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Opinion: How 360-degree care is crucial for diabetes management in India

A chronic insulin disorder, diabetes today afflicts a major chunk of the global population. The World Health Organization (WHO) estimates that in 2012 an estimated 1.5 million deaths were directly caused by diabetes, with more than 80% of diabetes related deaths occurring in low- and middle-income countries where awareness and monitoring systems are abysmally poor.

Dr Sanjiv Agarwal
Dr Sanjiv Agarwal

India is home to the world’s second largest population of diabetics after China with over 67 million Indians already recognized with having diabetes and an additional 77 million pre-diabetics. The number, already staggering, is further projected to rise to 109 million by 2035 and India will see the world’s biggest increase in diabetes during that time.

If these figures do not scare you enough, it is probably due to paucity of integrated awareness regarding the complications and other health disorders linked with diabetes. Despite being a high-risk nation, India lacks awareness and acceptance of diabetes as a major health risk. Unlike other lifestyle diseases such as cardiovascular disease, hypertension, obesity and even cancer, diabetes is not talked about or considered a ‘high risk’ disease by most people. Here, it is important to underline that the overall risk of dying among people with diabetes is at least double the risk of their peers without diabetes.

Understanding Diabetes

As stated above, the reason why diabetes is not considered a serious health hazard by a large section of the populace is because most people believe that unlike cardiovascular disease or cancer, nobody dies of diabetes directly. What most people are not aware of is that diabetes creates such health complications that a lot of people die of complications due to diabetes. If you have diabetes, you may also have hyperglycaemia, dyslipidaemia and hypertension. Each of these conditions is linked to a number of serious complications, including heart disease, vision loss, kidney failure, nerve damage, and even amputation.

Why 360-degree care?

Rachna (52) was diagnosed with diabetes six years ago. More aware than some of her peers, she did make sure she got her blood sugar and BP levels monitored occasionally and paid that occasional visit to the physician to have herself examined for any complications. However, her blood glucose levels suffered unexpected spikes resulting in irreversible complications. In the absence of continuous monitoring, spikes in blood sugar levels go unnoticed and untreated causing increased complications and deaths in India. When she noticed the challenges of diabetes care and its management, especially in India, she observed absence of awareness, acceptance (among affected populace), and lack of regular diabetes monitoring as the main issues.

Diabetes is a disorder that requires religious monitoring and management. For people who are aware of the importance of regular monitoring and timely intervention the problem is of access to the right care at the right place. A lot of people with diabetes do not get their blood sugar and blood pressure levels monitored regularly, failing to gauge the seriousness of their condition; some take recourse to alternate treatments; yet others do not make adequate lifestyle modifications requiring control on diet and weight. Many people believe they aren’t at risk for diabetes because of the notion that it only affects the elderly or obese. In reality, women, young adults, and children are at greater risk than ever before due to changing diets and sedentary lifestyles. Pregnant women are at particular risk for gestational diabetes that also affects newborns, an increasing problem in India. Self-monitoring is yet to become a norm.

The concept of 360-degree care for diabetes includes a 24×7 system to monitor critical indicators, report them to physicians immediately and get an urgent feedback from them. Since diabetes management includes an entire gamut of lifestyle changing measures, a comprehensive management system will also include daily diet and exercise measures that together keep the individual’s critical indicators in check.

In most cases in India, patients are required to go to different places at different times to have their readings and blood taken. These readings have then to be taken to a physician. This creates multiple broken pathways that discourage many patients, create obstacles to seamless care and are cumbersome. Such diabetes service models of periodic patient visits to their healthcare providers do not lend to regular, disciplined self-management and care required for successful treatment of diabetes.

Dr Sanjiv Agarwal is founder and managing director of Diabetacare, a dedicated diabetes management programme.

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