Beat Diabetes with provision of effective and affordable primary care

By Dr Oommen John

Diabetes mellitus is one of the most important causes of death and disability, crippling healthcare expenditure and reduced productivity posing a huge economic burden in India. According to current estimates, about 12.5% of all Indians have diabetes, half of whom do not know that they have it.

These individual are at high risk of developing cardiovascular, eye and kidney complications. In a recent study conducted by The George Institute for Global Health India among those starting dialysis for end stage renal disease, about a quarter had developed kidney failure as a result of diabetes.

While the theme of World Health Day this year is “Beat Diabetes”, the key to early detection of diabetes and the prevention of renal and other complications lies in the provision of effective and affordable primary care.

There is an urgent need to develop more effective strategies to deliver low-cost, evidence-based treatments for management of diabetes and prevention of complications. Cheap generic drugs that lower blood pressure, improve glycemic control and inhibit the renin angiotensin system are available in India. In combination with statins, these treatments can reduce the risk of diabetic complications by at least a half. 

To make such treatments widely available to all those who need them requires innovative approaches to the delivery of primary healthcare. Even to identify and treat those at the very highest risk of diabetic complications requires expansion of the primary care workforce and the sustained implementation of programs that deliver evidence-based care.

These challenges can only be solved by innovative methods of healthcare delivery. One promising strategy involves ‘task shifting,’ where front-line, non-physician health workers are delegated some of the tasks traditionally performed by physicians. Task-shifting has been shown to improve outcomes and processes of care in the setting of HIV-AIDS. This approach has been envisaged as a potential backbone for the national health mission and is likely to significantly improve the delivery of evidence based interventions in the rural and remote parts of India where about 70% of the population resides.

The George Institute for Global Health is working towards developing an innovate health care delivery approach which involves the non-physician healthcare workforce and training them to effectively identify people with diabetes, refer them appropriately for medical care and then provide continuum of care in the community. The ASHA model will be used as a platform for home based screening assisted by a mobile health enabled clinical decision support tool and the integrated delivery of diabetes management. Field based research to evaluate the feasibility and acceptability of this approach are underway.