National recommendations: Psychosocial management of diabetes in India

Abstract

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.

Quaternary prevention and gestational diabetes mellitus

“…[4] Anxiety, diabetes distress, social stigma, and financial ill-health are psychosocial adverse effects which may occur unnecessarily. [5]…”

Input of stakeholders on reducing depressive symptoms and improving diabetes outcomes in India: Formative work for the INtegrated DEPrEssioN and Diabetes TreatmENT study

“…Furthermore, prior to implementing this culturally-appropriate care model (named IN tegrated DEP r E ssio N and D iabetes Treatm ENT [INDEPENDENT]), we sought to gather information and perspectives from individuals involved in diabetes care in India to ensure the intervention aligns with the cultural and economic context in which it is situated. (Kalra, Balhara, & Mithal, 2013; Kalra, Sridhar, et al, 2013; Sridhar & Madhu, 2002) As its foundation, INDEPENDENT will include, 1) non-physician care coordinators that are trained in basic psychotherapeutic techniques (motivational interviewing, behavioral activation, problem solving techniques), 2) an electronic health record enhanced with guideline-based prompts for physicians, and 3) oversight by specialists to regularly audit and improve clinical decision-making. The goal of this qualitative study was to inform the culturally sensitive intervention modifications necessary for the INDEPENDENT model of diabetes and depression care to be effective in India.…”

“Eulexithymia” and Diabetes Care Professionals

“…The publication of comprehensive guidelines on this topic has improved awareness of the importance of psychosocial care as a part of diabetology praxis. 3,4 Simultaneously, enhanced appreciation of the patient-centered model of care has created an environment where psychosocial aspects are given due consideration.…”