Health Delivery

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Socio-economic determinants of the costs of diabetes in India

Diabetes is rapidly emerging as a major health-care problem in India, especially in urban areas where the prevalence of Type 2 diabetes has been reported as 12% of the adult population. Furthermore, there is an equally large pool of people with

Diabetes under fire

In the last issue of Diabetes Voice Panagiotis Tsapogas presented a view of diabetes care in Gaza from the perspective of his work with Médecins Sans Frontières. Here, Itamar Raz, President of the Israel Diabetes Association (IDA), presents a view from the perspective of an Israeli person living in the region, and from the leading Palestinian physicians with whom he collaborates. Together they struggle in the midst of the disruptions to deliver diabetes health care across the

The human perspective on health-care reform: coping with diabetes in Kyrgyzstan

Kyrgyzstan is a small mountainous country with a predominantly agricultural economy; it gained independence with the break-up of the Soviet Union in 1991. For a significant sector of the Kyrgyzstani population, economic difficulties at national level translate into high unemployment and widespread impoverishment. Kyrgyzstan inherited an extensive but basic health-care system, with a functioning – albeit fragmented – structure for managing chronic diseases.

Meal-time glucose control: the role of oral drugs

As a species, our condition has changed: from prolonged periods of fasting and occasional gorging, to nearly constant feeding with rarely occurring periods of fasting. The constant availability of ‘grazing opportunities’ has contributed to a change in the body build of humans towards increasing body weight, overweight, and obesity. With this change has come a massive increase in the number of people with diabetes and diabetes- and- obesity-related health problems.

Home blood glucose monitoring: a useful self-management tool

There is no doubt that the introduction of home blood glucose monitoring has helped to revolutionize diabetes management and reduce the amount of time people with diabetes need to spend in hospital to stabilize their condition. However, this has given rise to a series of compliance and management issues for the person with diabetes and the health professional who provides their care. Jan Alford reports.

The impact of low health literacy on diabetes outcome

According to the 1993 US National Adult Literacy Survey, approximately 90 million people in the USA have deficiencies in reading or computational skills that prevent them from fully participating in normal daily activities – such as reading a bus schedule or entering background information on an application form. Although the Survey did not evaluate the ability to read and comprehend health-related materials,

Cost and availability of insulin and other diabetes supplies: IDF survey 2002-2003

Insulin is a life-sustaining medication and as such has been designated an ‘essential drug’ by the World Health Organization (WHO). Insulin therefore should be universally available to everyone who requires it for survival. However, accessibility to the drug is often not secure. This results in life-threatening complications for people who depend on insulin for survival. The authors of this article, in reporting on the results of the International Diabetes Federation (IDF) survey, 2002-2003, make a call for improvements to the pricing and availability

Enhancing health communication: the German experience

The recent euphoria surrounding the positive effects of preventative measures with people with impaired glucose tolerance or manifest Type 2 diabetes is rarely reflected in the experience of the health-care professionals working with people with diabetes. Despite efforts to advise and inform, there is very little lasting change in health-care behaviour. Many health-care professionals report feelings of frustration and anger. They often describe the people in their care as 'difficult'.

In practice: DAWN in Latin America and the Caribbean

Relatively few studies have examined the psycho-social impact of diabetes. The Diabetes Attitudes, Wishes and Needs (DAWN) Programme addressed this issue in a study involving people with diabetes from 13 countries. A key finding was that depression was much more common in people with diabetes than in those without the condition, and was associated with impaired self-management and quality of life. Other studies confirm that depression often impairs metabolic control in people with the condition.

Keeping people at the centre of care: a challenge to health professionals?

The establishment of a practice which puts the person at the centre of care will require a change in the attitudes and beliefs of health professionals, and people with diabetes. A service which places the person with diabetes at the centre of care will undoubtedly demand the adoption of this philosophy by the organizations responsible for the delivery of diabetes care, as well as those networks serving the

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