualitative study of community, religious, and professional perspectives	Grace et al.	2008
	Type 2 diabetes and cardiovascular disease in the South Asians	Gholap et al.	2011
	Type 2 diabetes in south Asian people	Holt P	2012

After studying the above six key papers several times I went back and highlighted in seven different colour code to help me identify similarities and differenced between the papers and links to my research question, aim and objectives, this way finding the results and discussion of thematic was fairly clear and straightforward.

While taking the steps to identify the six key pieces of literatures the ethical consideration was at the top of the list. Avoiding being bias or judgemental of the literatures from right or wrong and not limiting in taking some information out. Furthermore, considering the standards of copy right and ant-discrimination. Kept the standards of professionalism and the importance of not to be harmful in any manner that will impact other or an organisation in a negative way (Advancedpractice.scot.nhs.uk, 2017).

5 Results

The key facts of diabetes are that it can cause major health effects, such as lower limb amputation, kidney failure, blindness, heart attacks & stroke. WHO projects that diabetes will be the 7th leading cause of death in the year 2030. Practically half of all deaths is due to high blood glucose occurrence before the age of 70 (World Health Organisation, 2016).

Literature paper (1) ‘Type 2 Diabetes and Cardiovascular risk in the UK South Asian community’ in 2006, was done by authors Anthony H Barnett, Srikanth Bellary, Sudhesh Kumar, Neil Raymond, Hanif M and O’Hare J. They mentioned of a popular supposition for the prevalence of cardiovascular and T2D disease in the UK is in the south Asian population. Authors of this cohort study compared and described the risk factors associated in the UK amongst the south Asian community (Barnett et al., 2006).

One results showed south Asian living in the city subcontinent presented higher of T2D associated with rural population. The bar graph bellow is of data collected from different ethnic groups of having prevalence of diabetes. It is showing men data in the blue bars and women data in orange. The bar graph shows clearly the south Asian men have greater prevalence then south Asian women and other ethnic groups (Barnett et al., 2006).

The commentary and quality about the relevance of this paper to the research question is a strength as it focuses on the south Asian community living in the UK with the risk of T2D.

Figure1

(Barnett et al., 2006).

Paper (2) ‘Risk perception among older South Asian people living in the UK with type 2 diabetes’ authors Leah Macaden and Charlotte L. Clark did the research on this literature in the year 2006.

The methods they used was by interviewing 20 older men and women with T2D and focus group with ethnic health development worker also seven health care professionals were interviewed individually. All interviews were transcribed and digitally recorded for future evidence.

Findings of this research showed results of the interviewed attributed a range of issues. Both older genders expressed that the control and management of diabetes is the responsibility of the health care providers.

Furthermore, issues like the environment and the cold weather influences T2D, and the family as well as the food influenced the dietary practices in the south Asian community. The interviews reviled religion and belief being one of the factors of T2D. The authors developed understanding of how the south Asian people experience T2D risk in relation to ageing, religion, dietary practice (Macaden and Clarke, 2006)

This journal was another strength for the research question, it is the highlighted one out of the 6 as the title had exact connections to the research project question which helped to find answers to the question of the health effects of T2D in the older south Asian population of England.

The journal article (3) ‘Pharmacological & lifestyle intervention to prevent or delay type 2 diabetes in people with impaired glucose tolerance’ 2007, is by the authors Clare L Gillies, Keith R Abrams, Paul C Lambert, Nicola J Cooper and Alex J Sutton, who did the primary research in the UK, mentioned prevalence & incidence of T2D is increasing rapidly. T2D is a continuous health problem, reducing life expectancy up to 15 years, up to 75% dying of macrovascular complications. 5% of NHS resources accounts for T2D. Lifestyle & pharmacological of individual interventions may be effective at delaying type 2 diabetes. In England, around 1.3 million people was diagnosed with diabetes, showing increasing numbers in all age group.

The methods of study in this literature included DPP and 22 trials of meta-analysis in three different reviews, first the labelling of the characteristics on lifestyles interventions, secondly the pharmacological/herbal intervention and finally the merging of the pharmacological and lifestyle interventions

Findings was that most results defined similarities to achieve clinical effectiveness for T2D, both lifestyle and pharmacological intervention has a high significant benefit to T2D. Furthermore, the DPP research trials proved positive result of the outcome of having early intervention to delay or prevent T2D (Gillies et al., 2007).

This literature review had some positive links to part of the question and the aim and some of the objectives of the research project. The weakness of the study was that it was not related to south Asian community rather it was of the people with impaired glucose tolerance. However, it was helpful for the fact that it gave numbers and figures of the sufferers of T2D in England.

Paper (4) ‘Prevention of type 2 diabetes in British Bangladesh: qualitative study of community, religious, and professional perspectives’ was done in the year 2008 by authors Clare Grace, Reha Begum, Syed Subhani, Peter Kopelman and Trisha Greenhalgh. They purposed the primary research method with 17 focus groups, run by sampling three sequential phase. Phase 1-Bangladesh people without diabetes, phase 2-Islamic scholars and phase 3-health care professionals working with managing lifestyle, weight and diabetes. This study took place in the heart of south Asian are ‘London Borough of Tower Hamlets’

Findings of healthy lifestyle were commonly reported from all three groups of participants. Furthermore, a strong sense to comply with cultural norms related to modesty was presented by the first two groups of lay participants.

Lay British Bangladeshi without diabetes expressed the risk of developing T2D disease and the opportunities for prevention and control was a strong theme. Health care professionals expressed they had lack of knowledge and confidence within themselves to provide cultural relevant advice on lifestyle changes (Grace et al., 2008).

This quality of this journal data was narrowed to only British Bangladeshi people, therefore, the outcome numbers are low, which was a weakness. However, the outcome showed the importance of the effects of having a healthy lifestyle in all 3 different groups of participants that was the strength.

Journal (5) ‘Type 2 diabetes and cardiovascular disease in the South Asians’ is by authors Nitin Gholap, Melanie Davies, Kiran Patel, Naveed Sattar and Kamlesh Khunti (2011), mentioned south Asian people have the prevalence of T2D in around 20% which means it is 5 times higher than the white population in the UK. T2D is rising at a pandemic level and it is due to the factors of the rapid increase CVD.

Methods of comparison studies between south Asian of 4.7% to 2.8% of white Europeans of having screen detected T2D has shown diabetes in that region occurs 5-10 years sooner with complication at the time of presentation.

Results reviewed the characteristic pathophysiology and knowledge on epidemiology of CVD and T2D, the health effects of heart failure, vascular disease, stroke and coronary heart disease, in south Asian community (Gholap et al., 2011)

This journals opinion about the relevance to the research question had some positive impact as it mentioned about the health effects of T2D which was relevant, however, it wasn’t in too much depth.

Paper (6) ‘Type 2 diabetes in south Asian people’ was accepted in February 2012. Author Paula Holt mentioned the reason to why south Asian population have higher risk of developing T2D is not yet fully understood.

Authors methodology of this study was the reviewing of other rated research and then combined the findings in numerous different cultural attitudes, such as the cultural beliefs and diabetes, fatalism, Ramadan and fat storage capability also the monitoring, educate and support.

Findings from the review is that the continuous consumption of traditional food has an impact on the appropriate dietary control. Trigger point south Asian BMI of 22.9 for men and 22 for women is different to the BMI of 30 to the white population, which indicates obesity triggering action to be taken by health care providers (Holt P, 2012).

The quality and expression of the relevance of this study in accordance to the research question is not as effective. However, the journal had a lot of links to the aim and objectives of the research. It mentioned of strategies to prevent, reduce and control T2D via getting advice from the health care professionals on diet, exercise and healthy lifestyle which resulted as the strength of the review.

The object to validate the needs for effective training & support on how to maintain a healthy diet and lifestyle after being diagnosed with T2D, as Dr Simon Atkins mentioned “To give yourself the best chance of keeping your diabetes under control, you need to play a full part in your own treatment by making some changes to you diet and life style” (Atkins, 2016).

As the patients of the south Asian culture usually assume a passive role by answering questions asked rather than actively participate in their healthcare decisions, they expect doctors to know all the answers to their health care and decisions making (Macaden and Clarke, 2010). Therefore, to minimise the risk that causes T2D, educating and give more health awareness to prevent T2D to the younger Asian generation living in the UK is upmost necessary.

Figure 2:

Statistic data from the WHO’s shows a dramatic increase in the number of people being diagnosed with diabetes in UK from the year 1980’s to 2014 on the above bar graph, it validates the lack of health awareness of T2D in the nation and the call for immediate action (World Health Organisation, 2016).

6 Thematic Discussion and Recommendation

Diabetes is a condition that is growing pandemically around the world. It is a grave life-long health disease that occurs when the pancreas doesn’t produce the right amount of insulin. leaving it untreated could cause high blood glucose levels which then can cause serious health issues (Souter, 2015). Regular physical activity, healthy diet & maintaining a normal body weight also avoiding tobacco are ways to reduce the onset of type 2 diabetes (World Health Organisation, 2016).

Asians are the 2nd major ethnic group of people after the white population, therefore this group of population are at the uppermost risk of developing type-2 diabetes. Asian population should be the key target for diagnosing in the early stage and prevention program. Therefore, it is essential Asian people received individual & optimized health care (Bellary, 2008).

According to the Health Survey for England annual survey for diabetes is the prime health treatment in England. The elderly Asian community have high chances of suffering from diabetes as people from Asian countries like Bangladesh, India and Pakistan are stated to have the poorest health conditions due to lack of health awareness and medical funds (Nation statistics NHS, 2017).

Identification of the common theme between the key papers in generalization is that TD2 is caused by unhealth lifestyle, being overweight, having lack of physical exercise and a poor diet (Barnett et al., 2006; Macaden and Clarke, 2006; Gillies et al., 2007; Grace et al., 2008; Gholap et al., 2011; Holt, 2012).

Authors of paper 3 and paper 4’s group 3 the health care professionals have shown evidence and approval of the clinical effectiveness of lifestyle changes and pharmacological intervention can have in T2D (Gillies et., 2007; Grace et al., 2008).

Out of the 6 literature papers, paper 2 and 4 had the key theme that raised from these literatures are the religion, religious beliefs and social culture have impact on the changes to lifestyle (Macaden and Clarke, 2006; Grace et al., 2008).

The overall implication of the findings for any future development in practice is to bring more awareness to the Asian community via educating the younger generation of implementing healthy life style and by making them aware of the complication of how unhealthy life style can bring many health complication like T2D. Other finding of research is that more is required by the researchers to why there is a high rise in type 2 diabetes in general in England.

Evidence to conduct a more conclusive assessment, need for individual data is required, for the fact as mentioned in the BMJ research journal of the clinical effectiveness of both lifestyle and pharmacological intervention is important to control and reduce the risk of TD2, need to be researched on to understand the outcome of the long-term effects of medications and lifestyle changes on the individuals (Gillies et al., 2007).

The above BMJ articles data is of 10 years ago, and as there has been clear indication from other journals and books of the increasing numbers of people being diagnosed with diabetes is of prevalence. Early interventions and education is upmost necessary to reduce the numbers. The article mentioned how 75% of people were dying of macrovascular complications, this is a serious matter. However, the article didn’t have any data of what age group people were dying nor did it mention of any ethnicity groups, it is a wide and broad piece of data collection, it’s giving a general overview of people living with diabetes in England in the year 2007 (Gillies et al., 2007)

Relevance of the journal ‘Risk perception among older South Asian people living in the UK with type 2 diabetes’ findings had a limited number of insufficient representative from each South Asian community, especially from the British Bangladeshi men due to difficulties with recruitment. Therefore, it would not be possible to regard the findings as relevant to all individual minority ethnic groups. Data were collected from only a single interview with each participant rather than a series of interviews with the same participant, which was primarily due to issues with participants consenting to be interviewed more than once. With an upsurge in interest in research among Minority Ethnic Groups, participants expressed not wanting to be interviewed repeatedly (Macaden and Clarke, 2010).

After reviewing the 6 main journals the implication of the reason why south Asian people are at higher risks of developing diabetes are still not understood fully as mentioned previously (Holt, 2012). However, the answer to the research project question of the health effects of TD2 in the elderly Asian people living in the England has been found from the key papers. The implication of the findings for future development in practice, research, policy and theory would be of the recommendation for the urgent need for further focused research on how to tackle the serious health challenges the elderly south Asian people face in the UK due to T2D.

7 Conclusion

After reviewing and revising the 6 key papers, I can conclude that T2D is growing at a pandemic scale, which is especially worse amongst the south Asian community living in the England.

Wider efforts need to be taken at a national scale by the health care professionals. Although, the answer to my question ‘What are the health effects of type 2 diabetes for the elderly Asian people living in England?’ have been found after reviewing the 6 literatures and doing a wider search there is still uncertainty to why Asian people have a higher risk of getting T2D. Therefore, the British Asian community need to be educated and made aware of this rising disease. Furthermore, the healthcare providers and professionals need to do more research only focusing on the south Asian population.

As mentioned in the journal “Type 2 diabetes and cardiovascular disease in South Asian” further adverse impact of effectively managing T2D in the Asian community is required as the evidence from the research has shown lack of knowledge, education and inequalities in access health care services, this is mainly due to the fact there are still the language barriers between professionals and service users.

After identifying and gathering key information’s from the 6 literature, there are noticeable gaps between literature in raising awareness of the health effects in particularly the Asian community caused by T2D. However, literatures have mentioned the health effects and complications T2D brings to the individual suffer of the disease.

The urgent need to bring to attention that Asian community should be the key target to have awareness of prevention and control of the health effects caused by T2D from an early stage.

Recommendation for future researchers to focus more in depth on the research question and aim of the project because the previous authors have done primary research but the fact is there is still a rise in T2D in the south Asian community living in the UK, which means more needs to be done.

Suggested having knowledge and understanding to study the development and onset of T2D is essential to prevent complications and delay the progress.

Recommendation of before going over and implementing or making any changes in the policies, legislations and practices more research is required on the aim of the research of the strategies used to prevent and reduce also control T2D, as the strategies available now are not as effective due to the fact T2D amongst the south Asian community is still on the rise as show on the evidence in the findings of the literatures.

Completing this research project is a strength for myself at a personal level because I can know understand T2D more. I can support and give advice to my mum and my senior relatives who are diabetic, on how they could manage their health better by making important changes in their daily life and diet.

8 Appendices

Abbreviations:

CVD – cardiovascular disease

DPP – Diabetes Prevention Program

HBM – The Health Belief Model

HbA1c Test –  Measures part of the red blood cell to keep check on blood glucose level.

HSE – Health Survey for England

IDDP – Indian Diabetes Prevention Program

T2D – Type 2 Diabetes

WHO – World Health Organisation.

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World Health Organisation, (2016). Diabetes fact sheet. [Online] Available at: http://www.who.int/mediacentre/factsheets/fs312/en/ [Accessed 22 04 2017].

10 Feedback of progress review

How well did your work meet the stated assessment criteria?

Overall, this was a reasonable attempt to address the requirements of the task. The student does attempt to justify the need for the research and the research question is clear. However, I feel, the objectives are overly ambitious and not realistic for a 6000 word Project carried out over a 5 month period. It is also not clear from the methodology how the many objectives would actually be achieved. For example, it is unclear how the student will achieve the following:

• “raise more awareness to reduce the health effects of type 2 diabetes in the Asian community.
• give health awareness to prevent type 2 diabetes for the younger Asian generation living in the UK (educate).
• control the health effects of type 2 diabetes in the Asian community.
• validate the needs for effective training & support on how to maintain a healthy, well-balanced diet and lifestyle after being diagnosed with type 2 diabetes.”

I would also suggest the student does some wider reading around methodology as arguing secondary research ‘provides more accurate information’ is not necessary accurate. Nor is the reasoning provided under the exclusion criteria section accurate (or clear) e.g. where the student says the reason for excluding primary research is because primary research “is done by the first person’s perspective, which is not necessary for the literature review. Primary research is designed to collect the information from using a wider range of media and materials, plus different audience, need to be targeted, for example, different age group, race and background people need to be approached to collect the data. Whereas here researcher is only focusing on the elderly Asian population.”

The student does correctly state that ‘academically credible’ sources will be used and it is fine to use those the student lists for the Project as a whole but the student needs to be clear that for the systematic literature review findings section, they must be focusing on critically reviewing primary research papers.

The student does mention ethics once – where they say: “Secondary data in itself is a highly ethical form of data collection method” but doesn’t mention all the ethical issues that can arise in secondary/library-based research. Secondary/library based research can be done in an unethical way i.e. it is not necessarily and automatically ethical.

With regard to the completion plan, it is a little unclear how the student aimed to ‘Create the title page, table of contents & summary of findings’ before actually carrying out the research i.e. summarising findings could be done before gathering data.

The student does attempt to reference according to the Harvard rules in the reference list but both this and in text referencing needs more work. The student also draws on some (three) peer-reviewed sources (Gillies et al., 2007, Kumar et al., 2006, and Wright, 2014)

Written expression is understandable but it does contain many inaccuracies such as errors in grammar.

How could you improve your future performance in this type of task?

As mentioned above, the student needs to do further reading around methodology, primary and secondary research and how to carry out and write up the methodology of a systematic literature review.  The student also needs to do some wider reading around the ethical consideration in carrying out secondary research.

I would suggest the student rethinks the objectives so they are achievable/realistic.

The student needs to work on referencing more systematically and using the correct Harvard format e.g. in the reference list, never list sources by the first author’s name and then a long list of initials of all the other authors, never include first names and journal follows article title and always reference only by author’s last name and year in the text. The student must also ensure that references provided are accurate e.g. there is no source:

Clare L Gillies, K. R. A. P. C. L., (2007). BMJ. Diabetic Type 2, 26(2), pp. 2-3.

The only BMJ article related to diabetes by Gilles in 2007 is Gilles, C.L., Abrams, K.R., Lambert, P.C., Cooper, N.J., Sutton, A.J., Hsu, R.T. and Khuti, K. (2007) ‘Pharmacological and Lifestyle Interventions to Prevent or Delay Type 2 Diabetes in People with Impaired Glucose Tolerance: Systematic Review and Meta-Analysis’, BMJ, 334(7588), pp.299-302

The web address given for the source “The Open University Press, (2010). The Good Reseach [sic] Guide. [Online]” i.e. the address https://xaperezsindin.com/2013/12/11/advantages-and-disadvantages-of-secondary-data-collection/ is to a blog by Xaquin S. Pérez-Sindin López who does cite as a secondary source: ‘Denscombe, M. (2010). The good research guide: for small-scale social research projects. Open University Press’

To get into higher grade bands the student needs to be encouraged to carry out wider reading of peer-reviewed academic journal articles and academic books. At Level 6 we would be expecting more than three.

The student must work on grammar and eliminating as many inaccuracies in expression as possible before submission. The student should also be told it is not good academic practice to use the & in place of the word ‘and’ in academic writing.

Unfortunately, I do not see this as a straight A (78%) piece of work; I would put it in the C+/B- borderline range for the reasons outlined above. In addition to the above, to be a straight A at final year undergraduate level, I would also expect very few errors in expression and no errors in referencing with all claims well supported by appropriate academic evidence. I will agree to a B-60%.