Abstract Details

Session title: Care delivery

Session type: Poster - Diabetes in Society and Culture Track: Diabetes in Society and Culture

Presentation number: P-1180

Abstract title:
Type 2 diabetes care in a resource limited setting in India [1994-2017] - Towards success of Berlin Declaration

Presenting author: Harsha A

Project DOSTI ['friendship']: D iabetes O rganization S upport T raining and I nteraction [1994 - current].

Over the last 3 decades, focusing on adult / type 2 diabetes, we have continued to innovate and implement several health care programs to provide best possible care to all socioeconomic segments of the society.

Beneficiaries: 5892 Type II diabetes adults - Diabetes Lifeline - Health for Helpless.

Activities: FREE Adult Diabetes Clinic, FREE medicines [oral medicines to all for diabetes (metformin=91%, sulfonylureas glibenclamide, glipizide= 60%), hypertension (atenolol 14%, amlodipine= 34% , ramipril = 7%, telmisartan= 42%, hydrochlorothiazide= 6%), dyslipidemia (atorvastatin= 62%, fenofibrate= 4%), cardiovascular prophylaxis (aspirin= 85%, clopidogrel= 7%); generic human insulins (regular, NPH, premixed)= 16% to an extreme poverty subset only; antibiotics and other general medicines], health for helpless programs, health awareness and counseling, continued care [monthly or quarterly clinic visits, plus SOS emergency need based visits; clinic spot blood glucose, blood pressure and vitals testing, eye care - fundus screening, foot care, ECG and clinical cardiac evaluation], psychosocial support, community diabetes camps etc.

Uniqueness: Social commitment and empathy of clinic staff (50% being honorary workers, majority self¬diabetes peers or family members obtaining care at the institution), individual philanthropy - free oral medicines and insulin support from 2 benefactors, a standardized seamless 'cafeteria or assembly line" approach to manage all the activities [reception - registration, clinical evaluation, treatment planning and prescription generation (preprinted check box format), medicines dispensing and counseling, referral to government hospitals for tertiary care etc] of the crowded first Sunday of the month clinic (200 plus patients).

Limitations: Absence of periodic biochemical evaluations (except via some time bound projects), self-home blood glucose monitoring unaffordable to all, inability to provide more than very basic patient self-care education; incapacity of the patients to purchase from market, even one or two low cost generic medicines during temporary 'out of stock" periods.

Outcome: Follow up 1- 20 years; Sample survey - Means: Blood Pressure= 128/73; HbA1c= 7.92 %; S
Creatinine= 0.72 mg/dl; eGFR= 93 ml/min; T Chol= 169 mg/dl; LDLc= 87 mg/dl; HDLc= 42 mg/dl; TG= 222 mg/dl.

Economics: Direct costs [Indian rupees] per person per year - at market rates: Medications= 19080; Doctor and counsellor consultations= 3000; Laboratory tests and other investigations: 5200 [Total direct costs in US $= 400 approx]

Besides the above mentioned FREE program, a much larger number of adults [50000 plus] have received SUBSIDISED medical care, medicines (low cost generics) and diagnostic services at approximately 20% of the prevailing market rates. Revenue generated from the relatively better socioeconomic classes supports expenses related to the lower classes [social engineering and cost cross subsidy model; project has been financial viable thus far, except for 4 months in year 2006- project closed].

Conclusion: As a small grass roots voluntary organisation, we have struggled to improve the lives of a 'microscopic' segment adults with diabetes and associated health problems in India, with a specific focus on lower-income population segments [model for the bottom of the socioeconomic pyramid]. However, without honest, sustained and committed government participation [supported by corporate social responsibility], such efforts might be almost futile on a national scale. These type of grass roots efforts, are crucial for the success of The Berlin Declaration [a global call to action urging policy makers to reduce the growing burden of type 2 diabetes, focused on four pillars of 'Early Action' in type 2 diabetes: preventing diabetes, diagnosing it early, controlling it early and ensuring early access to the right personalized interventions] - Small steps, Big results.

Type 2 diabetes care in a resource limited setting in India [1994-2017] – Towards success of Berlin Declaration