A tremendous increase in the coexistence of diabetes and hypertension has been observed recently in India. Apart from lifestyle and genetic factors, socioeconomic status, age, gender, occupation and lack of awareness are also contributing to the tremendous increases in the prevalence of both the diseases. Hypertension has been long recognised as one of the major risk factors for chronic disease burden, morbidity and mortality in India, attributable to 10.8% of all deaths in the country. Even though microvascular complications are frequently linked to hyperglycaemia, studies have also proven the critical involvement of hypertension in the development of these co-morbidities. The co-occurrence of hypertension in diabetic patients considerably escalates the risks of coronary heart disease, stroke, nephropathy and retinopathy. The annual expenditure for diabetes for the Indian population was estimated to be 1541.4 billion INR ($31.9 billion) in 2010. The expense of diabetes care further escalates in the presence of complications or co-morbidities. Generally, a diabetic patient with hypertension spent an average of 1.4 times extra than a diabetic patient without hypertension. Even though diabetes and hypertension are considered as important risk factors for cardiovascular and chronic kidney diseases, the awareness about the prevention, treatment and control of these diseases remains alarmingly low in the developing countries like India. The healthcare system in India should focus on better hypertension screening and control, especially in diabetic patients, to minimise the burden of the dual epidemic.India, with one of the largest and most diverse populations of people living with diabetes, experiences significant barriers in successful diabetes care. Limitations in appropriate and timely use of insulin impede the achievement of good glycemic control. The current article aims to identify solutions to barriers in the effective use of insulin therapy viz. its efficacy and safety, impact on convenience and life-style and lack of awareness and education. Therapeutic modalities, which avoid placing an undue burden on patients' life-style, must be built. These should incorporate patient-centric paradigms of diabetes care, team-based approach for life-style modification and monitoring of patients' adherence to therapy. To address the issues in efficacy and safety, long-acting, flat profile basal insulin, which mimics physiological insulin and show fewer hypoglycemic events is needed. In addition, therapy must be linked to monitoring of blood glucose to enable effective use of insulin therapy. In conjunction, wide-ranging efforts must be made to remove negative perception of insulin therapy in the community. Patient- and physician - targeted programs to enhance awareness in various aspects of diabetes care must be initiated across all levels of health-care ensuring uniformity of information. To successfully address the challenges in facing diabetes care, partnerships between various stakeholders in the care process must be explored.
Delivery of health-care; diabetes mellitus; health-care disparities; insulin; life-style; medication adherence; patient compliance; patient-centered care; physician-patient relations; safety
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