Authors: – Dr. Pankaj Bhardwaj (Dr Pankaj Bhardwaj, 

Academic Head, School of Public Health (SPH),

Professor of Community Medicine & Family Medicine

All India Institute of Medical Sciences (AIIMS), Jodhpur

and

Dr. Madhukar Mittal (Additional Professor and Head, Department of Endocrinology and Metabolism, All India Institute of Medical Sciences (AIIMS), Jodhpur

Currently India is struggling with the triple burden of diseases. Beside the burden of malnutrition and communicable diseases, the burden of NCDs is increasing exponentially. Amongst NCDs, the increasing prevalence of diabetes and hypertension is thought to be both an important driver and consequence of the epidemiological transition. The weak control cascade of hypertension and diabetes from the time of screening till the attainment of optimal control of the condition is a public health challenge, particularly in resource limited settings. 

India being the diabetes capital of the world requires that affordable access to diabetes care be made available in all parts of the country. The onset of type 2 diabetes in developing countries including India is commonly occurring much earlier in the 3rd-4th decade of life. With increased longevity and persistence of NCDs like diabetes into the twilight years, the burden of diabetes is bound to increase. 

The Tree: Trunk and Branches Model

Consider the two conditions of diabetes and hypertension as the trunk of a tree. Heart, kidney, eyes, Brain, Feet are like the branches of this tree. If the tree is nourished properly and the trunk remains healthy, then the multiple branches also remain healthy. On the contrary, if diabetes and hypertension are detected late and are uncontrolled, then various complications including heart disease, stroke, chronic kidney disease, eye disease-blindness, foot ulcers, lower limb amputations are likely to occur. Diabetes is the single most common cause for chronic kidney disease, coronary artery disease, blindness (nontraumatic), foot ulcer and lower limb amputations (after road traffic accidents). Hypertension with diabetes is the single most common cause for brain stroke.

Nudge to Policymakers

Government spending on healthcare is limited. In India, although the healthcare budget spending has increased over the years, there is still a vast gap between the actual needs of the population and the government expenditure. India has improved its indices with regards to infectious diseases. Currently, for any government to get the “maximum bang for the buck spent”, fiscal prudence demands focus on targeted spending on prevention of lifestyle disorders or NCDs, especially diabetes and hypertension. This would help in reducing/negating expenditure (both government and individual) to a significant degree on multiple other medical conditions like heart disease, kidney disease, eye blindness, brain stroke, lower limb foot ulcers and amputations. 

Currently Government of India as well as state governments are digitalizing population based screening records of community in different NCDs including Diabetes. The Accredited Social Health Activists (ASHAs) are filling Community Based Assessment Checklist (CBAC) forms for early detection of NCDs. Apart from screening many barriers to optimal hypertension and diabetes care can be overcome through IT- based quality improvement strategies, which includes electronic case record form (eCRF) which allows nurses to enter patient demographic information, medical history, physical examinations, and laboratory investigations into an electronic form through a web-based “NCD portal”.  Clinical decision support system (CDSS) which generates customized evidence-based treatment advisories for patients with hypertension and diabetes also supplements the routine care. So, we can help harness the power of technology to effectively tackle the rising burden of diabetes and hypertension in India. 

Using this approach, we can achieve the goal of this year’s theme of providing accessible diabetes care to all.