Managing type 2 diabetes in the South Asian population in the United Kingdom

Abstract

Individuals of South Asian (SA) heritage demonstrate the highest relative risk of developing type 2 diabetes (T2D) in the United Kingdom (UK). Managing and attaining optimal control of T2D poses significant challenges within this demographic, due to various factors including cultural dietary habits, language barriers, limited health literacy, socioeconomic issues, genetic predisposition, and inadequate access to healthcare resources. Given these complexities, further research is imperative to address the specific challenges associated with managing T2D in the SA population in the UK.

Chapter one is a systematic review examining the effectiveness of self-management interventions for SAs with T2D in the UK. Thirteen studies were found to match the inclusion criteria through a PRISMA-informed search across MEDLINE, Web of Science, PubMed, and PsychINFO. Three out of the nine studies found significant improvements in HbA1c levels following intervention, with most reporting small effect sizes. Four out of the six studies found improvement in quality-of-life measures. Additionally, five studies reported significant improvement in some behavioural domains such as improvements in knowledge, attitude, beliefs, and self-efficacy. The improved health outcomes achieved in certain studies suggest that culturally adapted self-management interventions may be a promising strategy in reducing the increasing public health challenges associated with T2D among SA populations residing in the UK. Further research is warranted to explore the impact of self-management on diabetes distress, and the role of individual components in self-management interventions.

Chapter two presents an empirical study on self-management experiences of older SA women with T2D in the UK. Twelve interviews were conducted with SA women aged 55 and over. Reflexive thematic analysis identified four overarching themes: (1) gender dynamics in T2D care; (2) the emotional burden of T2D; (3) attitudes towards T2D self-management behaviours and (4) religious obligations. The findings suggest that older SA women experience an internal conflict between the roles they adopt, their cultural, religious, and personal values and their ability to effectively manage T2D. Self-management behaviours were observed to be low among participants, with poor awareness and knowledge of T2D. Implications include acknowledging the potential for intergenerational transmission of generativity which may reshape healthcare perspectives. Future research should consider the role of gender in T2D interventions, incorporating cultural strategies that address attitudes, beliefs, and values.