Experiences of barriers to self-monitoring and medication-management among Indian patients with type 2 diabetes, their primary family-members and physicians
Abstract
Objectives: This study explored the subjective accounts of the main barriers to self-monitoring of blood-glucose (SMBG) and medication-management among Indian patients with type 2 diabetes (T2DM), their primary family-members (PFMs) and physicians. Methods: Using convenience sampling, patients with T2DM, their PFMs, and physicians, residing in a South Indian capital city, were recruited for semi-structured, audio-recorded interviews. Thematic analysis was used to analyze the data. Results: Fifty patients (female = 14; mean age = 42.5 years) and their PFMs (female = 38; mean age = 39 years), and 25 physicians (female = 4; mean age = 49.8 years) were recruited. Three superordinate themes were identified: (i) complex medication-regimen: confusion, forgetting and reduced motivation, (ii) family recommendations of alternative therapies due to the social pressures of avoiding stigma, intrusiveness and being misrepresented for injecting insulin, and (iii) an expensive illness: choosing to spend money on only medication. Discussion: Implications of the findings highlight the need to (i) train physicians in communication and empathy skills, (ii) empower patients to communicate their barriers to physicians through triadic communication models and question-prompt lists, (iii) educate communities on the benefits of insulin for managing T2DM to reduce stigma, and (iv) equip communities with information about health insurance to address the financial toll of T2DM management.
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A reason SMBG has not taken off in India is that people with diabetes are not empowered to use SMBG data to adjust their diet, physical activity, and medication (insulin or oral drugs) based on SMBG readings.
“Another reason why SMBG has not taken off in India is that the PwD are not empowered to use the data to make adjustments to their diet, physical activity, and medication, either insulin or oral drugs, based on the SMBG readings obtained [51].”
From Self-Monitoring of Blood Glucose as an Integral Part in the Management of People with Type 2 Diabetes Mellitus (2022) · cites this paper as [51]
Lack of reimbursement for SMBG systems and test strips is a major deterrent to frequent SMBG testing in India.
“A lack of reimbursement for SMBG systems and test strips has also been a major deterrent to frequent SMBG testing in India [50, 51].”
From Self-Monitoring of Blood Glucose as an Integral Part in the Management of People with Type 2 Diabetes Mellitus (2022) · cites this paper as [51]
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“However, medication-management differ in westernized and Asian countries.(3,20) In westernized countries, physicians addressed patients’ needs to reduce medication complexity,(21,22) and used shared decisionmaking, which improved the physicianpatient relationship.”
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- Authors
- Chittem, M., Sridharan, S. G., Pongener, M., Maya, S., & Epton, T.
- Affiliations
- Indian Institute of Technology Hyderabad (IN)
- University of Manchester (GB)
- Corresponding author
- Chittem, Mahati
- Venue
- Chronic Illness
- Publisher
- SAGE Publications
- Published
- 2021-07-14
- Volume
- 18
- Issue
- 3
- Pages
- 677-690
- ISSN
- 1742-3953 (ISSN-L)
- 1745-9206
- OpenAlex
- W3181666454
- Cited by
- 19
- References
- 39
- Citations by year
- 2026: 7 · 2025: 4 · 2024: 6 · 2023: 1 · 2022: 1
- FWCI
- 1.49
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Chronic Illness (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- Research Archive of Indian Institute of Technology Hyderabad (Indian Institute of Technology Hyderabad) (submittedVersion)
- Funders
- Ministry of Human Resource Development
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- type 2 diabetes, self-monitoring of blood glucose, medication adherence, family caregivers, physician-patient communication, complementary and alternative medicine, financial burden of illness, complex medication regimens, patient empowerment, health insurance, South India
- MeSH terms
- Adult, Diabetes Mellitus, Type 2, Female, Humans, Middle Aged, Physicians, Blood Glucose Self-Monitoring, Social Stigma, Insulins
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