title: South Asian women with diabetes: Psychosocial challenges and management: Consensus statement.
abstract: Diabetes is the ninth leading cause of death in women globally. In South Asians mortality in women with diabetes stands second highest. There is a marked gender discrimination which is faced by women across South Asia esp in access to services and support for diabetes, resulting in high rates of morbidity and mortality in women with diabetes. The most important risk factor identified for the diabetes epidemic is obesity along with genetic susceptibility. Lack of health care, social and cultural disparity, discrimination at work, disparity in marriage, restricted medical facilities are prevalent. Diabetes and depression are common in women. Increasing age, low level of education, low socioeconomic conditions, difficulties posed in finding partners, frequent divorce and family history of psychiatric illness are significant risk factors for diabetes and depression. Such patients usually have poor metabolic control, higher complication rates, increased healthcare costs, lost productivity, lower quality of life as well as increased risk of death. Preconception counseling should be incorporated in the routine diabetes clinic visit for all women of childbearing potential. Women with diabetes should have information and access to contraception. Proper family planning counseling and psychological support can help stop practices such as female foeticide and multiple pregnancies. Psychological support to patients and their families are needed to break the barrier. There is emerging evidence that women with diabetes are more prone to untoward outcomes as compared to men. Central obesity, metabolic syndrome and the polycystic ovary syndrome show ethnic specific differences in South Asian women. Optimal sexuality is an integral part of holistic health. Shortage of trained female health care professionals, lack of privacy in over-crowded health care facilities, a social taboo attached to such matters, and lack of confidence in patients contribute to the neglect of sexual issues in women attending diabetes clinics across South Asia. Guidelines for counselling in female sexual dysfunction, written in culturally appropriate manner for South Asia, are needed. Diabetes affects women more severely because of their unique biological, cultural and socioeconomic circumstances. Women have limited access to health care facilities because of illiteracy, ignorance and negative social customs. Transcending the gender hierarchy and inequality is a formidable challenge. Sensitising men, empowering women on self care and providing peer support maybe the answer to this challenge. It is essential for health care providers to use appropriate coping mechanism such as building psychological contact with the patient, including family and friends as part of social support and empower patient with complete process of managing diabetes. Increasing awareness through the media, seminars, posters, group discussions and education, regular monitoring and consulting the doctor, support group for women and facilities for aerobic exercises are recommended. The health care systems should consider custom-designed prevention and control programs tailored for women based on local and regional attitudes on health care, cultural beliefs, and available social support systems. Policies that empower adolescent girls and young women to take control of their metabolic management must be encouraged. Provision of gender specific diabetes education with a holistic life-cycle approach is recommended.
authors: Department of Medicine, MLN Medical College, Allahabad, India.
authors: Sarita
authors: S
authors: Bajaj
authors: Fatema
authors: F
authors: Jawad
authors: Najmul
authors: N
authors: Islam
authors: Hajera
authors: H
authors: Mahtab
authors: Jyoti
authors: J
authors: Bhattarai
authors: Dina
authors: D
authors: Shrestha
authors: Chandrika
authors: C
authors: Wijeyaratne
authors: Dimuthu T
authors: DT
authors: Muthukuda
authors: Niranjala Weegoda
authors: NW
authors: Widanage
authors: Than Than
authors: TT
authors: Aye
authors: Moe Wint
authors: MW
authors: Aung
authors: Bharti
authors: B
authors: Kalra
authors: R M
authors: RM
authors: Anjana
authors: Aswathy
authors: A
authors: Sreedevi
authors: Komal
authors: K
authors: Verma
keywords: South Asian region; Women empowerment; Women with diabetes; gender disparity; health care access; social & cultural factors
references: Diabetes Care. 2008 Mar;31(3):596-615
references: 18308683
references: N Engl J Med. 1996 May 9;334(19):1249-53
references: 8606721
references: Diabetes Care. 2008 Dec;31(12):2383-90
references: 19033418
references: N Engl J Med. 1997 Jun 26;336(26):1849-54
references: 9197212
references: J Pediatr. 1994 Aug;125(2):177-88
references: 8040759
references: N Engl J Med. 2005 Jun 16;352(24):2477-86
references: 15951574
references: Lancet. 2004 Jan 10;363(9403):157-63
references: 14726171
references: Hum Reprod. 2011 Jan;26(1):202-13
references: 21098627
references: N Engl J Med. 2008 May 8;358(19):1991-2002
references: 18463375
references: Cad Saude Publica. 2007 Dec;23(12):2820-34
references: 18157324
references: Lancet. 2011 Jul 2;378(9785):31-40
references: 21705069
references: J Immigr Minor Health. 2011 Feb;13(1):101-10
references: 19779820
references: Nurs Times. 2012 Mar 6-12;108(10):28, 30-2
references: 22479842
references: Kidney Int. 2003 Apr;63(4):1499-507
references: 12631367
references: Tidsskr Nor Laegeforen. 2006 Apr 6;126(8):1041-3
references: 16619062
references: Health Promot J Austr. 2010 Aug;21(2):130-7
references: 20701563
references: Eur J Clin Nutr. 2007 Jun;61(6):736-42
references: 17180158
references: Science. 2007 May 11;316(5826):889-94
references: 17434869
references: Diabetes Care. 2000 Jul;23(7):962-8
references: 10895847
references: Occup Med (Lond). 2012 Sep;62(6):413-9
references: 22915562
references: Nepal Med Coll J. 2007 Sep;9(3):154-6
references: 18092429
references: Diabet Med. 2008 Sep;25(9):1062-9
references: 19183311
references: Diabetes Care. 2007 Jul;30 Suppl 2:S251-60
references: 17596481
references: Am J Epidemiol. 2005 Apr 1;161(7):652-60
references: 15781954
references: Scand J Public Health. 2007;35(2):197-204
references: 17454924
references: N Engl J Med. 2000 Oct 19;343(16):1134-8
references: 11036118
references: Prev Med. 2010 Sep-Oct;51(3-4):290-4
references: 20600259
references: JAMA. 2003 Oct 8;290(14):1884-90
references: 14532317
references: Obstet Gynecol Clin North Am. 2007 Jun;34(2):173-99, vii
references: 17572266
references: BMJ. 2000 Feb 26;320(7234):526-7
references: 10688539
references: Diabetes Care. 2011 Jun;34(6):1249-57
references: 21617109
references: BMJ. 2004 Apr 3;328(7443):823-6
references: 15070642
references: BMC Public Health. 2012 May 25;12:380
references: 22630043
references: Lancet. 1991 Feb 16;337(8738):382-6
references: 1671422
references: World J Diabetes. 2012 Jun 15;3(6):110-7
references: 22737281
references: Indian J Med Res. 2007 Mar;125(3):251-8
references: 17496354
references: Diabetes Care. 2008 May;31(5):893-8
references: 18310309
references: Public Health Nurs. 1996 Aug;13(4):253-62
references: 8828386
references: J Indian Med Assoc. 2009 Nov;107(11):799-802, 804-6
references: 20469784
references: Diabetes Care. 1993 Jan;16(1):329-34
references: 8422804
references: J Pediatr. 2000 May;136(5):664-72
references: 10802501
references: Diabetologia. 2001 Sep;44(9):1094-101
references: 11596662
references: Diabetes Obes Metab. 2008 Dec;10(12):1135-56
references: 18494812
references: N Engl J Med. 2008 May 8;358(19):2003-15
references: 18463376
references: Diabetes Res Clin Pract. 2007 May;76(2):219-22
references: 17005289
references: Psychosom Med. 2001 Jul-Aug;63(4):619-30
references: 11485116
references: Diabetes Care. 2003 Mar;26(3):719-24
references: 12610028
references: QJM. 2001 Aug;94(8):435-44
references: 11493721
references: Diabetes Res Clin Pract. 2010 Jan;87(1):15-9
references: 19914728
references: Lancet. 2010 Jan 30;375(9712):408-18
references: 19875164
references: Int J Gynaecol Obstet. 2009 Mar;104 Suppl 1:S4-7
references: 19155007
references: Diabet Med. 1992 Nov;9(9):820-5
references: 1473322
references: Diabetes Care. 2011 Jan;34(1):244-6
references: 21193623
references: JAMA. 2009 May 27;301(20):2129-40
references: 19470990
references: Diabetes Care. 2004 Feb;27(2):407-14
references: 14747221
references: Diabetes Care. 1995 May;18(5):631-7
references: 8586000
references: Diabetes Care. 1990 Jan;13(1):34-40
references: 2404715
references: Diabetologia. 2007 Jul;50(7):1365-74
references: 17476474
references: BMC Med Genet. 2008 Jul 03;9:59
references: 18598350
references: Diabetes Metab J. 2012 Dec;36(6):422-32
references: 23275936
references: Indian J Med Res. 2012 Aug;136(2):205-10
references: 22960886
references: Indian J Med Res. 2007 Mar;125(3):473-82
references: 17496369
references: J Gen Intern Med. 1997 Jul;12(7):439-45
references: 9229283
references: QJM. 2009 Apr;102(4):261-9
references: 19147658
references: J Womens Health (Larchmt). 2008 Nov;17(9):1415-23
references: 18954234
references: Diabet Med. 2006 Nov;23(11):1165-73
references: 17054590
references: Diabet Med. 2007 Aug;24(8):872-7
references: 17403122
references: Diabetologia. 1992 Jul;35(7):595-601
references: 1644236
references: Diabet Med. 1992 Nov;9(9):850-4
references: 1473326
references: J Clin Endocrinol Metab. 2008 Nov;93(11 Suppl 1):S9-30
references: 18987276
references: Diabetes Care. 2012 Jan;35 Suppl 1:S11-63
references: 22187469
references: Diabetologia. 2009 Feb;52(2):247-52
references: 19005641