Diabetologist's perspective on practice of evidence based diabetes management in India

Hasan, Habib; Zodpey, Sanjay; Saraf, Abhay

doi:10.1016/j.diabres.2011.09.021

Cited by 10 publications

(8 citation statements)

References 15 publications

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“…In a large survey performed in Chennai, only 40% of patients with diabetes knew that their disease could lead to any organ complications[30]. Many experts also point to ‘clinical inertia’ in initiating and titrating medications[31, 32]. In an international comparison of physicians practices in managing diabetes, Indian physicians were among the most likely to delay insulin therapy[33].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of chronic kidney disease and risk factors for its progression: A cross-sectional comparison of Indians living in Indian versus U.S. cities

et al. 2017

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BackgroundWhile data from the latter part of the twentieth century consistently showed that immigrants to high-income countries faced higher cardio-metabolic risk than their counterparts in low- and middle-income countries, urbanization and associated lifestyle changes may be changing these patterns, even for conditions considered to be advanced manifestations of cardio-metabolic disease (e.g., chronic kidney disease [CKD]).Methods and findingsUsing cross-sectional data from the Center for cArdiometabolic Risk Reduction in South Asia (CARRS, n = 5294) and Mediators of Atherosclerosis in South Asians Living in America (MASALA, n = 748) studies, we investigated whether prevalence of CKD is similar among Indians living in Indian and U.S. cities. We compared crude, age-, waist-to-height ratio-, and diabetes- adjusted CKD prevalence difference. Among participants identified to have CKD, we compared management of risk factors for its progression. Overall age-adjusted prevalence of CKD was similar in MASALA (14.0% [95% CI 11.8–16.3]) compared with CARRS (10.8% [95% CI 10.0–11.6]). Among men the prevalence difference was low (prevalence difference 1.8 [95% CI -1.6,5.3]) and remained low after adjustment for age, waist-to-height ratio, and diabetes status (-0.4 [-3.2,2.5]). Adjusted prevalence difference was higher among women (prevalence difference 8.9 [4.8,12.9]), but driven entirely by a higher prevalence of albuminuria among women in MASALA. Severity of CKD—-i.e., degree of albuminuria and proportion of participants with reduced glomerular filtration fraction-—was higher in CARRS for both men and women. Fewer participants with CKD in CARRS were effectively treated. 4% of CARRS versus 51% of MASALA participants with CKD had A1c < 7%; and 7% of CARRS versus 59% of MASALA participants blood pressure < 140/90 mmHg. Our analysis applies only to urban populations. Demographic—-particularly educational attainment—-differences among participants in the two studies are a potential source of bias.ConclusionsPrevalence of CKD among Indians living in Indian and U.S. cities is similar. Persons with CKD living in Indian cities face higher likelihood of experiencing end-stage renal disease since they have more severe kidney disease and little evidence of risk factor management.

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Section: Discussionmentioning

confidence: 99%

Prevalence of chronic kidney disease and risk factors for its progression: A cross-sectional comparison of Indians living in Indian versus U.S. cities

et al. 2017

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“…[59] A large number of physicians find themselves unable to base their treatment decisions on culturally-dissonant western guidelines which do not accommodate uniquely Indian concerns (social and cultural). [21] Socio-culturally responsive Indian national guidelines must be evolved to address this need.…”

Section: Addressing Barriers In Diabetes Managementmentioning

confidence: 99%

“…In a survey of clinical diabetologists conducted through a semi-structured questionnaire in India, poor awareness among physicians (22.7%), western guidelines being not applicable to Indian patients (22.7%) and cost to patients (18.2%) were some of the barriers identified. [21]…”

Section: Introductionmentioning

confidence: 99%

Barriers and solutions to diabetes management: An Indian perspective

Wangnoo

Maji

Das

et al. 2013

Indian J Endocr Metab

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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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“…The biggest hindrances to the use of these guidelines locally are poor knowledge and the non-applicability of western guidelines in the Indian context. [12] The linguistic, social, cultural, economic, and ethnic heterogeneity of the Indian population and the enormous scale of the diabetes epidemic in India suggest the development of India-specific guidelines for psychosocial management, forged specifically for our sociocultural context. Both in terms of variety and in terms of the scale of challenges, the Indian diabetes landscape is unique and warrants the creation of country-specific guidelines, sensitive to our needs and limitations and based on our sociocultural strengths and resources.…”

Section: Introductionmentioning

confidence: 99%

National recommendations: Psychosocial management of diabetes in India

Kalra

Sridhar

Balhara

et al. 2013

Indian J Endocr Metab

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Although several evidence-based guidelines for managing diabetes are available, few, if any, focus on the psychosocial aspects of this challenging condition. It is increasingly evident that psychosocial treatment is integral to a holistic approach of managing diabetes; it forms the key to realizing appropriate biomedical outcomes. Dearth of attention is as much due to lack of awareness as due to lack of guidelines. This lacuna results in diversity among the standards of clinical practice, which, in India, is also due to the size and complexity of psychosocial care itself. This article aims to highlight evidence- and experience-based Indian guidelines for the psychosocial management of diabetes. A systemic literature was conducted for peer-reviewed studies and publications covering psychosocial aspects in diabetes. Recommendations are classified into three domains: General, psychological and social, and graded by the weight they should have in clinical practice and by the degree of support from the literature. Ninety-four recommendations of varying strength are made to help professionals identify the psychosocial interventions needed to support patients and their families and explore their role in devising support strategies. They also aid in developing core skills needed for effective diabetes management. These recommendations provide practical guidelines to fulfill unmet needs in diabetes management, and help achieve a qualitative improvement in the way physicians manage patients. The guidelines, while maintaining an India-specific character, have global relevance, which is bound to grow as the diabetes pandemic throws up new challenges.

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Diabetologist's perspective on practice of evidence based diabetes management in India

Cited by 10 publications

References 15 publications

Prevalence of chronic kidney disease and risk factors for its progression: A cross-sectional comparison of Indians living in Indian versus U.S. cities

Prevalence of chronic kidney disease and risk factors for its progression: A cross-sectional comparison of Indians living in Indian versus U.S. cities

Barriers and solutions to diabetes management: An Indian perspective

National recommendations: Psychosocial management of diabetes in India

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