The Burden Of Diabetes In India: Challenges & Solutions
Having completed his MBBS and MD - General Medicine from the Madras Medical College, Chennai, Dr. Mohan is one of the most eminent personalities in the Indian Diabetes realm and even received the prestigious Padma Shri award in 2018 for his contribution in the field of diabetes.Currently in second place with respect to the number of people with diabetes, India is expected to soon overtake China to become the ‘Diabetes Capital of the World’. More worrisome is the fact that diabetes is a major cause of blindness, kidney failure, amputations, and cardiovascular disease. Thus, diabetes leads to both premature morbidity as well as mortality. This underscores the need for urgently reducing the burden due to diabetes in India. This article lists some of the challenges that diabetes poses for our country and suggests possible solutions.
Challenge-1: Sheer Magnitude of the Problem of Diabetes
According to the Diabetes Atlas 2017 of the International Diabetes Federation, it is estimated that there are currently over 74 million people affected with diabetes in India, and this number is projected to increase to 134 million by 2045. The ICMR INDIAB Study showed that the prevalence of diabetes varied from 4.3 percent in Bihar to 13.6 percent in Chandigarh. Moreover, the rates of prediabetes are even higher. This shows that the diabetes epidemic is far from over. Diabetes will become a condition that has gone out of control unless intense and focused efforts are made by governments, communities and individuals.
Challenge-2: High Economic Burden
The annual cost of diabetes care was over Rs.1800 billion in the year 2010 and would be much higher now. Presence of complications further increases the cost of treatment. One study reported that the cost of diabetes care for a patient with foot ulcers was more than four times higher (Rs.19,020) than that for a patient without foot ulcers (Rs.4493). When the cost of diabetes as a percent of GDP was compared in five different countries, India had the highest (2.1 percent) much higher than US, UK, Den-mark and China.
Challenge-3: Translating Evidence into Practice
There is strong evidence that primary prevention of diabetes in those with prediabetes is possible. In the D-CLIP (Diabetes Community Lifestyle Improvement Program), we showed that through a step-wise program on lifestyle modification like diet,
exercise and weight reduction, we could reduce diabetes incidence by 32 percent in those with prediabetes. We have to therefore screen for prediabetes and advise lifestyle modification.
Challenge-4: Burden Due to Diabetes Related Complications
In the Chennai Urban Rural Epidemiology Study (CURES) carried-out by us, we showed that at least 20 percent of people with diabetes in Chennai have diabetic eye, kidney, heart or nerve complications, and many have more than one complication. The good news of course is that with early detection and good control of diabetes, these complications can be prevented. Hence, all efforts must be made to achieve good control of diabetes, right from the time of diagnosis of diabetes.
Challenge-5: 50 Percent of People with Diabetes Remain Undiagnosed
In the CURES study, we also showed that more than 50 percent of people with diabetes remain undiagnosed. Even among those detected, 50 percent do not take treatment. Finally among those who take treatment, over 50 percent are not under control. This means that 88 percent of people in the community do not have adequately controlled diabetes. Thus, there is an urgent raise in awareness about diabetes in the community at large.
Highly processed ‘junk’ foods, high in sugar and fats are mass-produced cheaply while healthier options like vegetables and fruit have become unaffordable to the common man. Advertisements promoting unhealthy foods and habits have become the norm. Restaurants offer super size meals of unhealthy foods. Industry can help to offer healthier lifestyle choices to people, which besides improving the health of people, can also be a profitable business.
Challenge-7: Lack of Availability, Accessibility & Affordability of Healthcare in Rural India
When 70 percent of the Indian population lives in villages, 75 percent of doctors practice in urban areas. To ad-dress this problem, we introduced the Chunampet Model for Rural Diabetes Care. A population of 50,000 people living in 42 villages in & around Chunampet in Kanchipuram district in Tamil Nadu were screened free of cost using a mobile van fitted with telemedicine facilities. In addition, a rural diabetes centre was setup to provide follow-up diabetes care. Within three years, the whole population was screened for diabetes, over 90 percent of those with diabetes underwent screening for diabetic complications and control of diabetes dramatically improved. All this was achieved with staff who were hired locally and at very low cost. The Chunampet Rural Diabetes Model can be scaled-up to reach-out to the rural poor in India.
Challenge-8: Rising Costs of Therapy
The last challenge is that the therapy is getting expensive. Newer drugs, insulins and technologies are undoubtedly welcome, but they come at exorbitant prices which are out of reach of the common man who usually pays ‘out of pocket’. It is essential to keep prices of life saving drugs and devices (eg., insulin syringes, pens, glucose meters and strips) low by exempting them from customs or other duties so that they are affordable. Medical insurance must be extended to people with diabetes, which should also cover costs of preventive checkups and costs of medication.
Undoubtedly, diabetes presents huge challenges to India. However, there are simple solutions such as those outlined in this article which if adopted, will ensure that despite the huge burden due to diabetes that our country is currently facing, a long and healthy life despite diabetes is possible for everyone. The time for action is NOW!
Challenge-4: Burden Due to Diabetes Related Complications
In the Chennai Urban Rural Epidemiology Study (CURES) carried-out by us, we showed that at least 20 percent of people with diabetes in Chennai have diabetic eye, kidney, heart or nerve complications, and many have more than one complication. The good news of course is that with early detection and good control of diabetes, these complications can be prevented. Hence, all efforts must be made to achieve good control of diabetes, right from the time of diagnosis of diabetes.
Challenge-5: 50 Percent of People with Diabetes Remain Undiagnosed
In the CURES study, we also showed that more than 50 percent of people with diabetes remain undiagnosed. Even among those detected, 50 percent do not take treatment. Finally among those who take treatment, over 50 percent are not under control. This means that 88 percent of people in the community do not have adequately controlled diabetes. Thus, there is an urgent raise in awareness about diabetes in the community at large.
Challenge-6: Opposing Industry ForcesIt is essential to keep prices of life saving drugs and devices low by exempting them from customs or other duties so that they are affordable
Highly processed ‘junk’ foods, high in sugar and fats are mass-produced cheaply while healthier options like vegetables and fruit have become unaffordable to the common man. Advertisements promoting unhealthy foods and habits have become the norm. Restaurants offer super size meals of unhealthy foods. Industry can help to offer healthier lifestyle choices to people, which besides improving the health of people, can also be a profitable business.
Challenge-7: Lack of Availability, Accessibility & Affordability of Healthcare in Rural India
When 70 percent of the Indian population lives in villages, 75 percent of doctors practice in urban areas. To ad-dress this problem, we introduced the Chunampet Model for Rural Diabetes Care. A population of 50,000 people living in 42 villages in & around Chunampet in Kanchipuram district in Tamil Nadu were screened free of cost using a mobile van fitted with telemedicine facilities. In addition, a rural diabetes centre was setup to provide follow-up diabetes care. Within three years, the whole population was screened for diabetes, over 90 percent of those with diabetes underwent screening for diabetic complications and control of diabetes dramatically improved. All this was achieved with staff who were hired locally and at very low cost. The Chunampet Rural Diabetes Model can be scaled-up to reach-out to the rural poor in India.
Challenge-8: Rising Costs of Therapy
The last challenge is that the therapy is getting expensive. Newer drugs, insulins and technologies are undoubtedly welcome, but they come at exorbitant prices which are out of reach of the common man who usually pays ‘out of pocket’. It is essential to keep prices of life saving drugs and devices (eg., insulin syringes, pens, glucose meters and strips) low by exempting them from customs or other duties so that they are affordable. Medical insurance must be extended to people with diabetes, which should also cover costs of preventive checkups and costs of medication.
Undoubtedly, diabetes presents huge challenges to India. However, there are simple solutions such as those outlined in this article which if adopted, will ensure that despite the huge burden due to diabetes that our country is currently facing, a long and healthy life despite diabetes is possible for everyone. The time for action is NOW!
