COVID-19 exposed the vulnerability of people with comorbidities, how prepared are we to protect the diabetic population?

By Sayantani Chatterjee 

The ongoing COVID-19 pandemic highlighted the vulnerability of patients with diabetes mellitus or most commonly referred to as diabetes. A Lancet Diabetes & Endocrinology study which referred to over 61 million medical records in the U.K. mentions in its findings that 30% of COVID- 19 deaths occurred in people with type 1 and type 2 varieties. Diabetes people are more prone to being infected, as elevated blood sugar levels can impair a patient’s immune system.

This is particularly worrisome for India with a high diabetes burden – a 2019 survey which maps out the top ten countries for people aged between 20–79 years with diabetes, India ranks second just after China, with a diabetes burden of 77 million.

To prevent and control widespread non-Communicable Diseases, the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) was operational under National Health Mission as a part of thorough primary healthcare in 2010. As part of this scheme, frontline health workers such as ASHA and ANM perform population-based screening and at the same time work towards generating awareness about the risk factors of NCDs.

Currently, the initiative is under implementation in 682 districts across the country as per the Ministry of Health and Family Welfare. Given the high mobile usage in India, an application called mDiabetes is also operational for generating awareness, advocating sustainable treatment, and instilling healthy habits like having nutritious food or engaging in physical exercise among the masses. There have been several media campaigns as well for generating awareness about the risk factors, causes and symptoms of diabetes. There has been an increased government thrust on NCD prevention and management; in 2019, the Union Health Minister Harsh Vardhan called for a “Jan Andolan” to combat various kinds of NCDs.

In spite of adopting such a multipronged approach, the data from the National NCD Monitoring Survey (NNMS) report, which was carried out by the Indian Council of Medical Research – National Centre for Disease Informatics and Research (ICMR-NCDIR), Bengaluru and released in January 2021 highlights the worrisome fact that 9.3% of the surveyed population had raised blood glucose. Moreover, the number of people with undiagnosed diabetes in India is at a staggering 43.9 million.

With the increasing prevalence of diabetes, there seems to be a rise in the incidence of Gestational diabetes mellitus (GDM) as well. Data shows that, about 10% of pregnancies globally are linked with diabetes and surprisingly around 90% of it is because of GDM. The prevalence of gestational diabetes to be as high as 17.9% in different parts of India. Women who have GDM and their children have more possibility of developing type 2 diabetes in later life.

All this hints at the fact that there is certainly a lacuna somewhere and India needs to have a more effective national diabetes prevention programme that requires the assistance from several quarters including medical education, health awareness campaigns at early stages.

Moreover, existing policies/schemes such as NPCDCS are more focused on prevention and screening/detection and lack much focus on diabetes management which also is equally important. Factors like poor health literacy, limited health budgets, inadequate health infrastructure and clinical expertise, lack of trained diabetes educators, high out-of-pocket health expenditures etc. are some major policy gaps towards diabetes management.

There is a need to have increased policy thrust to manage diabetes as although it cannot be cured it can be managed effectively. For that, there should be sustained conversations on the topic coupled with aggressive mass media campaigns. Lack of general awareness about diabetes and its complications among the population also leads to ineffective diabetes management practices and their implementation.

National Digital Health Mission, which was launched by Prime Minister, Narendra Modi in 2020 calls out for programmes like National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Strokes (NPCDCS) to be integrated so that relevant Health ID and medical records can be collated for better implementation of programmes. Once this is operational, artificial intelligence (AI) should be leveraged to its maximum potential to identify populations susceptible to diabetes and screening should be facilitated accordingly. If applied effectively artificial intelligence (AI) also has the capacity to assist in managing diabetes owing to more precise monitoring of diabetic neuropathy and diabetic ulcers and avoiding cases of limb amputations.

Additionally, while the nation is talking about Digital Health Mission and using technology for healthcare, there is a huge gap in technology adoption; hence there must be adequate intervention to improve digital literacy around the usage of digital devices/apps to monitor diabetes through various platforms.

Hence, to reduce the diabetic burden of India immediate multipronged action has to be taken in a proactive manner; in the scenario it isn’t by 2030 the number of diabetic patients is likely to rise to 101 million which is bound to affect the health indicators of this country.

(The author is Public policy consultant-Chase India. Views expressed are the author’s own.)