India, Pakistan researchers show low-cost way to manage diabetes

Medical researchers from India and Pakistan on Monday successfully demonstrated the utility of a low-cost strategy to manage diabetes, which may go a long way in improving public health in the sub-continent.

A new clinical trial at 10 centers in India and Pakistan showed how a regular clinic attendant, with little training, can work with the patients to help them control the blood-sugar level, which in turn reduces the disease burden.

This, researchers say, is the world’s first trial of comprehensive diabetes management in a low or middle-income country setting without expensive medication and have several takeaways for government programmes to control non-communicable diseases in both the countries.

Of the 415 million people with diabetes worldwide, almost 75% live in low or middle-income nations, including India, which alone is home to 70 million diabetics - the second highest number of diabetes patients in the world.

But despite taking medicines regularly, less than 20% people are able to maintain the desired blood-sugar level, necessitating the need for innovative sugar control strategies.

In a study involving about 1,150 Indians and Pakistanis, medical scientists from the two countries with support from their colleagues in the US proved how involving the clinic attendant as part of the strategy could change the landscape.

Care coordinators, who could be clinic attendant or a nurse or any other non-physician staff of a clinic lie at the core of the innovation.

Their role was modified to act as a bridge between the patient and doctor, for which they were paid separately. There was also a decision support software to ease their task.

“The care coordinators were responsible for following up with intervention patients at least once every 3 months and contacted patients by telephone at least once a month to discuss diabetes self-management, adherence to diet plans, exercise, tobacco cessation, medication use, self-monitoring of glucose levels (if the patient was receiving insulin), and stress management,” the researchers reported in the journal Annals of Internal Medicine.

After 28 months, those who received such extra attention from the care coordinators showed far superior level of sugar control, reducing the risk of heart attacks or kidney problems.

“Additional manpower would cost money but the long-term benefits outweigh the initial investment. In India, the government programme already has sanctions for such coordinators,” Nikhil Tandon, professor of endocrinology at the AIIMS told DH.