Disability as a Determinant of Diabetes Self-Management: A Comparative Case Study from Rural South India

In this current issues piece we present a case study comparing two patients from rural south India and highlight the complex interaction between disability and other social determinants in influencing diabetes self-management and control. The first patient is a 70-year-old man practicing the Hindu religion, belonging to a dominant caste, living in an affluent part of the village, a landowner belonging to an upper socio-economic class with good social networks and connections. He has severe hearing disability and sustained fracture of his right hip for which hip replacement surgery was performed, but due to lack of proper physiotherapy and rehabilitation services, his mobility is also restricted. He negotiates the various barriers he faces due the disability effectively and seems to be in fair control of his self-management of diabetes. The second patient is a 46-year-old Muslim gentleman, living in a secluded colony of the village, a manual laborer, belonging to a poor socio-economic class with poor living conditions. Some years ago, he had a stroke involving his left upper and lower limbs. Due to deep mistrust in government healthcare services, he takes sporadic treatment in the private sector by paying out of pocket for the treatment. Due to the prohibitive costs involved in the treatment, he is irregular on medicines. He never got proper physiotherapy or rehabilitation services for his disability due to stroke, which has severely limited his mobility. Lack of mobility and inadequate intake of medicines have made his diabetes control poor. The privileges that the elderly man had mitigated the limitations induced by the disabilities and have helped him have fairly good self-management behaviors, whereas multiple layers of vulnerability intersected with the disability in the 46-year-old-man and caused his diabetes self-management to be very poor. We discuss this case study using the intersectionality lens.