A Diabetes Case Management Study in a Rural Setting in India

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According to an expensive Lancet study, documenting the international work led by the Harvard University TH Chan School of Public Health, India and the United States are the top three countries in the world with regard to prevalence of Type 2 diabetes (Zhou et al., 2016). The diabetic population increased dramatically from 1980 to the present. For example, China had an increase from 20.4 million in 1980 to 102.9 million in 2014; the rise has been equally dramatic in India from 11.9 million in 1980 to 64.5 million. Prevalence of diabetes has more than doubled for men in India (3.7%–9.1%). Among women, the increase is by 80% in India (4.6%–8.3%). Furthermore, the projection for these numbers in India presents staggering implications. The number of people with diabetes will reach approximately 79 million by 2030, with onset at an earlier age (King, Aubert, & Herman, 1998; Ramachandran et al., 2004;Wild, Roglic, Green, Sicree, & King, 2004; Zimmet, Alberti, & Shaw, 2001). Approximately 70% of India's population lives in rural areas (Ramachandran et al., 2004), in resource-poor settings where the increasing prevalence and chronic nature of Type 2 diabetes become added burdens (Wild et al., 2004). Lack of awareness and poor access to quality health care have resulted in increase in diabetes-related complications. Effective case management in diagnosis and treatment is an effective strategy in preventing Type 2 diabetes–related complications (Ali et al., 2008; Satterfield et al., 2003; Versnel, Welschen, Baan, Nijpels, & Schellevis, 2011). “Efforts to reduce the global health and economic burden of diabetes should emphasize prevention of diabetes or delaying its onset, through enhancing healthy behaviors and diets at the population level, and early detection and management of high-risk individuals” (Zhou et al., 2016, p. 1525).
Clients who receive case management intervention, experience improvement in their level of blood glucose control, satisfaction with services, understanding of treatment goals, resource use, continuity of care, and efficiency and coordination of services (Norris et al., 2002). Therefore, we set out to use case management practice to explore whether it is beneficial for people living in the rural areas where medical facilities are lacking, to (a) increase the diagnosis rate for diabetes, (b) implement the use of pharmacologic interventions at earlier stage to avoid complications, and thus (c) reduce hospital visits for diabetes-related complications.
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