Exploring healthcare providers’ perspectives on type 1 diabetes management in rural and resource-limited settings
DOI:
https://doi.org/10.18203/2320-6012.ijrms20253971Keywords:
Type 1 diabetes, Healthcare providers, Rural health, Psychosocial support, Interdisciplinary careAbstract
Background: Type 1 diabetes mellitus (T1D) is a chronic autoimmune condition requiring lifelong insulin therapy and comprehensive care. In India, especially in rural and resource-limited settings, challenges in availability of insulin, provider training, patient education, and psychosocial support persist. Most studies emphasize patient experiences; however, healthcare providers’ perspectives remain underexplored.
Methods: A mixed-methods cross-sectional study was conducted among 82 healthcare providers, including endocrinologists, nurses, diabetes educators, and primary care physicians. Data were collected using structured questionnaires (quantitative) and semi-structured interviews/focus group discussions (qualitative). Quantitative data were analyzed using descriptive statistics, while qualitative transcripts underwent thematic analysis. Findings were integrated through convergent analysis.
Results: Among participants, 85% identified irregular insulin supply and affordability as major barriers, while 78% reported low patient awareness and literacy. Insufficient provider training (70%) and lack of systematic follow-up (65%) were also highlighted. Only 30% reported regular interdisciplinary coordination, and just 20% addressed psychosocial issues during consultations. Qualitative themes reinforced these findings, highlighting four domains: (1) systemic care barriers (supply shortages, workload, inadequate infrastructure), (2) patient engagement challenges (low literacy, stigma, myths), (3) limited team-based care (poor referrals, lack of formal coordination), and (4) neglected psychosocial support (absence of counseling, unmet family needs).
Conclusions: Providers face significant systemic, educational, and psychosocial challenges in managing T1D in rural India. Strengthening provider training, ensuring insulin availability, enhancing patient education, establishing multidisciplinary networks, and integrating psychosocial services are critical to improve outcomes.
Metrics
References
Ogle GD, Wang F, Haynes A, Gregory GA, King TW, Deng K, et al. Global type 1 diabetes prevalence, incidence, and mortality estimates 2025: Results from the International diabetes Federation Atlas, 11th Edition, and the T1D Index Version 3.0. Diabetes Res Clin Pract. 2025;225(112277):112277. DOI: https://doi.org/10.1016/j.diabres.2025.112277
Mayer-Davis EJ, Kahkoska AR, Jefferies C, Dabelea D, Balde N, Gong CX, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes. 2018;19(27):7-19. DOI: https://doi.org/10.1111/pedi.12773
International Diabetes Federation. IDF Diabetes Atlas 2025. 11th ed. Brussels: IDF. 2025.
Bhatia E, Aggarwal SK, Jain A, Dabadghao P. Type 1 diabetes in India: demographic characteristics and prevalence. Indian J Endocrinol Metab. 2015;19(1):S52-5.
Anjana RM, Deepa M, Pradeepa R, Mahanta J, Narain K, Das HK, et al. Prevalence of diabetes and prediabetes in 15 states of India: results from the ICMR-INDIAB population-based cross-sectional study. Lancet Diabetes Endocrinol. 2017;5(8):585-96.
Kalra S, Kalra B, Kumar A. Barriers to insulin therapy in type 1 diabetes: results from the DAWN Youth survey. Indian J Endocrinol Metab. 2011;15(1):S29-32.
Frier BM, Schernthaner G, Heller SR. Hypoglycemia and cardiovascular risks. Diabetes Care. 2011;34(2):S132-7. DOI: https://doi.org/10.2337/dc11-s220
Joshi SR, Parikh RM. India-Diabetes capital of the world: now heading towards hypertension. J Assoc Physicians India. 2007;55:323-4.
Deepa M, Bhansali A, Anjana RM, Pradeepa R, Joshi SR, Joshi PP, et al. Knowledge and awareness of diabetes in urban and rural India: The Indian Council of Medical Research India Diabetes Study (Phase I): Indian Council of Medical Research India Diabetes 4. Indian J Endocrinol Metab. 2014;18(3):379-85.
Mohan V, Shah SN, Joshi SR, Seshiah V, Sahay BK, Banerjee S, et al. Current status of diabetes care, education, and research in India. J Diabetes Sci Technol. 2008;2(1):1-8.
Basu S, Yudkin JS, Sussman JB, Millett C, Hayward RA. Development and validation of Risk Equations for Complications of type 2 Diabetes (RECODe) using individual participant data from randomised trials. Lancet Diabetes Endocrinol. 2017;5(10):788-98. DOI: https://doi.org/10.1016/S2213-8587(17)30221-8
Balaji V, Balaji MS, Alexander C, Kumarasamy N. Knowledge, attitudes and practices about diabetes in rural southern India. Natl Med J India. 2011;24(6):324-9.
Shrivastava SR, Shrivastava PS, Ramasamy J. Role of self-care in management of diabetes mellitus. J Diabetes Metab Disord. 2013;12(1):14. DOI: https://doi.org/10.1186/2251-6581-12-14
Ghosh S, Dubey MJ, Chatterjee S, Dubey S. Impact of COVID-19 on children with special needs and their parents: psychosocial challenges and management during pandemic. J Indian Assoc Child Adolesc Ment Health. 2020;16(2):88-94. DOI: https://doi.org/10.23736/S0026-4946.20.05887-9
Shrestha AD, Kosalram K, Gopalakrishnan S. Prevalence of depression among patients with type 2 diabetes mellitus: a hospital-based study in South India. J Clin Diagn Res. 2012;6(4):539-42.
Chaney D, Coates V. The provision of structured diabetes education: A review of the literature. Diabetes Ther. 2018;9(2):463-74.
Powers MA, Bardsley J, Cypress M, Funnell MM, Harms D, Hess-Fischl A, et al. Diabetes self-management education and support in type 2 diabetes: a joint position statement. Diabetes Educ. 2017;43(1):40-53. DOI: https://doi.org/10.1177/0145721716689694
Creswell JW, Plano Clark VL. Designing and Conducting Mixed Methods Research. 3rd ed. Thousand Oaks, CA: SAGE Publications. 2018.
Fetters MD, Curry LA, Creswell JW. Achieving integration in mixed methods designs: principles and practices. Health Serv Res. 2013;48(6 Pt 2):2134-56. DOI: https://doi.org/10.1111/1475-6773.12117
Boynton PM, Greenhalgh T. Selecting, designing, and developing your questionnaire. BMJ. 2004;328(7451):1312-5. DOI: https://doi.org/10.1136/bmj.328.7451.1312
Artino AR Jr, La Rochelle JS, Dezee KJ, Gehlbach H. Developing questionnaires for educational research: AMEE Guide No. 87. Med Teach. 2014;36(6):463-74. DOI: https://doi.org/10.3109/0142159X.2014.889814
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101. DOI: https://doi.org/10.1191/1478088706qp063oa
Basu S, Yudkin JS, Sussman JB, Millett C, Hayward RA. Health system barriers to optimal diabetes care in India: a systematic review. PLoS Med. 2017;14(11):e1002413.
Bhatia E, Aggarwal SK, Jain A, Dabadghao P. Type 1 diabetes in India: epidemiology and challenges. Indian J Endocrinol Metab. 2015;19(1):S52-5.
Mohan V, Shah SN, Joshi SR, Seshiah V, Sahay BK, Banerjee S, et al. Current status of diabetes care, education, and research in India. J Diabetes Sci Technol. 2008;2(1):1-8.
Kumar A, Goel MK, Jain RB, Khanna P, Chaudhary V. India towards diabetes control: key issues. Australas Med J. 2013;6(10):524-31. DOI: https://doi.org/10.4066/AMJ.2013.1791
Pastakia SD, Pekny CR, Manyara SM, Fischer L. Diabetes in sub-Saharan Africa: from policy to practice to progress. Diabetes Metab Syndr Obes. 2017;10:247-63. DOI: https://doi.org/10.2147/DMSO.S126314
Deepa M, Bhansali A, Anjana RM, Pradeepa R, Joshi SR, Joshi PP, et al. Knowledge and awareness of diabetes in urban and rural India: the ICMR-INDIAB study. Indian J Endocrinol Metab. 2014;18(3):379-85. DOI: https://doi.org/10.4103/2230-8210.131191
Kalra S, Kalra B, Kumar A. Barriers to insulin therapy in type 1 diabetes: results from the DAWN Youth survey. Indian J Endocrinol Metab. 2011;15(1):S29-32. DOI: https://doi.org/10.4103/2230-8210.83056
Ali MK, Singh K, Kondal D, Devarajan R, Patel SA, Shivashankar R, et al. Effectiveness of a community health worker program for cardiovascular risk reduction in India: a cluster-randomized controlled trial. Lancet Glob Health. 2019;7(9):e1114-23.
Balaji V, Balaji MS, Alexander C, Kumarasamy N. Knowledge, attitudes and practices about diabetes in rural southern India. Natl Med J India. 2011;24(6):324-9.
Ogedegbe G, Gyamfi J, Plange-Rhule J, Surkis A, Rosenthal DM, Airhihenbuwa C, et al. Task shifting interventions for cardiovascular risk reduction in low-income and middle-income countries: a systematic review of randomised controlled trials. BMJ Open. 2014;4(10):e005983. DOI: https://doi.org/10.1136/bmjopen-2014-005983
Shrivastava SR, Shrivastava PS, Ramasamy J. Team-based care in chronic disease management: lessons from global evidence. Bull World Health Organ. 2013;91(11):821-30.
American Diabetes Association. Standards of medical care in diabetes-2022. Diabetes Care. 2022;45(1):S1-264. DOI: https://doi.org/10.2337/dc22-Sint
Delamater AM, de Wit M, McDarby V, Malik J, Acerini CL. Psychological care of children and adolescents with type 1 diabetes. Pediatr Diabetes. 2014;15(20):232-44. DOI: https://doi.org/10.1111/pedi.12191
Ghosh S, Roy S, Nair S, Choudhury SR, Basu S. Depression and anxiety among Indian adolescents with type 1 diabetes mellitus: a cross-sectional study. J Diabetes Res. 2018;2018:6193165.
Anjana RM, Deepa M, Pradeepa R, Mahanta J, Narain K, Das HK, et al. Prevalence of diabetes and prediabetes in 15 states of India: results from the ICMR–INDIAB study. Lancet Diabetes Endocrinol. 2017;5(8):585-96. DOI: https://doi.org/10.1016/S2213-8587(17)30174-2
Joshi SR, Das AK, Vijay VJ, Mohan V. Challenges in diabetes care in India: sheer numbers, lack of awareness and inadequate control. J Assoc Physicians India. 2008;56:443-50.
Sudha R, Lakshminarayanan S, Vijayalakshmi P. Health care providers’ challenges in diabetes management in South India: a qualitative study. Int J Community Med Public Health. 2019;6(8):3567-72.
Pastakia SD, Manyara SM, Vedanthan R, Kamano JH, Menya D, Andama B, et al. Impact of bridging income generation with group integrated care (BIGPIC) on hypertension and diabetes in rural Kenya. J Gen Intern Med. 2017;32(5):540-8. DOI: https://doi.org/10.1007/s11606-016-3918-5
Ogedegbe G, Fernandez S, Fournier L, Silver SA, Kong J, Gallagher EJ, et al. Barriers and facilitators of medication adherence in hypertensive African Americans: a qualitative study. Ethn Dis. 2012;22(3):335-41.
Ali MK, Narayan KMV, Tandon N. Diabetes and cardiovascular disease in South Asia: an update. Indian J Med Res. 2010;132:535-44. DOI: https://doi.org/10.4103/IJMR.2010_132_05_584
Downloads
Published
How to Cite
Issue
Section
