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Diabetes Management in Asia

  • Roopa ShivashankarEmail author
  • Kavita Singh
  • L. R. Aravind
  • Nikhil Tandon
Chapter

Abstract

Asia is a diverse continent with the largest number of individuals with diabetes in the world. Most Asian countries belong to the low- and middle-income category and are dealing with double burden of diseases. In these countries either a national framework for diabetes or noncommunicable diseases do not exist or are only partially implemented. While health systems in Asian countries consist of both public and private sector, diabetes is commonly managed in the private health-care setting. Therefore, patients incur huge out-of-pocket expenditure leading to high financial burden and low compliance to medication.

Diabetes occurs at a younger age and lower body mass index in Asians. This, coupled with a low detection rate and inadequate quality of care, contributes to a higher frequency of diabetes complications. Interaction of dynamic factors at both physician (lack of local guidelines, overburdened clinics, and inadequate training in diabetes management) and patient (low levels of education, use of alternative treatment, cultural issues related to diet and physical activity) levels has led to sub-optimal diabetes control.

However, there have been many examples of successful small-scale diabetes care models including physician training, use of patient information system, and task shifting in many Asian countries. Countries such as Bangladesh, India, Malaysia, and Thailand have developed or are in the process of developing or scaling up a national program for diabetes management. Incorporation of successful care models in the national programs may improve diabetes outcomes and reduce complications in Asia.

Keywords

Asia; Diabetes mellitus; Quality of care; Health systems; Culture; Alternative medicines 

Notes

Glossary

BMI

Body mass index

CAM

Complementary and alternate medicines

CARRS

Centre for Cardiometabolic Risk Reduction in South Asia Translation Trial

D-CLIP

Diabetes Community Lifestyle Improvement Program

DM

Diabetes mellitus

DPP

Diabetes Prevention Program

DPP-4

Dipeptidyl peptidase-4

ECG

Electrocardiography

FVP

Foot vibration perception by tuning fork

FVS

Foot vascular status by Doppler

HbA1c

Glycated hemoglobin

IDF

International Diabetes Federation

IDMPS

International Diabetes Management Practice Study

IDPP

Indian Diabetes Prevention Program

IGT

Impaired glucose tolerance

INR

Indian rupee

INY

Integrated naturopathy and yoga

JADE

Joint Asia Diabetes Evaluation Program

LADA

Latent autoimmune diabetes in adults

LDLc

Low-density lipoprotein cholesterol

LMIC

Low- and middle-income countries

MAPS

Microalbuminuria Prevalence survey

NA

No information available

NCD

Noncommunicable disease

NPCDCS

National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease and Stroke

NSPNCD

National Strategic Plan for NCDS

OGTT

Oral glucose tolerance test

PPDM

Primary prevention of diabetes mellitus

QI

Quality improvement

RCT

Randomized controlled trials

SEA

Southeast Asia

T1DM

Type 1 diabetes mellitus

T2DM

Type 2 diabetes mellitus

USD

US dollars

WHO

World Health Organization

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Suggested/Further Reading

  1. Chan JC, Malik V, Jia W, Kadowaki T, Yajnik CS, Yoon KH, Hu FB. Diabetes in Asia: epidemiology, risk factors, and pathophysiology. JAMA. 2009;301(20):2129–40.PubMedCrossRefPubMedCentralGoogle Scholar
  2. Misra A, Tandon N, Ebrahim S, Sattar N, Alam D, Shrivastava U, Narayan KM, Jafar TH. Diabetes, cardiovascular disease, and chronic kidney disease in South Asia: current status and future directions. BMJ. 2017;357:j1420.PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Roopa Shivashankar
    • 1
    • 2
    Email author
  • Kavita Singh
    • 1
    • 2
  • L. R. Aravind
    • 3
  • Nikhil Tandon
    • 4
  1. 1.Public Health Foundation of India (PHFI)GurgaonIndia
  2. 2.Centre for Chronic Disease ControlNew DelhiIndia
  3. 3.Public Health Foundation of India (PHFI)GurgaonIndia
  4. 4.Department of Endocrinology and MetabolismAll India Institute of Medical SciencesNew DelhiIndia

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