LETTER TO EDITOR
|Year : 2018 | Volume
| Issue : 4 | Page : 324
Managing diabetes in the era of financial crisis: Need to look beyond the obvious
Theocharis Koufakis1, Christina-Maria Trakatelli2, Maria Grammatiki1, Kalliopi Kotsa1
1 Division of Endocrinology and Metabolism, First Department of Internal Medicine, Diabetes Center, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
2 Third Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
|Date of Submission||02-Aug-2018|
|Date of Acceptance||09-Oct-2018|
|Date of Web Publication||21-Dec-2018|
Dr. Kalliopi Kotsa
Division of Endocrinology and Metabolism, First Department of Internal Medicine, Diabetes Center, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Koufakis T, Trakatelli CM, Grammatiki M, Kotsa K. Managing diabetes in the era of financial crisis: Need to look beyond the obvious. Indian J Community Med 2018;43:324
|How to cite this URL:|
Koufakis T, Trakatelli CM, Grammatiki M, Kotsa K. Managing diabetes in the era of financial crisis: Need to look beyond the obvious. Indian J Community Med [serial online] 2018 [cited 2019 Jun 24];43:324. Available from: http://www.ijcm.org.in/text.asp?2018/43/4/324/248193
A 33-year-old male patient with a history of Type 1 diabetes (T1D), presented to the emergency department (ED) of our hospital, complaining of persistent, unexplained hyperglycemia over the past, few days. Apart from T1D, the rest of his medical history was unremarkable. Physical examination was normal, while laboratory evaluation revealed excessively high 2-h postprandial glucose plasma concentrations (450 mg/dl), glycated hemoglobin A1c levels of 11%, the absence of ketones in urine, and arterial PH within the normal range (7.38). He was admitted for further investigation. A thorough diagnostic work-up detected no source of infection or other underlying condition that could explain his diabetes decompensation. We simply put him on his regular insulin regime (glargine plus aspart) and euglycemia was easily achieved. He was subsequently discharged with instructions for regular follow-up in the diabetes outpatient clinic.
Two weeks later, he reattended the ED for exactly the same reason. We were informed that in the meantime, he had been admitted twice in different hospitals of the city; still, investigations performed there were also negative. At that time, we carefully reevaluated the patient's social history. He finally admitted that because he was unemployed and homeless, he used to deliberately omit his mealtime insulin doses, to be hospitalized and gain access to bed, food, and personal hygiene equipment. However, he was regularly injecting his basal insulin, to avoid ketoacidosis. The patient was referred to social service which ensured his accommodation, insulin, and food supplies and he is currently attending an individualized, rehabilitation program.
The presented case highlights-in an emphatic manner-the way that poor socioeconomic status interplays with diabetes management, especially in today's era of global, financial crisis, where the number of people living below poverty line has dramatically increased. In the case of Greece particularly, there is evidence supporting that the strict austerity program implemented in the country during the last decade, may have unfavorable effects on the healthcare of diabetes and its complications. This could be the consequence of multiple factors, including poor compliance to treatment, chronic stress, dietary changes, and limited access to health care services. Previous research has revealed significant differences regarding household income, educational level, insurance, and marital status between the well and poorly controlled T1D patients, suggesting a strong effect of social and financial parameters on diabetes self-management and control. Moreover, it is probable that physicians tend to focus mostly on patients' medical history and underestimate their social and financial backgrounds. According to Dr. William Osler's famous quote: “physicians should care more particularly for the individual patient than for the special features of the disease.”
In conclusion, this report aims to raise doctors' degree of concern regarding the significant impact of socioeconomic factors on diabetes management, especially among vulnerable groups of patients, living in the dark of social exclusion. Apart from appropriate medical care, social support is equally important, in order for these individuals to achieve optimal metabolic control and avoid long-term diabetes complications.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Aloumanis K, Papanas N. Greek financial crisis: Consequences in the healthcare of diabetes and its complications. Hippokratia 2014;18:4-6.
Simmons JH, Chen V, Miller KM, McGill JB, Bergenstal RM, Goland RS, et al.
Differences in the management of type 1 diabetes among adults under excellent control compared with those under poor control in the T1D exchange clinic registry. Diabetes Care 2013;36:3573-7.
Berman AC, Chutka DS. Assessing effective physician-patient communication skills: “Are you listening to me, doc?” Korean J Med Educ 2016;28:243-9.
Bryan CS. William Osler and Seymour Thomas, “the boy artist of Texas”. Proc (Bayl Univ Med Cent) 2016;29:337-41.