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Type 2 diabetes is a chronic disease in which people have problems regulating their blood sugar. Hyperglycemic hyperosmolar nonketonic syndrome (hhns) hyperglycemic hyperosmolar nonketonic syndrome (hhns) is a serious complication of diabetes that involves a. The Indian type 2 diabetes risk score also helps identify those at risk of macrovasvular disease and neuropathy (CURES-77).
How well do patients' assessments of their diabetes self-management correlate with actual glycemic control and receipt of recommended diabetes services? Socio-cultural aspects of diabetes care: Myths about diabetes in Qassim region, Saudi Arabia. Self-medication with herbal remedies amongst patients of type 2 diabetes mellitus: A preliminary study.
Culture and therapy: Complementary strategies for the treatment of type-2 diabetes in an urban setting in Kerala, India. Prevalence and pattern of use of indigenous medicines in diabetic patients attending a tertiary care centre. Perceptions and experiences of taking oral hypoglycaemic agents among people of Pakistani and Indian origin: Qualitative study. Self-reported health beliefs, lifestyle and health behaviours in community-based patients with diabetes and hypertension. Developing countries are predicted to have an 82% increase in the adult population and 170% increase in the number of people with diabetes. Type 2 diabetes symptoms will often develop gradually and may not always show symptoms at an earlier stage.
Understanding the broader cultural context can serve as important background information for effective care for diabetes. Moreover, culture may influence diabetes self-management as well.Very few studies have explored the effect of cultural beliefs and attitudes toward diabetes prevention and care services.
It would be important for diabetes care providers to understand cultural determinants in order to provide holistic care for people with diabetes. For data collection, we used the Explanatory Model Interview Catalogue (EMIC) interviews of diabetic patients. EMIC, the progenitor of which is the famous anthropologist Arthur Kleinman refers to a framework of the semi-structured interview based on a particular operational formulation of the concept of illness explanatory models and a set of explanatory model interviews based on that framework. The EMIC approach is useful in studying the illness as well as understanding the social and cultural factors affecting the course of the illness. Interviews were conducted by trained researchers in local language, each lasting about 35-45 min.
Care was taken to assure the respondents that they and the place of their work would not be identifiable in any subsequent report.All interview transcripts were read by the researcher and coded in the style of a grounded theory approach for data analysis.
Category headings were generated from the data and under these, all data were accounted for. Two independent researchers verified the seeming accuracy of the category system and after discussion with them; minor modifications were made to it.
In the grounded theory literature, a good category system is said to have emerged from the data. All respondents were currently on the antidiabetic medications.Respondents believed that the way in which they perceived the illness depended upon their tradition, customs and ethos, which were observed in their society since generations. Respondents also said that people mostly try home remedies for their illness, before going to a doctor.If anyone is ill in our family we first try home treatment, like using turmeric and milk for cold, ginger for cough. We go to the doctor only if our home treatment does not work.It was also learned that, perceptions regarding the diabetes were also influenced by cultural factors. Respondents stated that illness, and particularly chronic illness like diabetes, which do not show sign and symptoms early in the stage of disease are usually ignored until it interferes with their day to day living.

However, many felt that this was the most difficult thing to follow and religion or cultural factors were the main barriers.
Preparing special food for oneself or for one person goes against the cultural ethos of providing for all family members impartially.Respondents also found difficulty in having frequent meals at short intervals as advised by their providers. One male respondent narrated.I have to go to farm for work early in the morning, so mostly take morning tea and go to work.
People do not consider it a good thing to keep eating for the entire day (frequent meals).Regarding diabetes care seeking behavior, we found that cultural factors influenced the access to health care delivery services in a significant way. Respondents said that many people were not aware about the available of diabetes care services and people also ignored the disease as it was not considered to be of sufficient priority by the family. Overall; health illiteracy and cost of care, particularly indirect cost of care, were important barriers for seeking care. One respondent said.We feel why to go to doctors if we are not ill (not having signs and symptoms of illness). It also costs us 100 rupees to go to the hospital and doctors charge fees also.It was also notable to learn that most of people with diabetes, who were on conventional treatment, also used other treatment, like home remedies or some Ayurvedic formulations (Indian system of medicine).
One of the respondents mentioned-I was diagnosed as diabetic 4 years back and since then I am taking the medication regularly.
My uncle told me that diabetes is caused by excessive consumption of sweets, so consuming bitter things helps a lot.
From the last 2 years, I am also taking Neem juice, which is bitter in taste along with the medication given by doctors.Respondents observed that many times, it became difficult for them to understand what care providers were saying due to different language or too much use of English words during their conversation. As a result, people with diabetes, who sought care felt stressed and were not able to follow the correct advice. One respondent said.Doctors are always in a hurry as there are more patients waiting for them. Doctors use English words, which we do not understand.Female respondents talked about the various social and cultural factors as a barrier to follow the dietary and care advice given by their providers. It was also noted that females ignore their own health and also lack sufficient support from family for care of their illness. I do not prepare meals as told to me by the nurse (health care provider) as my family does not like it. Usually I eat last, after my husband finishes therefore cannot eat on time as told to me by the doctor.
My husband is busy with daily work, so he does not know what drugs I am taking for diabetes. He does not come with me to the hospital.Males also agree with the female respondents' views regarding difficulties faced by them for taking care of themselves. The problem is more if there are grandparents in home (joint family) or if there are many members in the family.It was also observed that female respondents were not aware of gestational diabetes. Beliefs regarding illnesses and in particular, chronic illness like diabetes are greatly influenced by cultural norms in a significant way.Culture and health beliefs and practicesCultural factors and belief influences how people perceive their overall health, illness and practices related to it. Ayurveda, the Indian system of medicine, which is culturally accepted in Indian community since ages, states that the persons are healthy till their bodily fluids are in the state of equilibrium or else the illnesses crop up. People from India have a common perception the diabetes is caused by excessive consumption of sweets. However, there could be the urban-rural difference in the influence of environmental factors like stress on diabetes management as a whole. People also believe that smoking and alcohol are not related to diabetes mellitus or its complications. Therefore, for optimum care of people with diabetes, understanding of socio-cultural context is critical as it affects perceptions about how people with diabetes are viewed and supported by their family and how their family.Culture and dietary beliefs and practicesDietary habits and practices are influenced by culture and religion as well as economic conditions. Culturally determined dietary practices involve the identification of foods, methods of food preparation, condiment selection, timing and frequency of meals, and the ritual, social, and symbolic use of foods.

Foods, especially, sweets are shared as gifts with relatives and friends in ceremonies.Dietary management is one of the most important components for a package of care for people with diabetes. Cultural beliefs are one of the many reasons for nonadherence with dietary recommendations in diabetes. Therefore, care providers' familiarity of these dietary practices is essential for planning culturally appropriate dietary management for persons with diabetes.Culture and diabetes care seeking behaviorDisease management decisions are closely linked to cultural background and resources available. Low health literacy, lack of knowledge related to diabetes services, misconception about diabetes, lack of family and social support and lack of patients involvement are some of the cultural determinants responsible for poor outcome of diabetes care program.
In most cases, providers are unaware of the fact that patients are taking Ayurvedic or herbal medication as well. Moreover, there is inconclusive evidence regarding the usefulness of herbal mediation in the management of type 2 diabetes.As regards the use of drugs, people feel it is required when there are signs or symptoms of disease or illness.
This perception of people is the single most important barrier for proper management of diabetes and adherence to treatment. People often judge the severity of an illness by the amount of pain, disability, and discomfort it produces in daily routine activities. Provider often feels that, since diabetes is a chronic disease, rural people do not care about the disease and about their health as well. People do not seek health care unless their condition interferes with social or personal activities of daily living, such as work and household maintenance functions.
Diabetic patients with strong family support are more likely to follow the recommendations of diabetes care providers. Health literacy is also influenced by cultural beliefs and education, which further influence a person's ability to obtain, interpret, and understand information about health and healthcare services.
Services of trained interpreter or bilingual family members may be useful in such situations. Culturally specific print materials in patient's primary language may be provided and hence that the information is available to patients, their family members and to other people in their support system.
Therefore, diabetes care providers, to ensure effective communication with persons with diabetes need to present themselves as a colleague, establish ties with family and friends of patients, demonstrate supportive and personalized approach. This responsibility to maintain cultural practices and pass them on to younger generations can make it difficult for them to successfully make lifestyle changes leading to poor health outcomes. To address these issues in prevention and care services, diabetes providers are expected to bear cultural competencies for assessment and planning culturally appropriate interventions. The problem also lies with suggesting a diet regimen which does not fit well with the way people eat in India. Merely following international or Euro-American ways of eating is not the answer, unless the family structure is similar to that which exists in the Euro-American context. It is all the more necessary that biomedical practitioners, who will be expected to bear the brunt if and when any public health program for diabetes is introduced, are attuned to the various factors affecting the understanding and treatment of diabetes. Cultural characteristics such as value systems, beliefs, customs, and family patterns may be used as clues for planning culturally appropriate care for diabetes. To deliver these culturally appropriate interventions and effective continuum of diabetes care needs innovative models with a multi-disciplinary team, including the lay care giver. These specific interventions, well aligned with local context and needs are likely to have a significant impact on diabetes care.

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