Fatema Jawad ( Department of Diabetology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan. )
Sanjay Kalra ( Department of Endocrinology, Bharti Hospital, Karnal, India. )
This communication shares the challenges and concerns associated with marriage in persons living with diabetes. It classifies the challenges as psychosocial and biomedical, and lists counselling tips to tackle these. It dispels the various myths associated with marriage, andsuggests proactive steps to improve societal attitudes and practices.
Keywords: Adolescent diabetes, Type 1 diabetes, Type 2 diabetes, Preconception care, Pregnancy, Psychosocial aspects of diabetes, Sexuality.
Marriage is an institution which forms the bedrock of, and is integral to, society. Marriage provides stability, purpose of life, and continuity to the human race. It is unacceptable, therefore, that myths and misconceptions are allowed to interfere with marriage. This article discusses the various psychosocial and biomedical concerns related with marriage in persons with diabetes, and offers pragmatic advise for the community at large.
Adolescents and young adults with diabetes often feel that they are "sick, "abnormal", or "disabled". These feelings are amplified when they experience social ostracization from potential suitors (and their families). Such self-perception may create a 'marriage phobia'; which may further impair self-esteem.1 Specific concerns, common to both persons living with diabetes, and potential suitors, relate to ability to consummate and maintain marital relations, risk of genital diseases, fear of sexual transmission of diabetes, ability to conceive, fear of ill-health during pregnancy, and risk to health of offspring. Families living with diabetes worry about acceptance in society after disease disclosure. 2-4 Another challenge, not highlighted adequately, is with regards to financial planning for the long term management of diabetes after marriage, including preconception care5 and high risk pregnancy management (Table-1).
Diabetes care is complex, and can be daunting, both for the person living with diabetes and her/his family. Contemplation of marriage or pregnancy adds to this complexity, and creates challenges which need to be addressed. Sexual counselling, perineal hygiene, contraceptive usage, preconception care and high-risk pregnancy management are required at various phases in married life. 6
Diabetes affects men and women equally. The female gender, however, bears more than its fair share of the burden associated with diabetes. 7This is especially true in the context of marriage. Psychosocial factors, so obvious in the South Asian context, create confusion regarding self-disclosure in families that have daughters who live with diabetes. Biological considerations place the onus of preconception and post conception treatment on women with diabetes. Young men living with diabetes at the same time, are not immune from marriage-related concerns: concerns regarding sexuality, virility and fertility are common in them as well. 8
A concerted effort, involving multiple stakeholders, is required in order to allay and manage marriage-related health issues in diabetes. Diabetes care professionals should discuss relevant issues with young adults of marriageable age, and their families, in a neutral and nonjudgmental yet empathic and friendly manner. All possible concerns should be identified and managed. Self- disclosure must be encouraged; there is no justification for hiding a medical condition from a potential life partner. 1 Facilities for pre-marriage, post-marriage, preconception and pregnancy management should be provided by the health care system, preferably under one roof. Such services should be integrated into routine diabetes care. Diabetes is said to be a disease of the family, and of society. 8 Therefore, all society should be targeted for health education, aimed to dispel myths and conceptions about diabetes. Persons with well controlled diabetes can marry and procreate, without fear of spreading diabetes, contracting sexually transmitted disease, or developing untoward complications, provided their condition is managed appropriately. Such information, if shared by religious leaders and leaders of civil society, has great impact. This is exemplified by best practices from Bangladesh, where Qazis have successfully helped propagate the message of timely care in gestational diabetes mellitus (GDM). Yet another best practice, from South Asia, relates to matrimonial websites designed to serve persons living with diabetes. Some examples include www.diabeticmatrimony.com, www.jeevansathi.com, www.bandhan.com and www.atozvivah.com. These websites facilitate manner, allowing persons with selfdisclosure of diabetes to find suitable matches.
1. Priya G, Kalra B, Grewal E, Dardi IK. Premarriage counseling in Type 1 diabetes. Indian J Endocr Metab 2018; 22:126.
2. Bajaj S, Jawad F, Islam N, Mahtab H, Bhattarai J, Shrestha D, et al. South Asian women with diabetes: psychosocial challenges and management: consensus statement. Indian J Endocr Metab 2013; 17:548.
3. Kesavadev J, Sadikot SM, Saboo B, Shrestha D, Jawad F, Azad K, et al. Challenges in Type 1 diabetes management in South East Asia: Descriptive situational assessment. Indian J Endocr Metab. 2014; 18:600.
4. Patel N, Eborall H, Khunti K, Davies MJ, Stone MA. Disclosure of type 1 diabetes status: a qualitative study in a mixed South Asian population in central England. Diversity in Health & Care. 2011; 8:217-83
5. Kalra B, Sridhar GR, Madhu K, Balhara YP, Sahay RK, Kalra S. Psychosocial management of diabetes in pregnancy. Indian J Endocr Metab. 2013; 17:815.
6. Kalra S, Sridhar GR, Balhara YP, Sahay RK, Bantwal G, Baruah MP, et al. National recommendations: Psychosocial management of diabetes in Indian J Endocr Metab. 2013; 17:376.
7. Young-Hyman D, De Groot M, Hill-Briggs F, Gonzalez JS, Hood K, Peyrot M. Psychosocial Care for People With Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care 2016; 39: 2126-2140.
8. Kalra S, Balhara YP, Baruah M, Saxena A, Makker G, Jumani D, et al. Consensus guidelines on male sexual dysfunction. J Med Nutr Nutraceut 2013; 2:5-18.