Addressing policy needs for prevention and control of type 2 diabetes in India

Abstract

India carries nearly one-fifth of the global burden of diabetes cases, the majority of which are of type 2 diabetes. Recognising the need for controlling diabetes, the Government of India has initiated a national level programme for prevention and control of diabetes along with other non-communicable diseases in 2008. Despite being piloted and implemented, there is hardly any published literature about the national level situation of diabetes and its control efforts. The present article is written with the aim to fill this gap to some extent and to provide a situational analysis of the diabetes problem in India in a holistic way, addressing policy needs for the national programme. It focuses on three main areas, namely, awareness of diabetes, costs of drugs for its treatment and healthcare-system related issues. It argues that poor coverage and weak implementation of the national level programme are major forces that push patients to seek help in the weakly regulated private sector. Approaching the private sector is likely to increase the cost of care, which in turn can lead to an increased financial burden for patients and their families due to factors such as patients' lack of awareness about diabetes, poor drug price regulation and prescriptions including combinations and/or patented products of medicines used for treating diabetes by the private sector. This article addresses several needs such as strengthening the national programme and increasing its reach to unreached districts, exerting drug price regulation and implementing community-based participatory programmes for prevention and management of type 2 diabetes. It also underscores a need for piloting and implementing a robust national level electronic reporting system for diabetes programmes.

The role of the private sector in noncommunicable disease prevention and management in low- and middle-income countries: a series of systematic reviews and thematic syntheses

“…The role of the private sector in healthcare provision increases the availability and accessibility of NCD services in LMICs (Agarwal, 2005 ; Ashigbie et al, 2020 ; Atre, 2015 ; Bhojani et al, 2012 ; Mukherjee et al, 2011 ; Musinguzi et al, 2015 ; Wearne et al, 2019 ). This increased availability is often less affordable (Balasubramaniam et al, 2014 ; Subramanian et al, 2018 ; Wirtz et al, 2018 ) however, the private sector is involved in other initiatives that aim to improve affordability such as private medical insurance or mitigating the cost of treatment or transport (Abraham et al, 2009 ).…”

“…Nine studies were considered high quality, six medium quality, and seven low quality (Appendix D). Studies were primarily downgraded for insufficient mention of ethics and bias (Abraham et al, 2009 ; Agarwal, 2005 ; Ashigbie et al, 2020 ; Atre, 2015 ; Balasubramaniam et al, 2014 ; Bhojani et al, 2012 ; Bissell et al, 2016 ; Cataife, 2012 ; Dabare et al, 2014 ; Mukherjee et al, 2011 ; Pandian et al, 2007 ; Polanczyk & Ribeiro, 2009 ; Rawal et al, 2020 , 2020 ; Subramanian et al, 2018 ; Syed et al, 2018 ; Wearne et al, 2019 ; Wirtz et al, 2018 ) and incomplete description of sampling (Abraham et al, 2009 ; Agarwal, 2005 ; Ashigbie et al, 2020 ; Atre, 2015 ; Balasubramaniam et al, 2014 ; Bhojani et al, 2012 ; Bissell et al, 2016 ; Cataife, 2012 ; Dabare et al, 2014 ; Pandian et al, 2007 ; Polanczyk & Ribeiro, 2009 ; Subramanian et al, 2018 ; Syed et al, 2018 ; Wearne et al, 2019 ).…”

“…The private sector often provides healthcare services that are missing in public healthcare, however, the care provided in the private sector is more expensive and patients must often decide between paying high OOP expenses or forgoing recommended treatment (Armstrong-Hough et al, 2020 ; Balasubramaniam et al, 2014 ; Bissell et al, 2016 ; Kasonde et al, 2019 ; Mhlanga & Suleman, 2014 ; Musinguzi et al, 2015 ; van de Vijver et al, 2013 ). Individuals opt to go to private facilities for NCD care due to perceived higher quality or because required services were not available in public centres (Atre, 2015 ; Rawal et al, 2020 ; Tusubira et al, 2020 ).…”

The burden of diabetes in India

“…This problem is further aggravated because of substantial variation in the prices of drugs in the Indian pharmaceutical market. 3 Because diabetes is not a notifiable condition, there are few data available on patients treated in the private sector, and thus its actual burden is unknown. As a result, the burden of diabetes in India might be underestimated.…”

Diabetic retinopathy detection and classification using capsule networks

“…The quantity of individuals with diabetes in India has expanded from 26 million to 65 million in 1990 and 2016, respectively [2]. Most of the diabetes cases are of type-2 diabetes [3]. In 2010, the Government of India started National Program for Preclusion and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS) [4].…”