Is India ready to manage the increasing burden of diabetes?

Dr Ratna Devi, CEO, DakshamA Health and Tamanna Sachdeva, Project Officer Policy, DakshamA Health talks about rising burden of diabetes in India and way forward

According to IDF Diabetes Atlas (2021), globally 537 million adults (20-79 years) are living with diabetes. This number is predicted to rise to 643 million by 2030 and 784 million by 2045. Diabetes is responsible for about 6.7 million deaths in 2021 – 1 every 5 seconds. Diabetes caused at least USD 966 billion dollars in health expenditure – a 316% increase over the last 15 years¹. It has been seen that while premature mortality from other major non-communicable diseases (NCDs) is decreasing, early deaths from diabetes actually increased by 5% between 2000 and 2016. The UN Sustainable Development Goal 3.4 aims, to reduce premature mortality from NCDs by one-third, through “prevention and treatment and promotion of mental health and well-being”. However most countries will fail to achieve this target with the current burden of diabetes and resulting comorbidities.

Around 49% of countries reported that their services for diabetes and related complications have been partially or completely disrupted by COVID-19². Despite the discovery of insulin 100 years ago, many children, adolescents and adults with type 1 diabetes are struggling to access the basic care for diabetes like insulin, as well as essential technologies such as blood glucose meters and test strips. About half of all adults with type 2 diabetes are undiagnosed. Those who are diagnosed are not guaranteed access to essential diabetes and related medicines and regular screening for complications. Incompetent health systems, including an inability to test for and diagnose diabetes and lack of medicines, disrupts the provision of vital services for diabetes and related complications.

According to the International Journal of Diabetes, developing countries, have been witnessing an alarming rise in the incidence of diabetes. Over 4 in 5 (81%) adults with diabetes live in low- and middle-income countries. Diabetes has been witnessed as one of the escalating health issues in India often referred to as the diabetes capital of the world. As per the ninth edition of the IDF Diabetes Atlas data, India ranks 2 in number of people living with diabetes, with the home to 77 million adults (20-79 years) living with diabetes and nearly 25 million  pre-diabetics.³.

With the increasing burden of diabetes WHO launched the Global Diabetes Compact to coincide with the 100th anniversary of the discovery of insulin, with the vision of reducing the risk of diabetes, and ensuring that people who  are diagnosed with diabetes have access to equitable, comprehensive, affordable, and quality treatment and care.. The compact recommends multi-sectorial approach with a coordinated strategy, drive-in diabetes prevention and management in primary health care, development and evaluation of low-cost technologies and digital solutions for diabetes care, Improve access to diabetes diagnostics, medicines, and health products, particularly insulin, in low- and middle-income countries, adopting context-specific and evidence-based interventions, awareness and learnings from the covid-19².

In India, there is an urgent need to ramp up access to diabetes diagnostic tools and medicines, particularly insulin. About 57% (in 2019) of Indians are still undiagnosed for diabetes. The NPCDCS program of India had 665 District NCD Cells, 637 District NCD Clinics, 4472 CHC NCD Clinics, 181 Cardiac Care Units and 218 Day Care Units functional in the country until March 2020. Around 6.61 crore persons attended NCD Clinics and were screened for common NCDs like Diabetes, Hypertension, CVDs and common Cancers during 2019-20. More than 1.1 crore population has been covered under Population Based Screening so far. In addition, during outreach activities, 5.6 crores NCD checkups were conducted. With the setting up of health and wellness centers these numbers are bound to increase. Catastrophic incidents are covered under the Ayushman Bharat Scheme and many rural Indians are seeing the benefit of AB for critical care. However a well-defined care continuum pathway with a robust referral mechanism is still missing. With the COVID- 19 pandemic teaching us early and rapid adoption of technology, it is time to look at technology enabling the care and access pathways and making the patient journey smoother and hassle free. The operational guidelines for NCPCDS were last revised in 2017. Perhaps it is time to have a relook and involve patients and carers to share their experiences, so that the guidelines are inclusive and holistic. Diabetes being the single highest risk factor for NCDs would need a special focus and access to life saving medicines like insulin needs innovative solutions that involve all stakeholders.

References

1. IDF Diabetes Atlas | Tenth Edition. Accessed November 10, 2021. https://diabetesatlas.org/
2. The Global Diabetes Compact what you need to know.
3. Atlas IDFD. International Diabetes Federation. Vol 266.; 1955. doi:10.1016/S0140-6736(55)92135-8