Diabetes is a major public health problem that is approaching epidemic proportions globally. According to International Diabetes Federation Atlas 2015, approximately 415 million adults have diabetes globally and more than 75% of adults with diabetes live in low and middle-income countries. India is particularly at risk. In India, an estimated 69.2 million people were diabetic in the year 2015, which as per the WHO assessment stood at 63 million in the year 2013. Diabetes prevalence has grown at an alarming rate in India with International Diabetes Federation estimating the number to be 100 million by 2030.
Uncontrolled diabetes significantly impacts the patients’ quality of life: it may lead to loss of workdays, multiple hospital visits, reduced mobility, and even death. If a patient has diabetes, he/she may also have obesity, dyslipidemia and hypertension. Each of these conditions is linked to a number of serious problems, including diabetes related complications like heart disease, loss of vision, kidney failure, nerve damage, and even amputation. The good news is that with proper medical care it is possible to effectively manage all types of diabetes.
The Indian healthcare sector is growing at a rapid pace due to increased investment by public as well private players. Deloitte Touche Tohmatsu India has predicted that as per 2017, the overall Indian healthcare market is worth around US$ 100 billion and is expected to grow to US$ 280 billion by 2020, a Compound Annual Growth Rate (CAGR) of 22.9 per cent. Together the pharmaceuticals industry and the healthcare delivery industry, which includes hospitals, nursing homes and diagnostics centres constitutes 65 percent of the overall healthcare market. There is a significant scope for enhancing healthcare services considering that healthcare spending as a percentage of Gross Domestic Product (GDP) is rising year on year. Though, hospitals and governments have funds to spend, they may not have dedicated resources or technology to take care of the chronic disease management. As per World Health Organization, in India 70 million people live with diabetes and an additional 36 million remain ignorant of their condition. This means that nearly 1 in 10 Indians suffers from this condition but is either unaware of it or is slipping through the treatment cracks with inadequate reporting and monitoring. Such gaps in chronic disease management provides an opportunity for technology driven clinical organisations to intelligently use technology which can make a huge difference in the management of diabetes. Such clinical organizations have the potential to bring about a paradigm shift in diabetes management system in India by moving it from a deeply fragmented model to a 360-degree comprehensive care model. These gaps can be classified as Six A’s.
Awareness: Awareness about diabetes in India, particularly in rural areas, is low. Urban population too, lacks in complete knowledge about diabetes. Though many might be aware of their diabetes status, they have very little know-how about the condition and its complications. Awareness of the major risk factors for diabetes, such as obesity, family history of diabetes, activity level is also considerably very low. Unless people know the risks, primary prevention of diabetes is unlikely in India.
Acceptability: Once a patient becomes aware about his/her diabetes status, he/she may tend to go into a denial mode. There is also social stigma attached to this due to which patients do not like to discuss their diabetic status with people. There is a need for trained health coaches to guide, educate and comfort the patients diagnosed with diabetes to accept their condition.
Access: One of the foremost aspects of diabetes care and management is timely diagnosis and adequate treatment, in the absence of which complications and morbidity due to diabetes can increase drastically. In India, for more than half of Type 2 diabetes population, this condition often remains undetected for many years and the diagnosis is usually made from associated complications or incidentally through an abnormal blood sugar test. Due to lack of access to specialists in hospitals, patients tend to get diagnosed by a general practitioners who depend mainly on medication driven treatment rather than lifestyle intervention and other modern treatment options to manage the patients’ condition. Also, in most patients, use of insulin is delayed due to misconceptions, that its use may have adverse effects on health.
Adoption: Managing diabetes involves a significant lifestyle modification including adoption of a healthy diet and a daily exercise regime, apart from medication and monitoring. But most people with diabetes are not able to adapt to this new change due to the effort and discipline involved. Many youngsters, who have been newly diagnosed with diabetes, do not like to take their medication in public or reveal their condition to their friends primarily due to the social stigma attached to the condition when finding spouses. This attitude towards managing diabetes further worsens the condition.
Adherence: Suboptimal knowledge of or improper adherence to the recommended guidelines is an issue present in India, which leads to a delay in diagnosis and improper management of blood glucose levels, resulting in an increase in related complications. It is essential for physicians to educate their patients about the importance of HbA1c. Adherence to medication and regular monitoring is a key contributor to diabetes treatment outcome. Without regular blood sugar monitoring, control on blood sugar level becomes difficult leading to poor glycaemic control, which can directly raise the risk of complications and increase the cost burden.
Affordability: Treatment of diabetes and its associated complications tends to be expensive especially when it is an out of pocket expense for the patient. Diabetes care involves consultation, oral medication/insulin, laboratory tests and hospital admission. Presence of related complications further increases the cost burden. Since, it is a painless condition most people do not prefer to spend on its management. Hence, it can be considered that the financial burden borne by people with diabetes depends on their awareness level, economic status and social insurance policies available in their country.
Lack of diabetes specialist doctors (or endocrinologists) in smaller cities and rural areas, is yet another hurdle in managing diabetes.
Solutions implemented by clinical organisations to manage diabetes
A productive and informative interaction between the patient, physician and the care team by using information technology based interventions can lead to improved diabetes care. Existing and emerging technologies such as wireless devices (cell phones), smart glucometers, Bluetooth devices, and the internet can help facilitate patient self-management of diabetes. Such devices provide a practical and cost-effective method for monitoring clinical outcomes and increasing patient adherence to treatments. Wireless technologies can be used as intermediary tools to facilitate the information between patient and provider and remotely provide treatment advice between clinic visits.
India is home to 450 million internet users as per a survey done in 2016 by ‘Internet and Mobile Association of India’ and ‘IMRB International’. With the introduction of easy-to-use technology interface, it has become a lot easier for people to interact with their physician and understand ways to tackle the condition. Clinico-technology solution can therefore prove to be one of the most efficient solutions for managing diabetes in India. From remote patient monitoring devices to health apps and from Electronic Medical Records to glucose monitoring, clinical organisations have used technology to build clinical decision-making algorithms that send real-time alerts and reminders to patients and their doctors simultaneously.
Clinico-technology solutions provided by clinical organisations enable efficient monitoring & management of people living with diabetes. They aim to enhance patient care, enabling healthcare providers to asynchronously communicate with their patients in a technology enabled, and high-touch model minimizing risk of errors & improving clinical outcomes. Diabetes management Centre set up by such clinical organisations is usually 24×7 clinical contact centre, staffed with Doctors, Diabetes specialist nurses and Diabetes educators. This team supports patients, treating physicians and patient families in improving compliance and providing round the clock care for better outcomes.
Seeing the benefits of this technology, today private and public hospitals in India are moving towards partnering with such clinical organisations to provide the best in healthcare for their patients. Since, hospitals have multiple speciality departments to handle; the partnership with such clinical organisations providing Clinico-technology solutions is a boon for them and their patients. It helps them retain their existing patients through technology driven personalized care and also reduce their operational costs by moving some parts of the patient care plan to the remotely located diabetes contact centre. Some of these clinical organisations are also accredited by NABH, which further helps in improving the patient and partner hospital satisfaction.
Considering the high cost incurred at various steps of screening, monitoring, and intervention, it is important to realize and implement the cost-effective measures of diabetes care. Result-oriented programs involving patient education along with educational programs for the medical fraternity on developments in the diabetes management are required to combat the current diabetes epidemic in India.