New initiative shows path to better diabetes control

A low-cost healthcare model involving non-physician workers using computer tools can help diabetes patients double their likelihood of controlling the disease.
According to a study conducted by researchers at AIIMS, Public Health Foundation of India, and the Rollins School of Public Health, Emory University in Atlanta, the model can help patients to improve their blood sugar levels and manage the disease on their own.
A trial conducted at ten clinical centres across India and Pakistan compared the diabetes-focused quality improvement (QI) strategy versus the usual care alternatives for heart patients with poorly controlled diabetes.
The results suggested that patients in the QI strategy group were twice as likely to achieve combined diabetes care goals and larger reductions for each risk factor compared to traditional care, said Nikhil Tandon, Professor and Head, Department of Endocrinology, AIIMS.

"This intervention doesn't require new or expensive drugs, but instead it enhances a patient's likelihood of managing their disease on their own by providing individualised support and enhancing the physician's likelihood of being responsive," he said.
The study was published in the July 12th edition of Annals of Internal Medicine.

Tandon, the senior author of the study, said the team compared the effects of multicomponent diabetes strategy (combining a non-physician care coordinator and decision-support electronic health record software) versus traditional care in South Asia, where resources are limited and diabetes is prevalent.
"Approximately 1,150 patients with diabetes and poor cardiometabolic profiles were randomly assigned to a multicomponent QI strategy or usual care for two and a half years. Results suggested that patients in the QI strategy group were twice as likely to achieve combined diabetes care goals and larger reductions for each risk factor compared with usual care.

"This was the first trial of comprehensive diabetes management in a low and middle-income country setting," Tandon said.
Findings from the trial also showed that the new intervention yielded sizeable improvements in the blood sugar, blood pressure, and cholesterol profiles of participants.
"By better controlling their blood sugar, blood pressure,
and cholesterol levels, our study offers a hope of reducing onset of diabetes complications like heart disease, eye disease, kidney failure, and amputations which are very common in people with diabetes in South Asia," said Tandon.
"Since these findings are relevant for India and many other countries -- low, middle, and high-income countries alike -- further research will uncover whether this approach reduces diabetes complications such heart attacks, strokes, eye disease, kidney failure, and amputations in the long-term and to assess patients' and providers' views so that the intervention can be delivered more widely," he said.

Of the 415 million people with diabetes worldwide, 75 per cent live in low/middle-income countries.