Socio-Cultural Changes and Diabetes

With India being dubbed the ‘Diabetes capital of the world’ it is necessary to understand the reasons that contribute to it, the changes it brings about in an individual’s life and explore ways to tackle them.

Great social and cultural changes have taken place in our society. The relatively simple and austere life style of our forefathers has given way to a lavish one where there is no limit to what money can buy.

People don’t exert themselves. The benefits of labour- saving devices and automated transport have forced people to reduce their levels of physical activity.


Easy access to mass produced refined high calorie foods which are affordable and heavily advertised have resulted in an increase in food consumption which is far more than what the body needs.

The fast pace of modern life ,changing values , longer working hours, and changes in family responsibilities have adversely influenced eating patterns and time spent on recreation and outside activities.


As a result, life style diseases such as diabetes, cardiac conditions, obesity, and circulatory problems are fast approaching epidemic proportions.

The three most important risk factors for Type 2 diabetes are sedentary life style,



poor dietary habits


and , the ensuing changes in body composition.


These are risks that can be avoided.

A person with diabetes has to get used to changes in lifestyle, has to adhere strictly to the treatment and also has to be prepared for the onset of diabetes related complications. So, prevention is better than cure.

Changes in the life of a T2DM

High blood glucose levels and poor control can result in medical complications such as cardio-vascular diseases, retinopathy, neuropathy, and nephropathy.


Apart from that, it can influence many areas of a person’s life – changes in the daily routine due to activities focused on adequate blood glucose control, ability to work, impact on other members of the family, quality of life, sexual functioning and so on.

Diet and exercise, blood glucose monitoring, timing and dosage of oral medication or insulin, hypo management and prevention, foot care, sick day management, visits to the doctor,


medical checks and education activities


– all these have to be integrated into the normal day-to-day activities of people with diabetes.


In addition, they may have to tackle unexpected crises.

In most cases, Type 2 diabetes shows up in middle adulthood. This is a time when behavior patterns of an individual are firmly set and changes for self- care have to be made to improve blood glucose control and to slow down the advancement of diabetic complications. It may require a lot of effort to make the necessary changes. It is difficult to make changes to food habits and even more challenging to maintain them.

During the time before complications set in or during the early period of complications, many people do not show symptoms. Unpleasant symptoms such as slow healing wounds or ulcers, thickening and narrowing of arteries, tingling or burning sensation in hands, legs and feet, protein in urine, or poor vision are usually followed by an awareness and fear of the seriousness of the disease . When they are absent, the patient is not motivated enough to make the necessary lifestyle changes. In short, they treat diabetes quite lightly.

Diabetes - related emotional distress


People with diabetes often experience emotional distress while living with diabetes and the effect of its complications. Many are afraid of living with diabetes and might get depressed at the thought of it. The cost of treatment is also a source of worry. Most often they worry about the future and the possibility of diabetic complications. They are constantly concerned about food and eating and feel deprived when they cannot eat what others can. They are also concerned if changes in their moods/feelings were related to diabetes.

A short tool, the PAID (Problem Areas in Diabetes ) Scale, (Psychosocial issues and Type 2 Diabetes – Gary W Welch, Katie Weinger and Alan M Jacobson), can be used to check high emotional distress related to life with diabetes. It consists of a set of twenty questions to be answered on a 5- point scale ranging between ‘not a problem’ to ‘a serious problem’.

A score above 50 shows a high level of emotional distress. Questions which score 4 on the scale indicate areas the patient finds difficult and may be’ hot- spots’ which are causing heightened emotional stress and might need professional attention.

Good listening is good for diabetes management.


Talking to people with diabetes about how they feel , and about the practical barriers they face for good diabetic self care is very important. Good listening increases the therapeutic bond and is good for diabetes management. Giving the patient a chance to talk about how he feels about his condition; being open, supportive and non-judgmental; using open- ended questions where the patient can provide information about feelings, instead of closed questions with yes/no answers; not interrupting or sharing personal views while the patient is talking; being aware of the patient’s body language(tone of voice, facial expressions use of hands, body posture, pauses, hesitations during difficult moments); maintaining good eye contact; using small encouraging body signals- nods, yes/no/ummm… are of great value to both physician and patient.

Briefly summarizing what you have heard, and checking with the patient whether what you heard is accurate at the end of the conversation is also essential.

A patient will feel less stressed once he has expressed his fears and hopes and will be motivated to make the necessary behavioural changes.

The greatest challenge in tackling T2DM is to focus on social and cultural changes and reverse the current trend through sensible, preventive strategies.

To control this growing problem , we need to prevent obesity as early in life as is possible , and this can only be done through a strong interaction between policy makers, medical fraternity and the individual.

Reference:
Gary W Welch; Katie Weinger; and Alan M Jacobson. "Psychosocial issues and Type 2 Diabetes." In Textbook of Type 2 Diabetes, Edited by Barry J Goldstein and Dirk Muller-Weiland. London, Martin Dunitz : 65-76; 2003.