Undoubtedly, Nigeria is the most populous country in Africa with about 400 ethnic groups and languages. There is a double burden of disease with rising incidence and prevalence of diabetes mellitus. World Health statistics indicate that Nigeria has the highest number of diabetics in sub-Saharan Africa. In spite of advances in diabetes care and facilities, desired outcomes are not good and linked to this, patient satisfaction is not optimal. Reasons include inadequate attention to biological aspects of diabetes, inadequate or inappropriate pharmacology and psycho-socio-cultural factors. In this review, crucial socio-cultural factors in Nigeria include traditional medicine, religion, diet, physical activity patterns, foot care, awareness, and stress management. Diabetes programs in Nigeria should adopt the principles of education and psycho-social support highlighted by the DAWN study, integrating our socio-cultural heritage, empowering individuals to take charge of their diabetes and achieve desired health outcomes. Religion should be explored as a potential tool to reach out on facts whilst doing away with erroneous beliefs about diabetes mellitus.

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Background: The American diabetes association (ADA) and European association for the study of diabetes (EASD) recently issued an updated position statement on the management of hyperglycemia in type 2 diabetes. The choice of nomenclature of these guidelines is refreshing as it highlights a patient-centered approach to managing diabetes. Discussion: This debate looks at these guidelines through the prism of patient-centeredness, it tries to assess if the authors of the ADA-EASD position statement have been able to "walk the talk" with respect to the patient-centered approach that they advocate. Conclusion: We conclude that the guidelines can be made more patient-centered, by emphasizing psychosocial and psychiatric comorbidity of diabetes, ethno pharmacy, and patient-friendly insulin regimes and oral fixed dose combinations, in a culturally competent, globally acceptable manner.

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Diabetes and depression are major public health problems associated with significant burden. They share many commonalities. Both the diseases have a very high prevalence, mortality, and disability. The current article reviews the available evidence on psycho-social interventions in management of depression in diabetes. A literature search was performed using MEDLINE, PubMed, PsycINFO, Embase, and Cochrane Review for English language articles published during 1960-2012. There is limited published literature on role of psycho-social interventions in management of depression among diabetics. The available evidence suggests that psycho-social interventions, particularly CBT, are effective in improving depression in patients with diabetes. However, these interventions are not consistently associated with improvement in markers of glycemia control (HbA1c levels).

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Qualitative research is a primary way to understand the context of diabetes in a person's life, beyond the medical outcomes. Identifying the qualitative issues such as patients' knowledge about diabetes, their beliefs and attitudes, and their relationship with health care professionals can serve as data to determine the obstacles and, in turn, resolutions to those issues in diabetes management. Characteristics of qualitative and quantitative methods are described, with the discussion that both methods are complementary, not conflicting, to further the field of diabetes research.

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Recently published guidelines on Psychosocial Management of Diabetes in India provide evidence-based recommendations for the whole nation. However, they do not fully address the myriad socio-cultural issues prevalent in the North Eastern states. The eight North Eastern states of India house 45 million people, belonging to 220 ethnic groups who speak an equal number of dialects, and follow distinctly unique cultures, which impact health-related behavior. Such diversity is difficult to cover in any national guideline. This lacuna makes it necessary to have a document, which addresses the specific needs and requirements of diabetes care professionals in the North-east of India. This consensus statement aims to highlight evidence- and experience-based strategies for psychosocial management of diabetes, based upon the unique ethnographic constitution of this part of the country. It is based upon the results of a daylong focused group discussion, held at Sonapur, Assam, on 9 ^th February 2013, involving key opinion leaders from most North-eastern states, including all geographical divisions of Assam. Recommendations are classified into three domains: General, psychological, and socio-cultural, and graded by the weight they should have in clinical practice. Eighteen recommendations of varying strength are made, to help professionals identify the psycho-socio-cultural determinants of diabetes, and to explore the role of psycho-socio-cultural interventions in devising support strategies for people with diabetes and their families. They also aid in developing core skills needed for effective diabetes management. These recommendations provide practical guidelines to fulfill unmet needs in diabetes management in the North-east and help achieve a qualitative improvement in diabetes care. The guidelines may also be useful for diabetes care professionals working with other indigenous groups across the world.

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Introduction: Diabetes is an emergency in slow motion in India. There is an urgent need of improving awareness and education on diabetes in the community and the social scientist working in the community health are the important group to make this happen. Objectives: To assess the prevalence of diabetes among the social scientists and measure their knowledge, attitude, and practice (KAP) on diabetes. Materials and Methods: A delegate of social scientists attending a national conference on social science and health were screened for random blood sugar and a survey was conducted through a structured self-answered questionnaire on KAP in diabetes. Excel Microsoft Office 2010 package was used for descriptive analysis. Results: A total of 245 social scientists attended the conference; of them, 211 (86%) social scientists voluntarily participated in diabetes screening, and among them, 99 (47%) voluntarily responded on KAP questionnaire. Prevalence rate of diabetes among social scientists was found to be 9.5% and the study revealed that the knowledge was fair, attitude was positive, and practice was good among the social scientists working in the field of social health. Conclusion: The social scientists could be the "Change Agents" for the changing diabetes in the community through appropriate strategies involving them.

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This article has a global perspective and includes examples from several continents i.e. Latin America, Africa, Asia and Europe. The Changing Diabetes^® Barometer (CDB) is a Novo Nordisk initiative that works as a worldwide quality monitoring system for diabetes management to measure the gains made in the fight against diabetes focusing on quality of care and patient outcomes. CDB provides a platform for countries to share local diabetes data and good practices. In doing so it aims to disseminate improved practices of care. CDB is conceptualised as a framework that can help change diabetes. Its three cornerstones are "Measure, Share, Improve" (MSI):

1. MEASURE the quality of diabetes care through patient outcomes and care processes.
2. SHARE data on the quality of diabetes care and good practices with all relevant stakeholders.
3. IMPROVE the quality of diabetes care by identifying and actively spreading good practices in diabetes care and inspire others to adopt and follow best practice examples.

Italy and Algeria both constitute best practice examples of CDB initiatives. In Italy a registry solution is already solidly implemented and improvements in patient outcomes have been documented. The initiative in Algeria has recently been initiated including establishment of IT equipment in participating clinics to ensure all relevant measurements. This will enable transparency on current level of quality of diabetes care. Both initiatives have the common goal of driving improvements in quality of care and patient outcomes across clinics. India is another good example where data is collected through the CDB aimed at driving improvement of diabetes care in order to improve quality of life for people with diabetes. CDB in India is implemented in five states (Goa, Bihar, Gujarat, Puducherry and Andhra Pradesh) and is planned to be expanded to five additional states.

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Socio-cultural factors can profoundly influence diabetes control in diabetic patients. Qatar is an oil-rich country characterized by rapid urbanization. Excessive consumption of fast food, sedentary rich life style with totally air-conditioned housing, luxury cars, servants, and little outdoors activities and exercise due to hot weather most of the year have led to an epidemic of obesity and high prevalence of type 2 DM and negatively interfered with metabolic control. Increased incidence of divorce (around 40%) appears to be a risk factor for repeated diabetic keto-acidosis and poor control in children with type 1 DM. In addition, the high prevalence vitamin D deficiency and its possible depressive effect on insulin secretion may be associated with poor diabetes control.

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Diabetes is continuing to be a huge burden in India with more than 60 million people suffering from it. Managing the growing menace of diabetes, we need to establish proper system and strategy in place. Despite a wealth of literature on prevalence, reliable data on the registry of diabetes is lacking in most parts of the world including India. Without such data, the fight against diabetes is being driven in the dark. The current national or state initiatives in the collection of data are incongruent and call for a concerted approach to gather information and track progress. In this prospect, the initiative taken by Government of Puducherry in collaboration with Novo Nordisk Education Foundation is highly innovative as it ensures whole population coverage, introduction of unique identity for each people, automated data processing, and web-based information system along with effective diabetes management.

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"Sho-goh-wah-pee-nay" or "sugar disease," an Oji-Cree word (Native American Indian terminology), is more commonly known as "diabetes." Over the last 70 years, diabetes has become an epidemic within Native American Indian tribes. At about 16%, American Indians and Alaska Natives have the highest occurrence of diabetes in the United States. There are 566 federally recognized tribes. Drifting genes, obesity, and lower educational levels are among the well-known causes of disease management in this group. However, often forgotten are the socio-cultural aspects of this issue. Disease perception, diet, traditional medicine, poor communication, sedentary lifestyle, poor socio-economic status are most important obstacles. Various government-funded programs like National Diabetes Education Program, "We have the power to prevent diabetes" and "Move it! And reduce your risk of diabetes" and diabetes prevention program are in place. Similar guidelines should be developed for all the ethnic or tribal groups across the world before it becomes a pandemic.

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