Indian study finds ways to control diabetes sans doctors
13 Jul 2016
Low-cost software used by a non-physician worker optimises treatment and lowers complications in diabetes patients by doubling blood glucose control and lowering blood pressure and 'bad' LDL cholesterol at no added cost, reports a study from India and Pakistan.
In India, close to 70 million people have diabetes and another 40 million are insulin-resistant, which is a precursor to diabetes. More than four in five diabetics on medication in India do not have their blood glucose under control.
The new study, of more than 1,100 patients across 10 centres – nine in India and one in Karachi, Pakistan – over five years and published in Annals of Internal Medicine, is the first global trial of diabetes management in low- and middle-income countries, home to 75 per cent of the world's 415 million diabetics.
The study found that non-physician coordinators with technology that welded electronic health records with decision-support software sizeably improved blood sugar, blood pressure and cholesterol profiles of patients and lowered risk of complications such as heart disease, eye disease (retinopathy), kidney failure and amputations.
''What makes this model workable is the low dependence on physicians, who are often few and far between, especially in rural areas. Any graduate or social worker with six or more months of experience in healthcare, social work or allied sciences and basic computing and good communication skills meets the requirement for a care coordinator, who then gets trained for 2.5 days to get acquainted with key principles of diabetes management,'' said Dr Nikhil Tandon, head of endocrinology, All India Institute of Medical Sciences (AIIMS), which partnered with the Public Health Foundation of India (PHFI) and Emory University, Atlanta, US, to do this ''real life study'' of patients getting treated for diabetes in public and private clinics and hospitals.
''No new or expensive drugs were added as the intervention is based on improved data-management and human intervention. It enhances the patients' skills of managing their disease on their own by providing individualised support and making the physician more responsive by making better data available,'' says Dr D Prabhakaran, vice president, research and policy, PHFI.
The outcomes were similar across public and private hospitals and the model has been replicated using the public-health resources. ''Auxillary nurse midwives at community health centres in Solan in Himachal Pradesh have used the intervention with excellent results, which shows it is translatable on a larger scale and at different levels of health care,'' says Dr Tandon.
''The decision-support software is free for public health facilities and will have a nominal charge for private clinics and users,'' says Dr Prabhakaran.
