Understanding Diabetes in Young Adults Living in India

I was lucky to discover my passion in global health at a young age. As a daughter of Indian immigrants living with type 1 diabetes in Silicon Valley, I was very aware of my privilege in access to healthcare resources and technology. Coming into Duke, I was so excited to develop this passion through summer opportunities with DukeEngage and Duke Global Health Institute (DGHI), but the pandemic had other plans. The summer of 2022 was my last summer as an undergrad, and with travel restrictions lifted, I knew I had to make it count.

Based on my previous experiences, personal and research related, I began a project to examine the relationships between social determinants of health, type 2 diabetes, and quality of life in young adults in South India. I have led this project in collaboration with the Public Health Research Institute of India (PHRII), a non-governmental organization based in Mysore, Karnataka. Upon sharing my research interests with PHRII, they granted me the opportunity to mold this project specific to my interests with the time, manpower, and passion from them as my community partner. Under mentorship from my advisors at DGHI (Dr. Sumedha Ariely and Dr. Eve Puffer) and PHRII, I have been encouraged and supported in developing this project from ground zero. After 9 months of project development, I spent two months living with the PHRII team in Mysore this summer and making my vision a reality.

Since I had already prepared my interview materials, I was able to jump right in when I reached Mysore. In the first week, I went to rural Primary Health Centres (PHCs) in Mysore district to recruit young adults aged 18-35 living with diabetes for my study. The non-communicable disease (NCD) staff at the PHCs were eager to learn about my project and comb through their registries looking for eligible participants. After a few mock interviews within the PHRII staff, we were ready to start conducting interviews! We spent 5 weeks conducting 20 in-depth interviews with young adults living with diabetes – 10 in rural and 10 in urban Mysore district. We noted the differences in experiences between people living just a few doors down from each other, as well as comparing experiences in rural versus urban settings.

Particularly in rural Mysore district, we noticed high levels of depression and perceived stigma along with minimal understanding of diabetes and self-efficacy. After each of the interviews, one of the PHRII field assistants would counsel the participants on what diabetes is and how they can better manage their condition as well as their mental health. The participants expressed their sincere gratitude for the PHRII staff for taking the time to educate them, and one even gifted us a rose before we left!

Based on the results we were seeing, we needed to implement a pathway so that these participants could be referred to professional diabetes and mental health support. We visited Mysuru District Hospital and spoke to the NCD and psychiatry staff to discuss my project and the outcomes we were noting. They said that we could refer patients there, where services and medications are all free of charge. The Indian national government provides funding for NCD services for adults over the age of 30, but the doctors assured us that the younger adults from our study would be taken care of.

This summer has been an immensely meaningful experience, as I gained real-world global health experience and was able to better understand parts of my own identity. At the end of the summer, the PHRII staff and I debriefed our last few interviews and discussed potential next steps for this project. The data from the interviews shone light on many barriers that young adults living with diabetes in Mysore face, so there were a lot of paths we could choose from. I am thrilled to be able to continue working with PHRII to follow up with an intervention to improve diabetes understanding, peer support, and quality of life outcomes in rural Mysore district.