Diabetes self-care in primary health facilities in India - challenges and the way forward

Table 1 Major challenges and potential solutions for promoting effective diabetes self-management through enhanced primary care

Major challenges	Potential solutions
Strengthening primary-care facilities for providing comprehensive outpatient care	Sustained political will and financial commitment towards NPCDCS
	Expand basket of laboratory investigations for maintaining the continuum of care
	Upgrading and maintaining registers by the introduction of data indicators and data standards with timely centralized data collection for the performance of clinical audits
Patient-centered care	Training paramedical staff as certified diabetes educators for enhanced DMSE/R
	m-Health applications for health education and behavior change communication
	Community outreach
Patient isolation and stress	Peer support
	Community linkages: yoga, meditation
Suboptimal adherence
Drug availability and refill adherence	Ensuring uninterrupted supply of drugs, promotion of generic drugs to reduce out of pocket expenses, expansion of drug types and availability of insulin with the development of proper storage facilities
Correct adherence assessment	Development of culturally valid adherence scales
Adherence Support	Health education, mHealth
Avoiding clinical inertia	Training health workers for the correct dispensation of insulin therapy
	Regular availability of insulin and syringes to eliminate any out of pocket expenses
Implementation research	Intervention studies to improve patient-centered care, adherence support, and DMSE/R
	Cohort studies to evaluate the quality of care and assess long-term health outcomes
Operational research	Promotion of community linkage in primary care for diabetes patients
Economic evaluations	Cost-effectiveness of diabetes management with primary care compared to specialist treatment
Health technology assessment	Does provision of free glucometers and strips increase patient adherence to SMBG and improve treatment outcomes (improved glycemic control, fewer hypoglycemic episodes)

DMSE: Diabetes self-management education; NPCDCS: National program for prevention and control of cancer, diabetes, cardiovascular diseases and stroke.