Barriers and solutions to diabetes management: An Indian perspective

Abstract

India, with one of the largest and most diverse populations of people living with diabetes, experiences significant barriers in successful diabetes care. Limitations in appropriate and timely use of insulin impede the achievement of good glycemic control. The current article aims to identify solutions to barriers in the effective use of insulin therapy viz. its efficacy and safety, impact on convenience and life-style and lack of awareness and education. Therapeutic modalities, which avoid placing an undue burden on patients’ life-style, must be built. These should incorporate patient-centric paradigms of diabetes care, team-based approach for life-style modification and monitoring of patients’ adherence to therapy. To address the issues in efficacy and safety, long-acting, flat profile basal insulin, which mimics physiological insulin and show fewer hypoglycemic events is needed. In addition, therapy must be linked to monitoring of blood glucose to enable effective use of insulin therapy. In conjunction, wide-ranging efforts must be made to remove negative perception of insulin therapy in the community. Patient- and physician – targeted programs to enhance awareness in various aspects of diabetes care must be initiated across all levels of health-care ensuring uniformity of information. To successfully address the challenges in facing diabetes care, partnerships between various stakeholders in the care process must be explored.

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“…52 In addition, there is lack of awareness and misconceptions about their concepts and attitudes toward diabetes, its complications, diet, exercise, drug therapy, understanding about insulin, and treatment among patients and as well as their family members. 12,[53][54][55][56][57][58][59] There is a need to enhance the availability of cost-effective and nutritious foods, especially when dining out. The importance of meal-dependent insulin dose adjustments should also be reinforced to every patient.…”

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“…Diabetes is a major public health concern worldwide , and a condition which requires regular medical care and patient self‐management education to prevent future complications . Approximately half of people with diabetes, however, do not achieve glycaemic, blood pressure (BP) and lipid level targets .…”

“…Examples of physician barriers include insufficient time, lack of knowledge regarding updated treatment guidelines, and poor record keeping. People with diabetes often lack awareness of risk factors, have difficulties adhering to medications, find treatments expensive, and have inaccurate perceptions of the disease . Health system barriers include fragmented healthcare delivery, lack of follow‐up visit planning, non‐availability of drugs, and limited insurance coverage .…”