Addressing the Challenges of Diabetes in India

27 Jun 2019

Dr V Mohan, MD, FRCP, Ph.D. D.Sc is the Chairman and Chief Diabetologist, Dr. Mohan’s Diabetes Specialities Centre Director, Madras Diabetes Research Foundation, Chennai, India. Dr Mohan is the first recipient of the College’s Clinical Leadership Award which was awarded in May 2019. You can get more details on our range of Awards for Scholarships here.

Diabetes has become a huge public health problem in India. With over 72 million individuals with diabetes already in 2011, this number is predicted to increase to 134 million by the year 2045. Thus, India is all set to become the ‘Diabetes Capital of the World’! It is not just the magnitude of the problem of diabetes in India that is worrisome. There are several other challenges including lack of adequate specialised manpower and the inability of the health system to provide optimal health care to millions of people who are at risk of developing end stage complications of diabetes like blindness, renal failure, amputations, heart attacks and stroke. Finally, the fact that for 70 – 80% of patients in India, healthcare is provided by private medicine meaning out of pocket expenditure. It is against these challenges that our work in the field of diabetes in India must be viewed.

A brief walk down memory lane will introduce readers to our work. Thanks to my father Professor M Viswanathan who is considered as the ‘Father of Diabetology in India’, I was privileged to start working in the field of diabetes even as an undergraduate medical student. Remarkably, even as a first year medical student, I got the opportunity to help my father set up the first private diabetes centre at Chennai in South India in 1971. After completing my undergraduate and postgraduate medical education, I worked as a Wellcome Research Fellow at the Royal Postgraduate Medical School and Hammersmith Hospital, London, doing research on diabetes in South Asians living in the UK and comparing them with White Caucasians. My work helped to understand (at least partly), the reasons for the increased susceptibility to diabetes in the South Asian community.

After returning to India, I found that the prevalence of diabetes was growing rapidly in India, first in the cities and later in rural areas as well. For example, in the city of Chennai, the prevalence of diabetes which was 2% in the 1970s, climbed steadily and today it affects over 24% of the adult population of Chennai. The ICMR-INDIAB study, which is the largest national study on diabetes, as well as the Global Burden of Diseases study in India showed that diabetes has now increased in all 31 states and Union Territories of India with highest prevalence rates in the more affluent five southern states and in Goa. The other epidemiological trend that we noticed recently is that in urban areas of the more affluent states in India, diabetes now affects poor people more than affluent. There are two other worrisome aspects about the epidemiological transition of diabetes in India. Firstly, diabetes, once considered a disease of middle and old age, soon started affecting young adults and today it even affects children. Secondly, diabetes which was until recently a disease of urban India, is now rapidly moving to its villages. This has serious health implications, as in many rural areas specialised diabetes care is not available.

In order to tackle the diabetes epidemic in India, we have taken up several leadership initiatives:

1. Capacity building: We have started several training programs including Fellowship in Diabetes, Post-Doctoral Fellowship in Diabetes and Certificate Courses in Diabetes, reaching out to several thousand physicians across the country and even in neighbouring countries.
2. Setting up of specialised diabetes clinics under the brand of ‘Dr. Mohan’s Diabetes Specialities Centre’: Over 50 clinics have been set up to date in 10 states of the country, serving over 450,000 patients with diabetes, one of the largest in the world. This has helped to take specialised healthcare to various parts of the country.
3. India’s first Rural Diabetes Model: The Chunampet Rural Diabetes Project was set up using telemedicine as a tool to reach out to the rural poor in India (n = 50,000). The population (n =50,000) living in 42 villages in Tamil Nadu were screened for diabetes and its complications using a mobile van fitted with all equipment for screening for diabetes and its complications. This program also provided employment to the rural people. The results were very encouraging. Within a year, the HbA1c of people in the villages could be brought down significantly using low cost generic drugs. Only 2% of patients needed to be referred to the city for specialised diabetes treatment.
4. Precision Diabetes: An Indo-Scottish joint project on Precision Diabetes called INdia-Scotland Partnership for pRecision mEdicine in Diabetes (INSPIRED) funded by the National Institute for Health Research (NIHR) has been set up in collaboration with the University of Dundee in Scotland with the aim of studying the heterogeneity between diabetes in India and Scotland and also to study the pharmacogenomics of response to various anti-diabetic agents. A rural model is also being developed in villages in Tamil Nadu to improve the healthcare of the rural people. Dr Colin Palmer and his team from the University of Dundee are heading this project in Scotland while my colleagues and I head the project in India. Dr Naveed Sattar from the University of Glasgow is also a collaborator on this project.

Some of our innovations which have helped to improve diabetes care in India include the following:

1. Development of Asia’s first Diabetes Electronic Medical Record system (DEMR).
2. Innovation and production of a high fibre low glycemic index white rice which has now been successfully commercialised.
3. Use of Artificial Intelligence in screening and diagnosing diabetic retinopathy.
4. A low cost rural model for diabetes prevention and care in rural areas.
5. Successful testing of a life style modification program for prevention of diabetes.
6. Using low cost generic medicines to improve diabetes control, we now have a large number of people with diabetes now living for 60 years or more without any complications of diabetes.
7. Through 3000 free diabetes camps 277,000 people in 10 states of India have benefitted.

In summary, it is satisfying to note that by providing the right leadership to initiatives involving healthcare, research, education and charity in India, we were able to develop successful programs which if scaled up can help to tackle the diabetes epidemic in India.

Category: Engagement