Subject : A survey to collect the insights on challenges and management of uncontrolled Type 2 Diabetes from healthcare professionals (GEM IV Survey)
Diabetes is one of the largest global health emergencies of this century, ranking among the 10 leading causes of mortality together with cardiovascular disease (CVD), respiratory disease, and cancer. Diabetes is endemic in India, and as per ICMR-INDIAB-17 study, 101 million people had diabetes, and the number with prediabetes was 136 million in India. Diabetes mellitus is an iceberg disease in India, with nearly 57% of adults (43.9 million) undiagnosed. The International Diabetes Federation estimates that 537 million people were living with diabetes in 2021, with an expected increase to 784 million by the year 2045.
Type 2 diabetes mellitus (T2DM), also known as non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes, constitutes about 90–95% of all diabetes cases. It is characterized by insulin resistance and β-cell dysfunction, leading to decreased sensitivity of muscle, liver, and adipose tissue to insulin. Initially, β-cells compensate by increasing insulin secretion, but over time, this compensation fails, resulting in hyperglycemia. Although insulin levels are reduced, they usually prevent diabetic ketoacidosis (DKA) except under severe stress or with certain medications. T2DM progresses slowly and often remains undiagnosed until severe hyperglycemia symptoms appear. Its etiology involves genetic predispositions and environmental factors, with higher prevalence in older adults, obese individuals, those with a family history of diabetes, and certain racial or ethnic groups.
Effective diabetes management requires person-centered care that respects individual preferences, barriers, and therapy costs. Shared decision-making, aided by decision tools, is crucial for high-risk individuals. Providers must consider cognitive impairment, literacy, cultural beliefs, and health concerns. Social determinants of health, like socioeconomic status and living conditions, significantly impact outcomes and must be addressed. Psychosocial factors also influence management and well-being, posing challenges for patients, families, and providers in integrating diabetes care into daily life. Because of the progressive nature of T2DM, first-line therapy often fails to provide effective glycemic control, necessitating the addition of add-on therapy. In this regard, FDCs can play a crucial role in achieving glycemic targets effectively. However, understanding the difference between rational and irrational combinations is necessary from the safety, efficacy, and tolerability perspective. Indian clinicians will have to use a multistep approach so that they can take informed decisions.
The purpose of this survey is to identify the primary challenges in managing patients with uncontrolled Type 2 Diabetes Mellitus (T2DM) and to explore potential strategies and solutions proposed by healthcare professionals to improve the management of uncontrolled T2DM.
We invite you to participate in this survey. On acceptance, you will need to fill the survey questionnaire form provided.
We would encourage you to carefully fill all available information to the fullest in the questionnaire.
If you agree to participate in the said survey, we would request you to sign and return the enclosed reply along with your visiting card for accuracy of records.
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