Young T2D subjects possess risk factors that confer high lifetime risk for macrovascular complications, and therefore merits aggressive cardioprotective treatment.

Diabetes self-management is a complex phenomenon which refers to patients' attending checkups regularly and adhering to a physician-prescribed regimen including following a strict diet, exercise, self-monitoring of blood glucose (SMBG), and medication. This review will unpack the facilitators and barriers for each of the recommended lifestyle change for improving diabetes management (i.e. the behaviors of diet, exercise, SMBG, and medication). Referred to as the “diabetes capital” of the world, the review will focus on diabetes self-management research and interventions in India, highlighting the dearth for appropriate evidence-based programs in the country. Finally, the review will discuss the scope for future research and practice within this field in the Indian context.

Objectives This study explored the subjective accounts of the main barriers to self-monitoring of blood-glucose (SMBG) and medication-management among Indian patients with type 2 diabetes (T2DM), their primary family-members (PFMs) and physicians. Methods Using convenience sampling, patients with T2DM, their PFMs, and physicians, residing in a South Indian capital city, were recruited for semi-structured, audio-recorded interviews. Thematic analysis was used to analyze the data. Results Fifty patients (female = 14; mean age = 42.5 years) and their PFMs (female = 38; mean age = 39 years), and 25 physicians (female = 4; mean age = 49.8 years) were recruited. Three superordinate themes were identified: (i) complex medication-regimen: confusion, forgetting and reduced motivation, (ii) family recommendations of alternative therapies due to the social pressures of avoiding stigma, intrusiveness and being misrepresented for injecting insulin, and (iii) an expensive illness: choosing to spend money on only medication. Discussion Implications of the findings highlight the need to (i) train physicians in communication and empathy skills, (ii) empower patients to communicate their barriers to physicians through triadic communication models and question-prompt lists, (iii) educate communities on the benefits of insulin for managing T2DM to reduce stigma, and (iv) equip communities with information about health insurance to address the financial toll of T2DM management.