India has a very high burden of type 2 diabetes with an estimated 77 million adults living with diabetes as of 2019, which is projected to increase to 101 million in 2030 and 134 million by 2045.1 Something must be done urgently and immediately to change the current trajectory. The challenge lies in diagnosing the condition in its prediabetes phase, so that steps can be taken to reverse the condition successfully in as many people as possible. By the time symptoms are detected and the condition is diagnosed, oftentimes microvascular and macrovascular complications have already set in. This means that the condition must be managed by patients over a lifetime which increases the risk of tertiary complications and adds to the financial strain on a family, and cumulatively, on the country. I believe that effective diabetes screening programmes at primary health centres is an urgent requirement to stop the rise of diabetes in India. Here, in my view, there is a big opportunity for the private sector to collaborate with the government to strengthen the primary health system by contributing expertise and skills needed for the task.
Role of primary health centres
Most of the Indian population lives in rural areas where there is poor awareness of the subject and a lack of urgency to get tested and diagnosed. Which is why we cannot truly tackle the challenge of diabetes in the country without effectively tackling the risking burden in rural areas. For this, primary health centres are crucial to our effort. These primary health centres must have regular screening programs for the local community. Screening can make a difference: if prediabetes is detected, suitable lifestyle changes can be suggested. If diabetes is diagnosed, early treatment can lower the risk of serious complications later.
In order for this to happen, these centres need effective workflow management systems to streamline patient data collection and record keeping, which is essential for continuous monitoring and follow-up care. Next, healthcare professionals working in these centres must have the specialized training and tools they need to better care for patients with diabetes and manage complications. Primary health centres must be suitably stocked with blood glucose meters, lancing devices, glucose strips, and blood sugar control medication to ensure seamless monitoring and treatment.
It is unrealistic to expect primary health centres to take on such a massive undertaking completely on their own. They need to be supported by the private health system, and in particular, by pharmaceutical companies. These companies can develop low-cost and easy to use workflow management systems that reduce the dependence on a paper trail and are more efficient at capturing data and ensuring follow-up. Companies can also organize continuing medical education programs in which centre-based healthcare professionals are trained by more experienced and renowned diabetes experts. When necessary, a teleconsultation facility can be arranged for cases that are difficult to treat or manage. And of course, given better access to resources, pharmaceutical companies can help to ensure that primary health centres are always stocked with the instruments and medication they need.
If all of this is in place, I believe primary health centres would be in a much stronger position to carry out regular screening programmes in the communities that they serve, so that patients are given the counsel and medication they need to lower the overall incidence of diabetes and its complications. In time, this would ease the burden on the community and on the country as well. A focussed, collaborative approach can thus help to address the growing burden of diabetes in India.
Diabetes management must be part of India’s overall public health agenda. The sudden and severe onslaught of Covid-19 and its lethal impact on those suffering from diabetes have given us one more reason why it is imperative that such chronic conditions are controlled effectively. Diabetes care must begin proactively in the community through primary health centres, ably supported by pharmaceutical and other private sector companies.
- International Diabetes Federation. IDF Diabetes Atlas. 9th edition, 2019. https://www.diabetesatlas.org/en/resources/
Views expressed above are the author’s own.
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