India shows the way to better diabetes care at no added cost
Low-cost software used by a non-physician worker doubles blood glucose control and lowers blood pressure and ‘bad’ LDL cholesterol in diabetes patients at no added costindia Updated: Jul 12, 2016 07:35 IST
Low-cost software used by a non-physician worker optimises treatment and lowers complications in diabetes patients by doubling blood glucose-control and lowering blood pressure and ‘bad’ LDL cholesterol at no added cost, reports a study from India and Pakistan.
In India, close to 70 million people have diabetes and another 40 million are insulin-resistant, which is a precursor to diabetes. More than four in five diabetics on medication in India do not have their blood glucose under control .
The new study, of more than 1,100 patients across 10 centres – nine in India and one in Karachi, Pakistan – over five years and published in Annals of Internal Medicine, is the first global trial of diabetes management in low- and middle-income countries, home to 75% of the world’s 415 million diabetics.
The study found that non-physician coordinators with technology that welded electronic health records with decision-support software sizeably improved blood sugar, blood pressure and cholesterol profiles of patients and lowered risk of complications such as heart disease, eye disease (retinopathy), kidney failure and amputations.
“What makes this model workable is the low dependence on physicians, who are often few and far between, especially in rural areas. Any graduate or social worker with six or more months of experience in healthcare, social work or allied sciences and basic computing and good communication skills meets the requirement for a care coordinator, who then gets trained for 2.5 days to get acquainted with key principles of diabetes management,” said Dr Nikhil Tandon, head of endocrinology, All India Institute of Medical Sciences (AIIMS), which partnered with the Public Health Foundation of India (PHFI) and Emory University, Atlanta, US, to do this “real life study” of patients getting treated for diabetes in public and private clinics and hospitals.
“No new or expensive drugs were added as the intervention is based on improved data-management and human intervention. It enhances the patients’ skills of managing their disease on their own by providing individualised support and making the physician more responsive by making better data available,” says Dr D. Prabhakaran, vice president, research and policy, PHFI.
The outcomes were similar across public and private hospitals and the model has been replicated using the public-health resources. “Auxillary nurse midwives at community health centres in Solan in Himachal Pradesh have used the intervention with excellent results, which shows it is translatable on a larger scale and at different levels of health care,” says Dr Tandon.
“The decision-support software is free for public health facilities and will have a nominal charge for private clinics and users,” says Dr Prabhakaran.
•415 million people with diabetes worldwide
•75% adults with diabetes live in low- and middle-income countries
•Close to one in two (46%) people with diabetes are undiagnosed
•Diabetes kills 5 million annually, one death every six seconds
•More than 542,000 children with type 1 diabetes
•One in seven births -- More 20.9 million worldwide -- affected by diabetes during pregnancy
•Health expenditure of US$ 673 billion dollars in 2015
•70 million in India
•One in 12 adults have diabetes
•80% patients with poorly controlled blood glucose (an HbA1c > 7%)
•30-50% diabetics with uncontrolled blood pressure and cholesterol
•Stay active. Walk at least 8 km (10,000 steps) each day
•Avoid processed food
•Cut back on sugar simple carbohydrates (refined flour, polished rice, potatoes)
•Keep a healthy weight
•Lose belly fat
•Get six to seven hours of sleep
•Get blood sugar levels tested at age 30 if your mom, father, brother or sister with diabetes
If untreated, uncontrolled blood sugar levels may cause:
•Eye damage (retinopathy)
•Stroke, cerebral circulation damage (cerebrovascular disease)
•Kidney disease (nephropathy)
•Peripheral nerve damage (neuropathy)
•Circulation problems in the legs (Peripheral vascular disease)
•Foot ulcers and amputations