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Global Health

Global Health


This essay explores diabetes as a highly prevalent disease among Indian seniors. Diabetes mellitus is usually more common than insipidus and the essay emphasizes on the former. Two subtypes of diabetes mellitus earn most attention in the study. They are diabetes type 1 and diabetes type 2, also referred to as insulin-dependent and insulin-independent respectively (Kumar, Goel, Jain, Khanna, & Chaudhary, 2013, Pg. 524). In Indian population, diabetes type 2 is more common and severer than type 1.With the characteristic change of livelihood in the recent years, the old in India get higher risk to diabetes than in the earlier days. Some primary care measures in the management of the situation are in place, and there is prospective to better the practice.

Epidemiological Background of Diabetes in India

Diabetes has affected a large population in India, and it still remains a major health issue. The disease accounts for a large percentage of deaths in the country especially among the aged. Currently, 62 million Indians have the condition according to research (Kaveeshwar & Cornwall, 2014, Pg. 45). Studies indicate India as among the nations most affected by diabetes. In 2000, investigations indicated the country as the most hit by diabetes. While India had a diabetic population of 31.7 million, America, the second placed had 20.8 million. China was third with 17.7 million people being diabetic (Kaveeshwar & Cornwall, 2014, Pg. 45). There is likelihood that when global diabetic population increases, India will have contributed the largest population. Factors predisposing Indians to diabetes are many and the situation creates uncertainties for the nation regarding the issue. Though some factors are easily identifiable, others are complicated and stakeholders in healthcare face the challenge of understanding them. Issues that hinder researchers from understanding risk factors include the population’s heterogeneity in relation to ethnicity, culture and socioeconomics (Kaveeshwar & Cornwall, 2014, Pg. 46). Factors currently identified include genetics and the Indian environment. As an environmental factor, livelihood in India predisposes people to obesity, which in turn makes them prone to diabetes.Regional variations are also identified as risk determinants, whereby Indians in rural areas are less exposed to diabetes than their counterparts in towns. The Indian Council of Medical Research (ICMR) found that Maharashtra and Tamil regions have higher statistics of affected people than Chandigarh and Jharkhand, which are to the north of the state (Kaveeshwar & Cornwall, 2014, Pg. 46). Such disparities are also common in other countries such as Australia (Sukala, Page, Rowlands, Lys, Krebs, Leikis, & Cheema, 2012, Pg. 432).  Research is yet to prove whether the fact of most people in northern India being migrants while those in south are host could influence the variations. Geographical locations in India also influence diabetes management as access to screening and necessary medication is limited in the rural areas. People who suffer from diabetes in poor regions are more likely to die of the same compared to those in developed regions. In impoverished regions, there is higher likelihood of inadequacy of education offered to people. The aged, for example, may not access education on preventive practices and could face greater risk of diabetes than their educated counterparts (Khalil, Tan, & George, 2012, Pg. 577). The prevalence of diabetes in India is peculiar in that the population is not as much exposed to obesity like in some western countries, yet it records higher cases of diabetes than them. Obesity is not more common in India than these countries, yet it is usually the lead causal factor (Rao, Kamath, Shetty & Kamath, 2011, Pg. 54). In the recent, diabetic complications have increased among the older Indians. A large diabetic population in India expresses inability to control blood sugar level, and ends up developing abnormalities in their vascular structures.

Challenges in the management of diabetes in India include unavailability of HbA1c tests to most Indians (Kumar, 2010, Pg. 128). Insulin therapies are also hard to administer following decreased clinical activeness. Indian guidelines also fail to sufficiently address issues with insulin use therefore making it hard to practice the clinical role (Unnikrishnan, Anjana, & Mohan, 2011, Pg. 10). Managing the current status of diabetes in India requires efforts from the, government as well as other involved parties (Kumar, Goel, Jain, Khanna, & Chaudhary, 2013, Pg. 530). The Indian government has made efforts toward the control the illness. Efforts by the government include the establishment of National Diabetes Control Program (Kumar, Goel, Jain, Khanna, & Chaudhary, 2013, Pg. 524). Healthcare practitioners require helping the population with strategies that address early detection, prevention, and management of diabetes (Kaveeshwar & Cornwall, 2014, Pg. 47).  Generally, issues addressed on management of diabetes in India include increasing access to services, increasing the affordability of medicines, improving service quality as well as conducting more studies to develop helpful initiatives (Kumar, Goel, Jain, Khanna, & Chaudhary, 2013, Pg. 525).

Social Determinants in the Management of Diabetes in India

Management of diabetes is subject to several social factors. Stakeholders need to pay attention to such factors in their strategies to improve outcomes in diabetic patients. There is the necessity of research to test outcomes based on social determinants. To curb the increased prevalence of diabetes in India, such research studies are mandatory. Social factors also entail environmental issues, in addition to cultural ones.  Diabetes is prevalent among the poor, middle-earning as well as rich populations. India is generally a middle-earning country, and diabetes is more prevalent among the poorer people. Environmental influences in diabetes include feeding habits and physical activities. Intake of food that is highly calorific has increased among Indians causing development of obesity and hence diabetes. Measures in diabetes management include monitoring of one’s diet to lower the risk of taking too much fats and sugar. Asif wrote that people aim at maintaining the safest concentration of sugar and lipids in blood (2014). Health professionals advocate for increased uptake of fruits, whole grains, vegetables, low-fat dairy products and food high in unsaturated fats (Asif, 2014). On the other hand, diabetes management requires reduced intake of red meat, legumes, fish and nuts (Asif, 2014).The International Expert Committee provided dietary guidelines for management of diabetes. In the guidelines, experts advise patients to take carbohydrates as starch. While patients should avoid refined sugars, they may take non-nutritive sweeteners. In addition, people should avoid animal fats, salt, and tobacco smoking (2009, Pg. 1328). Again, failure to engage in physical strains as is the common situation with advanced technology, places people at the risk of diabetes. Given that India has realized substantial developments in technology, the aged in the country are unlikely to take manual activities. For instance, the old would prefer driving to walking even when covering short distances. Failure to exercise leads to too much fat deposits in the body and individuals are likely to become obese. Since the old have machines at their disposal, management of diabetes could be difficult as it requires them to forego machines for manual actions. As a measure to manage diabetes, care providers educate patients on matters relating to the disease. As Larranaga, Docet and Garcia-Mayor wrote, teams concerned with the management of diabetes should monitor insulin regimens, while still educating patients (2011, Pg. 190). Psychosocial approaches are also important in the management of diabetes in India. Kalra, Sridhar, Balhara, Sahay, Bantwal, Baruah, and Kumar addressed psychosocial influences in diabetes management. The researchers indicated that optimal outcome in managing the disease entails physical, social as well as psychological fitness (2013, Pg. 380). Psychological status, particularly, affect administration of self-care in diabetic patients. Kalra et al. noted that psychological factors affecting patients in India differ significantly from those associated with patients elsewhere (2013, Pg. 380). Economic factors are also crucial in the management of diabetes. A significant part of the Indian population is poor, and may not meet the financial costs of insulin treatment. In addition, culture and religion as social practices determine the level of diabetes management. Generally, these practices interact with healthcare provision, hence influencing it. Some attitudes developed with culture, combined with illiteracy may hinder care for diabetic patients. Some uneducated people are unlikely to understand the complexity of issues associated with diabetes management. Use of traditional medicine, a relatively common practice in India, also influences diabetes management from a societal perspective. 14% of Indians use herbal medication and some people in the population may not readily accept convectional medicine that most care providers offer (Kalra, et al. 2013, Pg. 379).

Primary Healthcare Delivery in the Management of Diabetes among the Aged in India

Milat, O’hara and Develin explained that primary care usually focuses on disease prevention (2009, Pg. 87). As such, campaigns characterize the type of care. If properly conducted, primary care can reduce the occurrence of diabetes. In people who are already diagnosed with the disease, elderly Indians for this case, primary care aims at attaining a normal concentration of sugar in their blood. (Ramachandran, Das, Joshi, Yajnik, Shah, & Kumar, 2010, Pg. 8). There is need for clinicians to offer quality care to patients as complications of diabetes could result into other life-threatening illnesses. Ramachandran et al. noted hat more than half of diabetic patients in India possess poor ability to control their blood sugar, and their vascular structures have abnormalities (2010, Pg. 8). Clinicians also require awareness on high standards of care especially with newly developed therapeutic agents. United Kingdom Prospective Diabetes Study (UKPDS) offered recommendations that 53% of diabetes patients receive insulin therapy for six years, while 75% should take more than one treatment strategies for approximately nine years. When offering primary care, practitioners should understand that too much insulin could induce obesity, worsening the situations of patients resistant to it (Ramachandran et al., 2010, Pg. 8). In primary care, clinicians can attend large populations of patients and establish follow-ups. When attending aged people with diabetes, practitioners in India should establish links with their patients to facilitate the process of care delivery. Nurses should lead in implementation of strategies that educate patients on diabetes. In addition, primary care providers need to be optimistic, and encourage their patients to increase their chances of recovery. Though diabetes is a chronic disease, patients can still lead an enjoyable lifestyle if they receive high quality primary care. Since nurses have intensive expertise in counseling, they assume the most effective position in primary care for diabetic patients. In addition to offering primary care, nurses should develop strategies to improve their services to patients. Nurses require being creative and initiative as professional virtues. When combined with their caring character, the two traits would enable nurses make essential transformations in diabetes management.It is also advisable that since the occurrence of diabetes varies with genetics, culture, social practices and geographical locations, nurses and other practitioners should be sensitive of the variations. Generally, primary care should see to it that preventive measures are fully exploited just as the ones addressing diabetes treatment. In primary care for instance, clinicians should encourage patients to engage into healthy livelihood. Dietary and exercise intervention are essential at the primary level of care for old people with diabetes. Other parties involved in primary care for diabetic patients include dieticians, pharmacists, physicians and psychologists. Professionals from various fields should cooperate to facilitate primary care. Team work as seen in interdisciplinary teams could offer the best outcomes in diabetes management. Patient care is often complex but can be promoted if stakeholders associate appropriately. Practitioners should ensure that the care they offer is patient-centered, and that it constitutes healthy communications with patients, partnerships and focuses beyond the situation at hand. Practitioners require explaining essential concepts of the disease to patients. In addition, they should be able to assess the feelings, expectations as well as beliefs of their patients. Generally, care providers need developing common grounds with their patients. When primary care is patient centered, there are higher chances that satisfaction will be obtained for both the providers and receivers of services.

Future Healthcare Directions in the Management of Diabetes among the Aged in India

Currently, the occurrence of diabetes among the aged in India is alarming. There should be long-term strategies to help overcome the situation. There are, therefore, rapid changes in the management of diabetes as approaches are unlimited (Universit5y of Melbourne, 2011). Researches are carrying out studies to develop better means of addressing diabetes among all populations. For instance, there are moves to develop new drugs that can be more effective than the current regimens. Ramachandran et al. explored possible drugs that may help fight diabetes in the future. The researchers indicated that analogues of glucagon as well as those of dipeptidyl peptidase-4 could offer better therapeutic agents in the future (2010, Pg. 8). Researchers are carrying out clinical studies on new drugs and in the near future, there could be drugs that would change the common regimens applied for diabetes. Drugs in advanced developmental stages include DPP-4 inhibitors, which include vidagliptin and sitagliptin (Ramachandran et al., 2010, Pg. 8). As Ramachandran et al. expressed, the two drugs improve the sensitivity of beta cells to insulin, and could be useful for diabetes mellitus type 2 (2010, Pg. 8). Measures that address livelihood seem to offer the best approach on management of diabetes. Dietary modifications and engagement in exercise can lead to high performance in minimization of diabetes cases in India, especially among old people. Oral drugs, which currently are the most used in diabetes, may not be the first-line choices as times goes by. Better means of managing diabetes will be developed to ease the burden of having to take medications on daily basis.Drugs that would be more preferred in the future, should not only manage diabetes, but also its comorbidities. Again, their use should guarantee optimal safety while still being effective. Since insulin is the central hormone in diabetes, researchers are likely to develop its receptor agonists as therapeutic agents (Sanofi Diabetes, 2012). There are also moves to develop long-acting drug compounds that would have great effect in management of diabetes.Usually, challenges with the current diabetes therapies necessitate the development of new therapies.


India has the highest cases of diabetes mellitus in the world. Diabetes mellitus is more prevalent among the old than it is with the young. Indian population faces several risk factors that predispose them to the disease. These factors include genetics as well as social and cultural factors. Social practices and cultural beliefs often influence health care provision. In most cases, cultural beliefs work against care provision for the aged diabetic patients in India. To address the high occurrence of diabetes in India, clinicians and the government take a central position. It is upon clinicians to ensure that they offer quality care to diabetic patients in the move to manage the disease.


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