Diabetes self-care in primary health facilities in India - challenges and the way forward

Abstract

India has approximately 73 million people living with diabetes and another 37 million with prediabetes while nearly 47% of the diabetes cases are undiagnosed. The high burden of poor glycemic control and early onset of complications with associated economic costs indicates a high prevalence of poor self-management practices. It is well-established that achieving patient-centered primary care consistent with a chronic care model ensures optimum diabetes self-management support and improves long-term clinical and health outcomes in diabetes patients. The public sector primary care system in India provides services free of cost to beneficiaries but lacks patient-centered care that undermines diabetes self-management education and support. Furthermore, factors like poor patient knowledge of diabetes, suboptimal medication adherence, persistent clinical inertia, lack of data for monitoring and evaluation through clinical audit worsens the standards of diabetes care in primary care settings of India. There is a need for government initiatives to be directed towards the provision of comprehensive outpatient care that is inclusive of uninterrupted supply of drugs, provision of essential laboratory investigators, training and availability of qualified diabetes educators and availability of specialist support when required. Furthermore, the integration of depression screening and smoking cessation services at the primary care level is warranted.

Keywords: Primary care, Diabetes, Self-care, Adherence, India

Core tip: Public primary care facilities in India, especially in rural and suburban areas, are frequently unable to deliver patient-centered care for diabetes self-management through education and support due to the lack of trained diabetes educators and team-based support, and the absence of community linkages. Studies from Indian primary care facilities indicate the high prevalence of suboptimal medication adherence, poor glycemic status, clinical inertia, poor patient knowledge of diabetes, lack of depression screening and inadequate assistance for tobacco cessation. Developing prospective registries with predefined data standards in Indian primary care facilities is essential for enabling clinical audits and monitor the quality of patient care.