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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