Researchers at the All India Institute of Medical Sciences (AIIMS), New Delhi, the Public Health Foundation of India (PHFI), and the Rollins School of Public Health, Emory University, Atlanta have found a low-cost care, intervention model that can help patients with diabetes double their likelihood of controlling the disease. The model helps patients improve their blood sugar level using non-physician workers and computer tools.
Led by researchers at these three health institutions, the initiative is a result of over two years of trial at 10 clinical centres across India and Pakistan.
Briefing the media persons at AIIMS, New Delhi on July 14, Dr Nikhil Tandon, Professor and Head, Department of Endocrinology, AIIMS, (who is also the senior author of the study published in the July 12th edition of Annals of Internal Medicine), said that this was the first trial of comprehensive diabetes management in a low and middle-income country setting.
The trial compared the diabetes-focused quality improvement (QI) strategy versus the usual care alternatives for heart patients with poorly controlled diabetes. It was conducted on 1,150 patients with diabetes and poor cardio-metabolic profiles who were randomly assigned to a multi-component QI strategy or usual care for two-and-a-half years.
The results show that the intervention yielded sizeable improvements in blood sugar, blood pressure, and cholesterol profiles of the participants. “This shows that patients in the QI strategy group were twice as likely to achieve combined diabetes care goals and larger reductions for each risk factor compared to traditional care,” he said.
“This intervention doesn’t require new or expensive drugs, but instead it enhances a patient’s likelihood of managing the disease on his/her own by providing individualised support and enhancing the physician’s likelihood of being responsive,” said Dr Tandon.
Dr Tandon said the team compared the effects of multi-component diabetes strategy (combining a non-physician care coordinator and decision-support electronic health record software) versus traditional care in South Asia, where resources are limited and diabetes is prevalent.
Significantly, not much difference was seen in the benefits derived in public and private diabetes clinics, which indicates that with structured care, health inequalities can possibly be reduced.
“This study offers a hope of reducing onset of diabetes complications like heart disease, eye disease, kidney failure, and amputations, which are very common in people with diabetes in South Asia,” Tandon said.
Of the 415 million people with diabetes worldwide, 75 per cent live in low/middle-income countries. India alone is home to the second highest number of people with diabetes [nearly 70 million] worldwide.
According to researchers, these findings are relevant for India, Pakistan, the US and many other countries. Further, the study is relevant not just for low-income and middle-income countries, but also high-income countries where achievement of diabetes care goals is sub-optimal and where health disparities are common.