Roles and expenses of self-care behaviours for tackling type 2 diabetes in developing countries

Type 2 diabetes mellitus is a rapidly growing concern in developing countries. The economic burden on patients in these regions is substantial, exacerbated by limited healthcare infrastructure.
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Distribution and determinants of healthcare costs for self-care behaviours among patients with type 2 diabetes across low-resource communities in Nepal - Discover Health Systems

Background Type 2 diabetes mellitus (T2DM) is a global public health problem, imposing significant financial burden on its’ management and care. Patients’ self-care behaviours can help to reduce the financial burden on healthcare resources. However, no studies have examined the distribution of healthcare costs related to self-care behaviours in low and lower middle-income countries. Therefore, this study aimed to explore the distribution and associated determinants of healthcare expenses incurred on self-care behaviours among patients with T2DM in low-resource communities in Nepal. Methods We conducted a cross-sectional study, collecting data from 481 patients with T2DM across low-resource communities in the Kavrepalanchok and Nuwakot districts of Nepal. We applied micro-costing with a bottom-up approach to estimate the healthcare costs for 6 month periods. Self-care behaviours were assessed using a self-reported questionnaire. The relationship between healthcare expenses and self-care behaviours was modelled by using a generalised linear model with an identity-link function and 10,000 bootstrapping resampling techniques. Results The average healthcare cost for managing T2DM is US $22.87 per patient for 6 months. Patients who engaged in footcare had the highest total expenses at US $71.98, followed by those who regularly conducted glucose monitoring (US $29.55), met physical activity recommendations (US $23.68), adhered to prescribed medication intake (US $23.59) and adhered to recommended dietary habits (US $22.98). Those patients who met the physical activity guidelines, regularly conducted glucose monitoring, and engaged in footcare had 18%, 32%, and 102% higher expenses respectively, compared to their counterparts. Conclusions Footcare was the most expensive and least practised component of self-care behaviour for managing T2DM, followed by glucose monitoring and physical activity, underscoring the significance of making these behaviours affordable and accessible in diabetes management. This provides valuable insight for decision-makers to prioritise and ensure these behaviours are affordable for patients with diabetes. Graphical Abstract

Developing countries face unique challenges in managing T2DM, where the disease imposes significant financial strain on patients. The direct costs include medications, regular medical consultations, and hospitalisations, while indirect costs cover lost productivity, transportation to healthcare facilities, and long-term complications. For many patients, these expenses are overwhelming, leading to inadequate disease management and poorer health outcomes. Our recent research, published in Discover Health Systems, explores the healthcare costs associated with Type 2 diabetes mellitus (T2DM) across various self-care behaviours and highlights the critical role these behaviours play in effective disease management.

Evidence shows that self-care behaviours are pivotal in managing T2DM effectively. These include regular physical activity, which helps maintain blood glucose levels and overall health; dietary adherence, where following a balanced diet can prevent blood sugar spikes and manage weight; and medical adherence, where consistent medication use ensures optimal blood glucose control. Additionally, glucose monitoring, through regular blood sugar checks, helps patients make informed decisions about their care, and foot care prevents complications like infections and ulcers, which can lead to severe outcomes if untreated.

Our study focused on analysing the healthcare costs associated with these self-care behaviours among T2DM patients, and the findings are revealing. Foot care emerged as the most expensive self-care behaviour, despite being the least practiced. Foot complications can lead to severe outcomes, including amputations, significantly raising healthcare costs. Glucose monitoring was also a high-cost behaviour, essential for preventing long-term complications but often neglected due to financial constraints. Physical activity, while crucial for maintaining health, faces barriers in cost and accessibility of facilities and safe environments for exercise. This research underscores the need for strategies to make these self-care behaviours more affordable and accessible. By addressing these barriers, we can improve T2DM management and outcomes for patients in developing countries.

Our findings provide valuable insights for policymakers, healthcare practitioners, and patients. Policymakers must prioritise funding and initiatives that reduce the cost of essential self-care behaviours. Subsidies for glucose monitoring, affordable footwear, and community exercise programs could alleviate the economic burden on patients. Healthcare practitioners should emphasise the importance of comprehensive self-care in diabetes management, educating patients about cost-effective strategies and available resources to enhance adherence to these practices. Patients should be encouraged to incorporate affordable self-care practices into their daily routines, with community support groups and educational programs playing a crucial role in this effort.

Managing T2DM in developing countries requires a multifaceted approach that addresses the economic barriers to effective self-care. Our research highlights the significant costs associated with essential self-care behaviours and the urgent need to make these practices more accessible and affordable. By doing so, we can improve health outcomes and reduce the financial burden on patients, ultimately enhancing the quality of life for those living with type 2 diabetes.

Our research not only highlights the economic challenges faced by T2DM patients but also provides a roadmap for stakeholders to implement changes that can lead to better disease management. Ensuring that self-care behaviours are affordable and accessible is a critical step toward reducing the prevalence and impact of type 2 diabetes in developing countries. For details https://link.springer.com/article/10.1007/s44250-024-00117-2.

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Type 2 Diabetes
Life Sciences > Health Sciences > Clinical Medicine > Diseases > Diabetes > Type 2 Diabetes
Health Economics
Life Sciences > Health Sciences > Public Health > Health Policy > Health Economics
Lifestyle Modification
Life Sciences > Health Sciences > Public Health > Health Promotion and Disease Prevention > Disease Prevention > Lifestyle Modification

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