Improving Prevention, Treatment and Management of Diabetes in India

Diabetes is a growing public health concern in India where an estimated 63 million people are living with diabetes and that number is projected to increase to 101.2 million by 2030. Because of its chronic nature, the severity of its complications and the means required to control them, diabetes is a costly disease, affecting individual, his/her family and also the health system.

Nearly 600 million people will be living with diabetes by 2035, says the International Diabetes Federation. The IDF, PSI and others are marking World Diabetes Day today to call attention to the increasing problem faced by people in every part of the world.

“Diabetes is a disease of development,” says IDF president Sir Michael Hirst.

“The misconception that diabetes is ‘a disease of the wealthy’ is still held, to the detriment of desperately needed funding to combat the pandemic. In coming years we have much to do in making the case for those who have diabetes now and will have in the future.

Studies estimate that, for a low-income Indian family with an adult with diabetes, as much as 25% of family income may be devoted to diabetes care. Despite the availability of proven and effective treatments, detection and control rates of these diseases are abysmally low in the country.

There is a huge gap between detection and adequate treatment. Less than half of those who have diabetes are actually detected, less than half of those detected receive appropriate treatment and less than half of those receiving treatment have their blood sugar to recommended targets.

Enter Project UDay.

Project UDAY is an operational research project and through comprehensive program design and implementation will improve prevention, treatment and optimal management of diabetes and HBP. The five year program will cover 400,000 people above the age of thirty in two states in India, Haryana and Andhra Pradesh. PSI is implementing Project UDAY with program partners; Public Health Foundation of India & Project HOPE with fund support of pharmaceutical company Eli Lilly under NCD partnership.

The project hypothesize that education of the public on diabetes and its risk factors such as  overweight, physical inactivity, unhealthy diet, use of tobacco etc.  will lead to increased self-referral and prevention, while education of the healthcare providers will promote  screening for diabetes and purposeful implementation of evidence based diagnostic and management guidelines.

Considering pharmacists as linkage between health care provider and community, would be  trained in identification of people at risk of and with diabetes, maintenance of a database of patients on insulin/oral hypoglycaemic, correct dispensing and filling of prescriptions and to advise patients on treatment compliance/adherence and lifestyle modification and maintenance of insulin cold chain. They would also be motivated to supply door delivery of drugs and credit lines to poorest patients.

UDAY includes an innovative m Health component. The m-Health system will utilize Decision Support Software applications (DSS) that incorporate evidence-based treatment guidelines and management algorithms to assist physicians and other healthcare providers in the screening, diagnosis and formulation of a management plan for individual patients

Baseline survey supplemented with qualitative research would determine the levels of access, supply chain, stock of medicines, potential barriers to diabetes and HBP care and the degree of conformity to the Indian Public Health Standards (IPHS) recommendations in health care system. This would be followed by Midyear evaluation (Year 3) and post intervention survey (Year 4).

PSI has conducted a qualitative research study to understand perceived risk and susceptibility about diabetes among general population and also to understand the opportunities and barriers to utilize health care services, especially among those who already have diabetes mellitus. Based on the findings and in consultation with Government officials and project partners, mass media campaign is being developed.

PSI has also conducted the orientation training to the pharmacists with pre-test & post –test, initial analysis shows 24 % increase in the level of knowledge.

Expected results after 5 years of implementation is to increase in baseline in levels of:

– 50% increase in public awareness and knowledge about diabetes & risk factors
– 50% increase in diagnosis, treatment and controlled levels of  blood sugar  among patients
– 50% increase in use of guideline based management among health care providers
– 50 % increase in access to care and  adherence to treatment