Problems associated with diabetes care in India

Viswanathan, Vijay; Rao, V Narayan

doi:10.2217/dmt.12.62

Cited by 21 publications

(12 citation statements)

References 26 publications

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“…This study is expected to help in understanding the emergence of complications at a relatively early age. It is known that diagnosis of diabetes takes place in India quite late in the disease cycle and that the complications of diabetes in Indians appear a decade earlier than in people with diabetes in the West . The literature from population‐based studies in India indicate that disease diagnosis remains undetected in about half of the population with diabetes and may support the observation of a large majority of people having complications at the time of diagnosis itself .…”

Section: Discussionmentioning

confidence: 99%

Rationale, study design and methodology of the LANDMARC trial: a 3‐year, pan‐India, prospective, longitudinal study to assess management and real‐world outcomes of diabetes mellitus

et al. 2019

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Aim India contributes towards a large part of the worldwide epidemic of diabetes and its associated complications. However, there are limited longitudinal studies available in India to understand the occurrence of diabetes complications over time. This pan-India longitudinal study was initiated to assess the real-world outcomes of diabetes across the country.Methods The LANDMARC study is the first prospective, multicentre, longitudinal, observational study investigating a large cohort of people with type 2 diabetes mellitus across India over a period of 3 years. The primary objective of this ongoing study is to determine the proportion of people developing macrovascular diabetes complications over the duration of the study (36 months AE 45 days) distributed over seven visits; the secondary objective is to evaluate microvascular diabetes complications, glycaemic control and time-to-treatment adaptation or intensification. Overall, 6300 participants (aged 25-60 years) diagnosed with type 2 diabetes for at least 2 years will be included from 450 centres across India. Data will be recorded for baseline demographics, comorbidities, glycaemic measurements, use of anti-hyperglycaemic medications and any cardiovascular or other diabetes-related events occurring during the observational study period.Conclusions The LANDMARC study is expected to reveal the trends in complications associated with diabetes, treatment strategies used by physicians, and correlation among treatment, control and complications of diabetes within the Indian context. The findings of this study will help to identify the disease burden, emergence of early-onset complications and dose titration patterns, and eventually develop person-centred care and facilitate public health agencies to invest appropriate resources in the management of diabetes.

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Section: Discussionmentioning

confidence: 99%

Rationale, study design and methodology of the LANDMARC trial: a 3‐year, pan‐India, prospective, longitudinal study to assess management and real‐world outcomes of diabetes mellitus

et al. 2019

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“…In a Pan-India study, only 43.4% patients had their BP checked at the time of diagnosis; the figures were 17.6%, 5.6% and 4.2% for eye examination, kidney function tests and lipid tests, respectively, for diabetics with complications [47]. At the facility level, there is a lack of timely supply of drugs and medical equipment including diagnostic kits, lack of trained providers such as medical officers, pharmacists and laboratory technicians [47]. A study found that only 10-12% of people with diabetes received modern pharmacological treatment in India on an average.…”

Section: Gaps In Facility Readiness and Provider Capabilitymentioning

confidence: 98%

“…The availability of key oral anti-diabetic drugs such as Glibenclamide varied from 100% in the state of Karnataka to 3.8% in West Bengal. Although insulin therapy is accepted as one of the most effective and dependable treatment options, barriers to its use were identified [47]; In most patients, insulin was delayed until it was absolutely necessary or when the HbA1c levels had deteriorated further to approximately 9%. Inadequate use of patient medical records and improper adherence to standard treatment protocols affect clinical decision-making; only six of the 15 health facilities in an urban health study had a system that tracked medical records of diabetes patients and providers in all these facilities expressed that there was no such thing called standard treatment protocols and treatment depends upon the individual analysis of patient condition [48].…”

Section: Gaps In Facility Readiness and Provider Capabilitymentioning

confidence: 99%

A narrative review of gaps in the provision of integrated care for noncommunicable diseases in India

et al. 2020

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Background: Low-and middle-income countries (LMICs) account for a higher burden of noncommunicable diseases (NCD) and home to a higher number of premature deaths (before age 70) from NCDs. NCDs have become an integral part of the global development agenda; hence, the scope of action on NCDs extends beyond just the health-related sustainable development goal (SDG 3). However, the organization and integration of NCD-related health services have faced several gaps in the LMIC regions such as India. Although the national NCD programme of India has been in operation for a decade, challenges remain in the integration of NCD services at primary care. In this paper, we have analysed existing gaps in the organization and integration of NCD services at primary care and suggested plausible solutions that exist. Method: The identification of gaps is based out of a review of peer-reviewed articles, reports on national and global guidelines/protocols. The gaps are organized and narrated at four levels such as community, facility, health system, health policy and research, as per the WHO Innovative Care for Chronic Conditions framework (WHO ICCC). Result: The review found that challenges in the identification of eligible beneficiaries, shortage and poor capacity of frontline health workers, poor functioning of community groups and poor community knowledge on NCD risk factors were key gaps at the community level. Challenges at facility level such as poor facility infrastructure, lack of provider knowledge on standards of NCD care and below par quality of care led to poor management of NCDs. At the health system level, we found, organization of care, programme management and monitoring systems were not geared up to address NCDs. Multi-sectoral collaboration and coordination were proposed at the policy level to tackle NCDs; however, gaps remained in implementation of such policies. Limited research on the effect of health promotion, prevention and, in particular, non-medical interventions on NCDs was found as a key gap at the research level.

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“…It includes hospital expense, laboratory expense, and cost of medications as the direct cost. 3 It was postulated that the total annual cost of diabetes care in India was INR 1230 to 1837.3 billion in 2010. 4…”

Section: Financial Burden and Diabetes-related Healthcare Costmentioning

confidence: 99%

Diabetes and Insurance

Ghosh

Mukhopadhyay

Bajaj

2019

Journal of Social Health and Diabetes

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India has healthcare expenditure of more than 5 billion dollars on diabetes-related healthcare management. Globally, approximately 12% of health expenditure is spent on diabetes and related comorbidities. Hospitalization includes hospital and laboratory expenses and cost of medications as the direct cost. India is among the countries, where if the insured dies during the time period specified in the insurance policy and the policy is active, or in force, then a death benefit will be paid. Studies in India reported that medical reimbursement is availed by 21.3% in the high-income group and only 6.4% of the urban low-income group. An average cost of management of diabetic complications like diabetic foot, retinopathy, and patients with two complications was almost close to the average cost of claimed amount. Patients may be advised to take insurance for diabetes when there is any indication of future disease and risk factors contributing to diabetes like a strong family history, obesity, hypertension, and other vascular diseases. Diabetes Safe from Star Health and Varistha Mediclaim from National Insurance were among the first insurance policies to be launched in India.

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Problems associated with diabetes care in India

Cited by 21 publications

References 26 publications

Rationale, study design and methodology of the LANDMARC trial: a 3‐year, pan‐India, prospective, longitudinal study to assess management and real‐world outcomes of diabetes mellitus

Rationale, study design and methodology of the LANDMARC trial: a 3‐year, pan‐India, prospective, longitudinal study to assess management and real‐world outcomes of diabetes mellitus

A narrative review of gaps in the provision of integrated care for noncommunicable diseases in India

Diabetes and Insurance

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