Abstract
ObjectiveAlthough South Asian populations have among the highest burden of type 2 diabetes in the world, their diabetes management remains poor. We systematically reviewed studies on South Asian patient’s perspectives on the barriers and facilitators to diabetes management.MethodsWe conducted a literature search using OVID, CINHAL and EMBASE (January, 1990 –February, 2014) evaluating the core components of diabetes management: interactions with health care providers, diet, exercise, and medication adherence. South Asian patients were self-reported as Indian, Pakistani, Malaysian-Indian or Bangladeshi origin. From 208 abstracts reviewed, 20 studies were included (19 qualitative including mixed methods studies, 1 questionnaire). Barriers and facilitators were extracted and combined using qualitative synthesis.ResultsAll studies included barriers and few facilitators were identified. Language and communication discordance with the healthcare provider was a significant barrier to receiving and understanding diabetes education. There was inconsistent willingness to partake in self-management with preference for following their physician’s guidance. Barriers to adopting a diabetic diet were lack of specific details on South Asian tailored diabetic diet; social responsibilities to continue with a traditional diet, and misconceptions on the components of the diabetic diet. For exercise, South Asian patients were concerned with lack of gender specific exercise facilities and fear of injury or worsening health with exercise. Patients reported a lack of understanding about diabetes medication management, preference for folk and phytotherapy, and concerns about the long-term safety of diabetes medications. Facilitators included trust in care providers, use of culturally appropriate exercise and dietary advice and increasing family involvement. Overall themes for the barriers included lack of knowledge and misperceptions as well as lack of cultural adaptation to diabetes management.ConclusionDiabetes programs that focus on improving communication, addressing prevailing misconceptions, and culture specific strategies may be useful for improving diabetes management for South Asians.
Highlights
South Asians represent approximately one-fifth of the global population and have a disproportionately higher incidence of type-2 diabetes mellitus
South Asian patients were concerned with lack of gender specific exercise facilities and fear of injury or worsening health with exercise
Diabetes programs that focus on improving communication, addressing prevailing misconceptions, and culture specific strategies may be useful for improving diabetes management for South Asians
Summary
South Asians represent approximately one-fifth of the global population and have a disproportionately higher incidence of type-2 diabetes mellitus. Diabetes occurs at 50% higher rates in South Asian patients compared to the general population [1]. Multiple randomized controlled trials identified pharmacological and non-pharmacological strategies to substantially reduce the risk of diabetes related complications and premature mortality. These effective strategies for chronic diabetes management are incorporated into diabetes guidelines and include: ongoing diabetes monitoring by a health care provider, adherence to a diabetic diet, exercise and medical therapy [3]. South Asian patients were 24% less likely to achieve these critical targets than White patients [9] and had 60–113% higher A1C levels compared with the general population [10,11,12]. Understanding patient level barriers and facilitators perceived or experienced underlying poor diabetes management is essential to inform the development of effective diabetes education and management programs to reduce risk of diabetes-related complications
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