Dear Editor,
We commend Kumar and colleagues for their study on diabetes self-management practices among 230 participants from the Andaman and Nicobar Islands using the Diabetes Self-Management Questionnaire (DSMQ).[1] The study’s findings, which link higher educational levels, rural backgrounds, and longer diabetes duration with better self-management, are compelling. Notably, rural patients had higher glucose management scores, and those with normal postprandial blood sugar levels (BSL) demonstrated better diet control.[1]
However, the study would benefit from additional details to contextualize these findings. For instance, the distribution of population characteristics according to rural and urban areas would allow readers to better contextualize the results. Although the study employed stratified random sampling and included both new and long-standing cases of diabetes, a more detailed stratified analysis could clarify the outcomes. Combining new and existing cases may obscure the differences in DSMQ scores among participants and could centralize the results. This is particularly important given that nearly 60% of the study participants had elevated fasting and postprandial BSL.
While diagnosing diabetes with a single test may be feasible in the Indian context, confirming the screening with an additional test would be ideal.[2] Fasting BSL, Oral Glucose Tolerance Test, and HbA1C (Glycated Hemoglobin) should be used together for accurate diagnosis, with lifestyle modifications attempted before medication is prescribed.[2]
The DSMQ, though comprehensive, lacks a focus on foot care.[3] Future studies should consider adding foot care as a separate domain to better assess self-management practices. The study also highlighted differences in DSMQ scores, 1.2 points, between males and females were not statistically significant, whereas a difference of 1.66 points between rural and urban areas was significant.[1] Regardless of the P value, it is important to consider the practical significance of a 1- or 2-point difference, as it reflects a change of one point across all questions.
Lack of proper education significantly increases the risk of developing diabetes and its complications (4 times more likely).[4] Kumar et al.[1] reported that only participants with postgraduate-level education reported significantly higher DSMQ scores around 38, while others had scores around 30, and nearly a quarter of the participants were illiterate, highlighting a crucial target population for addressing diabetes management and preventing complications. Raising awareness and dispelling misconceptions are key to improving diabetes management outcomes. Majumdar et al.[5] reported from eastern India that health education sessions effectively improved knowledge and awareness among diabetes patients, irrespective of socioeconomic status, and that this knowledge was retained over longer periods.
Challenges here include health literacy, attitudes, availability of resources, and practice. Educators play a crucial role in mitigating the impact of environmental factors, preventing disease aggravation, and helping patients return to their social roles. Providing comprehensive health education and counseling, covering all domains of diabetes management, is essential in India, where diabetes is prevalent. This approach could resemble providing an answer key to the questionnaire, covering all domains of diabetes management (medication, diet, physical activity, foot care, regular check-ups). Such an approach could ensure better self-care outcomes and improved health maintenance.
In conclusion, enhancing health education and refining tools like the DSMQ by incorporating essential components like foot care are critical steps in improving diabetes management and outcomes.
Authors contribution
NSG and SMV: Concepts, design, definition of intellectual content, investigation, manuscript writing.
Conflicts of interests
Both authors declare no conflicts of interest that may influence this letter.
Funding Statement
No funding received from anyone for this letter.
References
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