Diabetes self-care in primary health facilities in India - challenges and the way forward

Abstract

India has approximately 73 million people living with diabetes and another 37 million with prediabetes while nearly 47% of the diabetes cases are undiagnosed. The high burden of poor glycemic control and early onset of complications with associated economic costs indicates a high prevalence of poor self-management practices. It is well-established that achieving patient-centered primary care consistent with a chronic care model ensures optimum diabetes self-management support and improves long-term clinical and health outcomes in diabetes patients. The public sector primary care system in India provides services free of cost to beneficiaries but lacks patient-centered care that undermines diabetes self-management education and support. Furthermore, factors like poor patient knowledge of diabetes, suboptimal medication adherence, persistent clinical inertia, lack of data for monitoring and evaluation through clinical audit worsens the standards of diabetes care in primary care settings of India. There is a need for government initiatives to be directed towards the provision of comprehensive outpatient care that is inclusive of uninterrupted supply of drugs, provision of essential laboratory investigators, training and availability of qualified diabetes educators and availability of specialist support when required. Furthermore, the integration of depression screening and smoking cessation services at the primary care level is warranted.

RSSDI-ESI clinical practice recommendations for the management of type 2 diabetes mellitus 2020

“…Specialist referral for diabetes management is a major challenge in remote and rural primary care facilities, often lacking trained diabetes specialists. [ 932 ] Indian studies have also shown that barriers to insulin therapy are due to lack of awareness, causing wrong perception, and false beliefs. People with ongoing insulin therapy had better understanding and acceptability towards insulin therapy than those not on insulin; besides intensification remains a challenge in these patients.…”

“…Specialist referral for diabetes management is a major challenge in remote and rural primary care facilities, often lacking trained diabetes specialists. [ 932 ]…”

Cardiovascular disease risk assessment and treatment among person with type 2 diabetes mellitus at the primary care level in rural central India

“…Primary care practise in rural India faces multiple challenges to deliver diabetes diagnosis and care services due to the lack of trained diabetes care providers. [ 29 30 ] Despite the increased risk of CVD in persons of T2DM and benefits of management of this risk factor, our study revealed only a few received comprehensive risk assessment and treatment for these risk factors. People with T2DM from the rural area were having one or more risk factors for CVD, yet awareness regarding CVD risk factors in these populations was unsatisfactory.…”

Audit of diabetic care in family practice center in Abha City, Aseer region: CBAHI standards application

“…[ 18 ] The variations in the rates of complications in these studies have many explanations including duration of DM, metabolic control, associated other risk factors, incomplete documentation of such complications in patients file in addition to different health care settings as reported from South Africa and India. [ 19 20 ]…”