1. A study to ascertain whether UK South Asian people change their dietary habits once diagnosed with Type 2 diabetes Dr Thriveni S Beerenahally M.B.B.S. (Mysore University, India) M.B.B.S. (Mysore University, India) PG Diploma Hospital Management PG Diploma Hospital Management (AIIMS,India) (AIIMS,India) DPH (University of Wolverhampton ) DPH (University of Wolverhampton ) Dissertation Supervisor Dr Ingrid Callwood Head Of Division – Community Health University of Wolverhampton University of Wolverhampton

2. Over View Introduction Introduction Background to Study -Diabetes in UK South Asians Background to Study -Diabetes in UK South Asians Research Question Research Question Aim of the Study Aim of the Study Literature Review Literature Review Methodology Methodology Presentation & Analysis Presentation & Analysis Conclusion Conclusion Recommendations Recommendations References References

3. Introduction Diabetes mellitus is a disorder of elevated blood glucose resulting from decreased insulin secretion and defective insulin action. Diabetes mellitus is a disorder of elevated blood glucose resulting from decreased insulin secretion and defective insulin action. Diabetes mellitus, with two different clinical types, Type 1 & type 2 is an important public health condition in the UK. Diabetes mellitus, with two different clinical types, Type 1 & type 2 is an important public health condition in the UK. Type 2 diabetes constitutes for 90% of total diabetes cases in the UK. Type 2 diabetes constitutes for 90% of total diabetes cases in the UK. There is a increase in the prevalence of diabetes in people of South Asian origin, throughout the world as well as in the United Kingdom. There is a increase in the prevalence of diabetes in people of South Asian origin, throughout the world as well as in the United Kingdom.

4. Type 2 Diabetes in UK South Asians 194 million with diabetes worldwide in 2005 194 million with diabetes worldwide in 2005& Will be reaching 333 million by 2025 and Will be reaching 333 million by 2025 and 170 million are Asians and pacific Islander. (WHO) 170 million are Asians and pacific Islander. (WHO) About 1.4 million people in the UK have diabetes & About 1.4 million people in the UK have diabetes & About 500,000 of them from Asian community. About 500,000 of them from Asian community. Prevalence: 5 times more in the South Asians living in UK compared to Europeans. Prevalence: 5 times more in the South Asians living in UK compared to Europeans.

5. Cont.. Diabetes tends to develop 10 years earlier in South Asians than in Europeans. Diabetes tends to develop 10 years earlier in South Asians than in Europeans. About 25% of Asians have type 2 diabetes About 25% of Asians have type 2 diabetes compared to 5% of Europeans Complications with diabetes like kidney disease and heart disease occur more commonly in the South Asians. Complications with diabetes like kidney disease and heart disease occur more commonly in the South Asians. Death rate: due to diabetes is 3 times greater than the Europeans. Death rate: due to diabetes is 3 times greater than the Europeans.

6. Factors Influencing High Rate of Diabetes in South Asians Low levels of physical activity Low levels of physical activity High fat diet High fat diet Urbanization Urbanization Smoking Smoking Genetic factors with environmental factors Genetic factors with environmental factors Belief in traditional folk healers by some of South Asian people Belief in traditional folk healers by some of South Asian people

7. Access to Health Care by Ethnic Minority Groups in UK Minority ethnic people are the highest users of primary care services, but are less likely to access appropriate health services and treatment. (Balarajan and Raleigh 1995). Minority ethnic people are the highest users of primary care services, but are less likely to access appropriate health services and treatment. (Balarajan and Raleigh 1995). People from ethnic minority communities may not get the services that they need because of differences in language & literacy. (Day2005) People from ethnic minority communities may not get the services that they need because of differences in language & literacy. (Day2005) Knowledge about diabetes and risk factors are poorer in ethnic minority communities. (Audit Commission 2000). Knowledge about diabetes and risk factors are poorer in ethnic minority communities. (Audit Commission 2000).

8. Research Question A study to ascertain whether UK South Asian people change their dietary habits once diagnosed with Type 2 diabetes

9. Aim of the Study 1. To establish whether any dietary change was made on initial diagnosis of disease. 2. To explore whether dietary changes were maintained and 3. If not why they were not maintained?

10. Literature Review Reviewed research published in the English language from 1996 onwards to ascertain the current level of knowledge Reviewed research published in the English language from 1996 onwards to ascertain the current level of knowledge Scrutiny of electronic databases, National Electronic Library for Health, Cochran library and bibliography, hand searches of recent editions of relevant journals, reference list of other reviews and papers between 1996 to 2006, generated the literature to be reviewed. Scrutiny of electronic databases, National Electronic Library for Health, Cochran library and bibliography, hand searches of recent editions of relevant journals, reference list of other reviews and papers between 1996 to 2006, generated the literature to be reviewed.

11. Cont.. Themes identified: Lack of Social and family support, major factor in the difficulty with maintaining diet. Lack of Social and family support, major factor in the difficulty with maintaining diet. Patients’ transfer the responsibility of their health care on healthcare professionals Patients’ transfer the responsibility of their health care on healthcare professionals Difficulty with language and communication with the health care providers. Difficulty with language and communication with the health care providers.

12. Methodology Study Design: Qualitative Study Data Collection: Semi-structured Interview, Digital tape recorded and transcribed. Sample: Purposive Sample Gaining Access to Ethical Approval : Study got approved from General Practitioner, University of Wolverhampton Ethics Committee and LREC. Gaining access to participants: Participants information sheet posted with self addressed stamped envelop along with consent form and Questionnaire.

13. Presentation & Analysis Characteristics of Participants: 7 type 2 diabetes patients 7 type 2 diabetes patients All were registered in one general practice area. All were registered in one general practice area. One Pakistani and six Indians One Pakistani and six Indians One female and six men One female and six men Ages ranging from 42 to 75 years Ages ranging from 42 to 75 years 5 were interviewed in English and two in Hindi language. 5 were interviewed in English and two in Hindi language.

14. Cont.. Findings: All participants had some difficulties maintaining diabetes self care All participants had some difficulties maintaining diabetes self care Only 2 of them could change and maintain their dietary habits. Only 2 of them could change and maintain their dietary habits. Others had either family or personal problems to keep up the change. Others had either family or personal problems to keep up the change. On the whole participants had a inconsistent approach to dietary management. On the whole participants had a inconsistent approach to dietary management.

15. Cont.. Themes identified: 1. Lack of family and social support to change the dietary habits. 2. Belief that blood sugar level could be maintained by reducing the quantity of food intake. 3. Difficulty in compromising with taste. 4. Not understanding the advice given by the dietician and difficulty to follow the advice.

16. Conclusion The qualitative approach in the study allowed to explore the insight of views & helped in gaining access to concern with the dietary management with diabetes The findings from the study require further enquiry. Although the study was small and generalisability of findings cannot be assumed the study has gone some way toward filling gaps in the knowledge regarding south Asian diabetic patients views about dietary habit.

17. Recommendations The effective use of The effective use of -Link workers, -Bilingual workers and -Health visitors to educate regarding food habits and life style can help to reduce the incidence of diabetes in South Asians. Health education as part of health promotion activities. Health education as part of health promotion activities. Empowering the people to create awareness for early diagnosis of disease in the community. Empowering the people to create awareness for early diagnosis of disease in the community. Conducting diabetes screening clinic for high risk groups by NHS & GPs for early detection of type 2 diabetes. Conducting diabetes screening clinic for high risk groups by NHS & GPs for early detection of type 2 diabetes.

18. References Balarajan, R. and Raleigh, V.S. (1993) Ethnicity and Health : a guide for the NHS. London: Department of Health. Balarajan, R. and Raleigh, V.S. (1993) Ethnicity and Health : a guide for the NHS. London: Department of Health. Balarajan, R. and Raleigh, V.S. (1995) Ethnicity and Health in England. London: HMSO. Balarajan, R. and Raleigh, V.S. (1995) Ethnicity and Health in England. London: HMSO. British Diabetic Association (1996) Diabetes in the United Kingdom. London: British Diabetes Association. British Diabetic Association (1996) Diabetes in the United Kingdom. London: British Diabetes Association. Diabetes UK. (2005). [online]. Diabetes UK. (2005). [online]. http://www.diabetes.org.uk/infocentre/carerec/preconcept.htm Day, J. (2005) Living with Diabetes. The Diabetes UK guide for those treated with diet and tablets. Chichester: John Wiley and Sons, Ltd. Day, J. (2005) Living with Diabetes. The Diabetes UK guide for those treated with diet and tablets. Chichester: John Wiley and Sons, Ltd. Helman, C. (2000) Culture, Health and Illness. Oxford: Butterworth Heinemann. Helman, C. (2000) Culture, Health and Illness. Oxford: Butterworth Heinemann. Raleigh, V. S. (1997) Diabetes and Hypertension in Britain’s ethnic minorities: implications for the future of renal services. British Medical Journal, 314, p.209. [online]. [ cited 7th July]. Raleigh, V. S. (1997) Diabetes and Hypertension in Britain’s ethnic minorities: implications for the future of renal services. British Medical Journal, 314, p.209. [online]. [ cited 7th July]. World Health Organisation Study Group (1994) Prevention of Diabetes Mellitus. Geneva: World Health Organisation. World Health Organisation Study Group (1994) Prevention of Diabetes Mellitus. Geneva: World Health Organisation. WHO. Global Prevalence of Diabetes. WHO. Global Prevalence of Diabetes.

19. Thank You

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