Komal Verma

South Asian women with diabetes: Psychosocial challenges and management: Consensus statement

Diabetes is the ninth leading cause of death in women globally. In South Asians mortality in women with diabetes stands second highest. There is a marked gender discrimination which is faced by women across South Asia esp in access to services and support for diabetes, resulting in high rates of morbidity and mortality in women with diabetes. The most important risk factor identified for the diabetes epidemic is obesity along with genetic susceptibility. Lack of health care, social and cultural disparity, discrimination at work, disparity in marriage, restricted medical facilities are prevalent. Diabetes and depression are common in women. Increasing age, low level of education, low socioeconomic conditions, difficulties posed in finding partners, frequent divorce and family history of psychiatric illness are significant risk factors for diabetes and depression. Such patients usually have poor metabolic control, higher complication rates, increased healthcare costs, lost productivity, lower quality of life as well as increased risk of death. Preconception counseling should be incorporated in the routine diabetes clinic visit for all women of childbearing potential. Women with diabetes should have information and access to contraception. Proper family planning counseling and psychological support can help stop practices such as female foeticide and multiple pregnancies. Psychological support to patients and their families are needed to break the barrier. There is emerging evidence that women with diabetes are more prone to untoward outcomes as compared to men. Central obesity, metabolic syndrome and the polycystic ovary syndrome show ethnic specific differences in South Asian women. Optimal sexuality is an integral part of holistic health. Shortage of trained female health care professionals, lack of privacy in over-crowded health care facilities, a social taboo attached to such matters, and lack of confidence in patients contribute to the neglect of sexual issues in women attending diabetes clinics across South Asia. Guidelines for counselling in female sexual dysfunction, written in culturally appropriate manner for South Asia, are needed. Diabetes affects women more severely because of their unique biological, cultural and socioeconomic circumstances. Women have limited access to health care facilities because of illiteracy, ignorance and negative social customs. Transcending the gender hierarchy and inequality is a formidable challenge. Sensitising men, empowering women on self care and providing peer support maybe the answer to this challenge. It is essential for health care providers to use appropriate coping mechanism such as building psychological contact with the patient, including family and friends as part of social support and empower patient with complete process of managing diabetes. Increasing awareness through the media, seminars, posters, group discussions and education, regular monitoring and consulting the doctor, support group for women and facilities for aerobic exercises are recommended. The health care systems should consider custom-designed prevention and control programs tailored for women based on local and regional attitudes on health care, cultural beliefs, and available social support systems. Policies that empower adolescent girls and young women to take control of their metabolic management must be encouraged. Provision of gender specific diabetes education with a holistic life-cycle approach is recommended.

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.

Diabetes and quality of life: A theoretical perspective

With changing time and lifestyle, general health of population has been drastically affected, and deteriorating quality of life. The transition from a traditional to modern lifestyle and consumption of diets rich in fat and calories combined with a high level of mental stress has compounded the problem further. Diabetes is one of the consequences of such a lifestyle change. Over the past 30 years, the status of diabetes has changed from being considered a mild disorder of the elderly to one of the major causes of morbidity and mortality affecting the youth and middle-aged people. This paper aims to present review of association between diabetes and quality of life as quality of life is considered to be one of the major factors affecting diabetes.

Bhagavad gita for the physician

This communication presents verses from the Bhagavad Gita which help define a good clinicians skills and behavior. Using the teachings of Lord Krishna, these curated verses suggest three essential skills that a physician must possess: Excellent knowledge, equanimity, and emotional attributes. Three good behaviors are listed (Pro-work ethics, Patient-centered care, and Preceptive leadership) and supported by thoughts written in the Gita.

Social media: A well-being mechanism for diabetic patients

Methods: This paper presents the results of a part of an on-going cohort-registry (a single centre prospective observational) study conducted in western Iran. Patients meeting the inclusion criteria; clinical history consistent with myocardial infarction; Electronic Cardiograph (EKG) demonstrating ST-elevation myocardial infarction and >18 years oldhave been registered from 1st July 2016. Those do not will to participate and those who die before data collection have been excluded. The baseline data was collected via patients’ interviewing, medical records and health information system. Using SPSS-applying descriptive statistics, t-test and logistic regression, the frequency, rates and associations between variables were estimated, whenever applied. The regressions and Odds ratios for outcomes variables were obtained adjusting for the likely contributing variables such as age.

Handling Insulin-Related Emotions

This article discusses a simplified, yet comprehensive approach to handle complex varieties of emotions related to insulin injections prescribed to patients with diabetes. Diabetes management requires balancing of biomedical and psychosocial complexities, so that varied emotions faced by individuals with diabetes which lead to undesirable reactions/behavior are understood and managed. This realization has inspired useful mnemonics such as OPEN OUT, SHAKTI, ASHA/HOPE, SHANTI/SHALOM, and LISTEN. These, if used in diabetes care practice, will make insulin acceptable and well tolerated.

Optimizing Geographical Clusters through R for Job Allocation in Make in India

Make in India initiative by the Govt. of India is an endeavor to enable transfer of technology and boost the production across India. It is optimally desired to employ workforce that geographically maps the industry location of a produce. The paper focus es on analyzing make in India Big Data through K-means algorithm using R-studio. Analyzing the said data set shall enable decision makers to identify the workforce and deploy the same to enhance the cost incurred by the setup. The proposed analytics shall capture, store and analyze the dataset to form region wise clusters based on the skill sets that may be possessed. This paper describes data analytics using the R-tool. The tool is used for organizing the data, giving a statistical and tabular description stating how the optimal skillset based allotment can be done. Through R-Tool the entire work force shall be grouped into clusters which are represented region wise and thus it would be financially viable to allocate skillset based job allocation in the prescribed region.

Asian paradox of psychological support: findings from the second Diabetes Attitudes Wishes and Needs study (DAWN-2).

Dear editor, Major differences have been found in manifestations of psychological problems, expressions used to communicate these problems, and help-seeking behaviors of individuals across cultures and societies (Office of the Surgeon General [US] et al., 2001). These cultural variations also shape the perceived importance of psychological health among individuals, service providers, and policy makers across countries. This culture-driven attitude and approach toward psychological issues in patient care can be discerned from the findings of the second Diabetes Attitudes Wishes and Needs Study (DAWN-2 study). DAWN-2 study interviewed, among others, approximately 4,500 health care professionals (HCPs) across 17 countries. These communications make observations on the barriers against and solutions for providing optimal psychological care for people with diabetes mellitus based on findings of this study. The benchmark papers based on the second DAWN-2 study have been published recently. The cross-national comparisons on various indicators have been made (Holt et al., 2013; Kovacs Burns et al., 2013; Nicolucci et al., 2013; Peyrot et al., 2013). However, many important issues related to provision of psychological support by HCPs have got limited attention in these publications. With an aim to highlight these issues, we focus on specific mental variables of DAWN-2 study from two Asian countries (India and Japan) and two Middle Eastern countries (Turkey and Algeria). Only 30.3% (overall mean 52.9% across all 17 countries) of Japanese HCPs reported that they discussed emotional issues with most or all of the patients. Japan ranked last among all the countries on this variable. A similar proportion (30.9%) reported that they had no resource to offer services to patients who are emotionally distressed or at risk of depression. This was highest among all participating countries (overall mean 12.1%). On the other hand, Indian HCPs reported the highest access to such resources, with only 5.5% reported having no resources. Around 51% of HCPs from India mentioned that they discussed emotional issues with patients. Algeria and Turkey, the two Middle Eastern countries included in DAWN-2, reported lower levels of discussion of emotional issues (45.3% and 42.7%, rank 14 and 16), as well as lower availability of resources to address these problems (18.1% and 23.4%, rank 15 and 16). Interestingly, the availability of resources for the provision of psychological support and care does not seem to be the factor guiding the perceived need to offer these services to potential beneficiaries across these countries. Of all the countries, HCPs in Japan perceived the least need for improvement in this sphere (42.0%, rank 1; overall 63.3%). More Indian HCPs expressed the need to build on these services (65.6%). Turkey and Algeria, which reported lack of resources to offer services to patients who are emotionally distressed or at risk of depression, also perceived the need for major improvement in resources for provision of psychological support and care (Algeria: 78.5%, rank 17; Turkey: 75.9%, rank 16). Indian, Turkish, and Algerian HCPs score high on all three parameters of person-centered chronic illness care, with 73.3%, 66.9%, and 63.2% (ranked first, second, and fourth, respectively) of them asking their patients how diabetes affected their life. This contrasts with the relatively lower response rate from Japan (37.3%, rank 15). Only 44.7% (lowest among 17 countries) HCPs from Japan expressed need for training in management of psychological aspects of diabetes. On the other hand, 69.4%, 67.8%, and 63.6% of Turkish, Indian, and Algerian HCPs (ranked third, fourth, and seventh, respectively) expressed such need. It is likely that this observation was a function of training already received as only 14.5% of Japanese HCPs have received postgraduate training in management of bs_bs_banner Offi cial journal of the Pacifi c Rim College of Psychiatrists