Ganapathy Bantwal

National recommendations: Psychosocial management of diabetes in India

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.

Guidelines regarding management of adrenal insufficiency in the Holy month of Ramadan

Adrenal insufficiency is a life-threatening event, so it is recommended for patients with known adrenal insufficiency to be properly educated regarding sick-day management. In the month of Ramadan, people refrain from eating and drinking during daylight hours. It is very important for patients with adrenal insufficiency, who wish to keep a fast, to be well aware of the disease, the suitable drug to be used for that particular period, warning signs, sick-day management, physical activity, and dietary limits. This article describes guidelines for the sick-day management of patients with adrenal insufficiency, in the month of Ramadan.

Children with diabetes friendly services: A blueprint

Children with diabetes, despite their small numbers, form a population with needs different from adult subjects with diabetes. This emphasizes the need to establish child- friendly standards in services rendered to these children. The care providers for children with diabetes are quite heterogeneous and include generalists, paediatric subspecialist and endocrinologists and care is delivered in various circumstances. Various aspects of caring for children need to be taken into account when a system is created for children with diabetes. This includes but is not limited to physical infrastructure of the system, qualified medical personal with experience in handling children and quality systems to maintain cold chains for insulin and laboratory reporting. The system should be able to reach out to other stake holders that include the community and family of children with diabetes. The system should be subjected to self audit, and performance on various key indicators should be assessed.

The ADA-EASD patient-centered guidelines for management of hyperglycemia: Are they patient-centered enough?

Background: The American diabetes association (ADA) and European association for the study of diabetes (EASD) recently issued an updated position statement on the management of hyperglycemia in type 2 diabetes. The choice of nomenclature of these guidelines is refreshing as it highlights a patient-centered approach to managing diabetes. Discussion: This debate looks at these guidelines through the prism of patient-centeredness, it tries to assess if the authors of the ADA-EASD position statement have been able to walk the talk with respect to the patient-centered approach that they advocate. Conclusion: We conclude that the guidelines can be made more patient-centered, by emphasizing psychosocial and psychiatric comorbidity of diabetes, ethno pharmacy, and patient-friendly insulin regimes and oral fixed dose combinations, in a culturally competent, globally acceptable manner.