Hyderabad: In a narrow lane in Hyderabad, a woman in her fifties begins her day before sunrise. She sweeps the floor, prepares tea, cooks for the family, and sends everyone off. She has diabetes. She takes her medication every day. But she eats what everyone else eats, skips exercise, and rarely checks her blood sugar.
This is not neglect. It is a constraint.
A recent study by the ICMR–National Institute of Nutrition (NIN), which spoke to 107 low-income adults living with type 2 diabetes across four communities in Hyderabad, reveals a stark disconnect between medical compliance and actual disease management. While access to medicines appears largely successful, the daily realities of managing diabetes remain deeply compromised by social, economic, and psychological barriers.
Nearly 96% of participants reported taking their medication regularly. On paper, this suggests success. But the study quickly dismantles that assumption. Three out of four participants followed no structured diet. Almost half reported little to no physical activity. Blood glucose monitoring was sporadic, often triggered only when symptoms worsened.
“If I feel I am down, I go for a check-up,” a 71-year-old man told researchers, highlighting a reactive, rather than preventive, approach to care.
The study’s composite self-care score averaged just 3.2 out of 7, reflecting poor overall management despite high medication adherence. Researchers noted that adherence to practices such as diet control, exercise, and monitoring “remained inconsistent,” even among those who took their prescriptions without fail.
Participants were not unaware. Many understood the risks of sugar and processed foods. Yet awareness did not translate into action. “I eat everything, even sweets and ice cream,” admitted a 66-year-old woman. Another participant said bluntly: “I don’t follow any dietary restrictions.”
The gap is not about ignorance. It is about the inability to act.
When care begins at home, and ends there
For women, the burden of diabetes management falls within the household.
The study found that women consistently scored lower on self-management indicators. Researchers linked this to caregiving roles, domestic labour, and what they described as “time poverty.” Women, often responsible for cooking and running households, prioritise family needs over their own health.
One woman explained, “No stamina, I do household chores and puja, but no outdoor exercise.” Another, just 34 years old, captured the economic trade-off: “Even though I have diabetes, food is more important, and medicines are costly.”
Even dietary choices are rarely individual. “I eat with my family, no restrictions,” said one participant, reflecting how household norms override medical advice. In such settings, following a separate diabetic diet is often unrealistic.
Researchers concluded that women’s poorer adherence was “closely linked to their disproportionate burden of caregiving, household labour, and food preparation responsibilities.” These pressures “limit opportunities for self-care, even when awareness exists.”
The disease, in effect, competes with daily survival.
When the body carries more than one burden
Diabetes rarely exists in isolation. And when it does not, the strain multiplies.
Nearly 64% of participants also had hypertension, and many were managing multiple chronic conditions. The study identified multimorbidity as the only statistically significant predictor of poor self-management.
Each added condition brings more medicines, more costs, and more decisions. Over time, the system a patient builds to manage their health begins to strain.
“The high burden of multimorbidity further compounded these challenges,” the study noted, “increasing both physical and psychological strain.”
A 68-year-old man navigating this complexity admitted, “I am not very aware of what to eat and what to avoid.” His words point not to indifference, but to a system that has not adequately guided him.
The silent weight of distress
Somewhere between taking a pill and living with a disease, mental health slips in quietly.
Nearly 40% of participants showed signs of diabetes-related emotional distress. Younger adults, particularly those in their thirties and forties, reported higher levels of anxiety, driven by concerns about income, family responsibilities, and the long-term costs of illness.
“For these individuals, concerns about future earning potential and the ability to meet family obligations appeared to intensify distress,” researchers observed.
Quality of life scores were consistently low, with social relationships emerging as the weakest domain. Many participants described feeling isolated in their illness.
Coping mechanisms varied. Among some men, alcohol became a way to manage stress. “Whatever the case, at the end of the day, I consume alcohol; it reduces tension and keeps us calm,” said one participant.
Strikingly, none of the 107 individuals reported receiving structured mental health support as part of their diabetes care.
The system treats the body. The mind is left to cope on its own.
What the doctor never fully said
Doctors remained the primary source of information for most participants. But beyond prescriptions, guidance appeared limited.
Dietitians were rarely consulted. Nearly one in three participants reported using herbal remedies alongside their prescribed medication, pointing to gaps in counselling and follow-up.
A 68-year-old man admitted he did not know what foods to avoid, despite living with diabetes and being under medical care. The system had provided medicine, but not clarity.
This is unfolding in a country carrying one of the world’s largest diabetes burdens. India now has over 101 million adults living with the disease, with urban prevalence rising sharply in recent decades.
The study argues that diabetes care cannot be reduced to access alone. “Diabetes self-care management outcomes in low-income urban settings are shaped by interconnected social and structural factors,” it states.
Researchers call for “gender-responsive strategies,” integrated care models, and community-based interventions that reflect how people actually live, not how guidelines assume they should.
What the pill bottle cannot fix
A woman eating sweets with her family is not ignoring medical advice. She is navigating a household, a budget, a role, and a disease, all at once.
As the study puts it, “Socioeconomic disadvantage, inadequate access to diabetes-related information, time constraints arising from work and household responsibilities, restrictive household norms and gender roles, financial barriers, and psychological fatigue collectively hinder effective self-care practices.”
It is a dense sentence. But it reflects a lived reality.
The pill is only one part of diabetes care. The rest lies in everyday life, in kitchens, in work schedules, in stress, in silence.
And that is where the system continues to fall short.
