Understanding goals and challenges in type 2 diabetes mellitus management in India: Time to do more in diabetes
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LETTER TO THE EDITOR
Understanding goals and challenges in type 2 diabetes mellitus management in India: Time to do more in diabetes Ambrish Mithal 1 & Abdul Hamid Zargar 2 & Anirban Majumder 3 & Mala Dharmalingam 4 & Ganapathy Bantwal 5 & Parag Rajnikant Shah 6 & Sanjay Kantilal Shah 7 & Subramanyam Venkataraman 8 & Uday Keshav Phadke 9 & Shankar Kumar 10 & Nishan Mathias 10 Received: 12 February 2020 / Accepted: 21 April 2020 # Research Society for Study of Diabetes in India 2020
Despite the availability of a plethora of well-tolerated treatment options, optimal therapeutic glycemic targets are not met in almost half of the people with diabetes [1–3]. A nationwide, cross-sectional survey in India was conducted in lines with a global survey by market research company, Kantar Health across 6 countries [4]. The objective was to gain clarity in the attitudes, behaviors of physicians, and patients towards diabetes management, identify underlying factors for clinical inertia, and seek solutions to improve management. For a period of 2 months, the respondents (diabetes patients aged 40–69 years and physicians) were interviewed face-toface across twenty-five tier I and tier II cities divided into five geographic zones. The healthcare professionals were selected through random sampling. Participant’s consent regarding confidentiality, adverse event reporting, non-promotional
* Shankar Kumar [email protected]; [email protected] 1
Division of Endocrinology and Diabetes, Medanta The Medicity, Gurgaon, India
2
Centre for Diabetes and Endocrine Care, Srinagar, India
3
KPC Medical College and Hospital, Kolkata, India
4
M S Ramaiah Memorial Hospital, Bangalore, India
5
St.John Medical College Hospital, Bangalore, India
6
Gujarat Endocrine Centre, Ahmedabad, India
7
NH Multispeciality Hospital, Howrah, Kolkata, India
8
Apollo Hospital, Chennai, India
9
Hormone and Diabetes Care, Galaxy Hospital, Pune, India
10
Medical Affairs, Sandoz UK Limited, Surrey 400051, UK
exercise, was obtained prior to the survey. The questionnaire covered 3 main aspects—diagnosis consultation, hypoglycemia awareness and reporting, and getting to glycemic goals. The final sample achieved post corroboration to the screening criteria was 638 for physicians and 641 for type 2 diabetes patients. There is an evident gap in communication between physicians and patients. Key topics on drug treatment, lifestyle changes, blood sugar control, and monitoring were discussed extensively in consultation by physicians. However, patients’ understanding remained modest (51%) (Fig. 1). Patient recollection of topics discussed was poor, which suggests communication gaps. Approximately, one (22%) in five patients reported hypoglycemia. Only 40% physicians felt that hypoglycemia is under-reported. Eighty-four percent patients who reported hypoglycemia were briefed during consultation. Thus, if patients are sensitized to hypoglycemia, they are more likely to report it. There is strong need to facilitate commitment to lifestyle and dietary
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