Access to Diabetes Care

Diabetes, a growing health challenge of the 21st century, is a serious long-term condition and one of the chronic non-communicable diseases (NCDs). It is a metabolic disorder resulting from a defect in insulin secretion, insulin action, or both. Insulin deficiency, in turn, leads disturbances of carbohydrate, fat, and protein metabolism with chronic hyperglycemia (high glucose) as the central abnormality. Diabetes can be categorized into Type 1 diabetes (T1DM) is a condition where body produces very little or no insulin, happens in children, generally nonobese and requires insulin for preventing coma); Type 2 diabetes mellitus (T2DM) is characterised by inability of the body’s cells to respond fully to insulin, usually on obsess and adults, managed by many options). Gestational diabetes mellitus (GDM) is condition of high blood glucose levels during pregnancy and has many consequences to baby and mother. Prediabetes means higher than normal blood sugar level but not higher enough to be considered as Type 2 diabetes mellitus. It leads to serious damage to the heart, blood vessels, eyes, kidneys and nerves. The risk factors for diabetes include, family history of diabetes mellitus, lack of exercise, overweight, PCOS, hypertension, ethnicity, history of GDM.

To mark World Diabetes Day, the International Diabetes Federation (IDF) has announced Access to Diabetes Care as the theme for World Diabetes Day 2021-23


World Diabetes Day (WDD), a globally celebrated event was created in 1991 by International Diabetes Federation [IDF] and the World Health Organization in response to growing epidemic of diabetes and escalating health threat posed by diabetes. November 14th marks the birthday of the gentleman who co-discovered insulin, F. Banting in 1922 with Charles Best.

Access to Diabetes Care

Access to diabetes care is lacking in this region owing to several problems; lack of appropriate facilities for diabetes care, an inadequate infrastructure, scarcity of trained healthcare personnel etc. Diabetic people require access to affordable holistic medical care and support for management, treatment and to avoid related complications. Over 422 million people worldwide have diabetes, the majority living in low-and middle-income countries, and 1.5 million deaths are directly attributed to diabetes each year. Covid19 epidemic infection has further frightened and harmed people with diabetes and posed an additional major health threat. Emerging data reported that COVID-19 is common in patients with diabetes, hypertension, and cardiovascular disease (CVD). Understandably, prevalence of diabetes in patients with COVID-19 varies by region, age and ethnicity. Nearly 40% of people who have died from Covid-19 were patients with diabetes. The government and current public health system need to hand in hand and promote access to diabetes care

There are evidences of gaps and challenges in the care of people with diabetes. The stand out areas includes lack of diabetes educators, education programs and fragmented care. Furthermore, the covid19 epidemic poses a challenge to combat diabetes and its complications. Though, there has been an outpouring of support from medical personnel and others on the front lines for those afflicted. The diabetes community urgently needs immediate access to affordable diabetes care. It is imperative that the healthcare sector is equipped with trained diabetes educators to assist endocrinologists, diabetologists for delivering quality care for patients with diabetes and its management. Alongside, virtual interactions can be used to guide the care of patients, providing remote access to ones who may be otherwise inaccessible.

With escalating prevalence of diabetes in India, people with diabetes should receive access to affordable medical care from a physician-coordinated team. Such teams may include, but are not limited to, endocrinologists, physicians, nurses, dietitians, pharmacists, with expertise and a special interest in diabetes. There is an immediate need to fill the gap in the diabetes care which can begin with to train science graduates from various streams (nursing, dietetics, pharmacology etc) as diabetes educators to impart education to diabetics and empower health care system.

Our Experience

Diabetes care in Jammu and Kashmir continues to be a challenge for the primary care physicians/endocrinologists as urbanization continues to predict a steep rise in disease prevalence over the next few years. Rapid urbanization with increasing addiction on e-gadgets and sedentary lifestyle contribute significantly to this epidemic with a commensurate upward trend in the prevalence of prediabetes. Recently our group has published a study wherein we found 11.6% of population had Prediabetes. The prevalence of diabetes mellitus was 6.3% in general population and (1.3%) in tribal population of same geographical area of Jammu and Kashmir. The astonishing observation that we made was that 96% individuals with Diabetes mellitus/Prediabetes were undiagnosed. These nerve-racking percentages can be attributed to lack of awareness and scarcity of trained manpower cum health care facilities.

Keeping these things in mind, we believe that we need to have comprehensive diabetes care models in place wherein diabetes educators will begin to have a larger role in maintaining doctor–patient relationship, creating awareness and educating those people who are struggling to adhere to their treatment regimens and lifestyle modifications or those who have not come to terms with their diagnosis.

How to celebrate the event?

The world diabetes day, a truly global event falls on Sunday 14th November, 2021. It is celebrated under a theme access to diabetes care. The quantum of diabetes care is still far from adequate in India. We do not have sufficient number of diabetologists and endocrinologists to curb the menace. The general physicians are generally managing the diabetes in the society and unfortunately, the specialized care and treatment is missing. The healthcare institutions should be equipped with highly trained personnel who can provide training and education for multidisciplinary healthcare providers. The lack of such models for prevention and management of diabetes at our place is still missing thus, adding more salt to the injury. Unless we go hand in hand in combating the spread of this disease, by implementing relevant programs, it is expected that diabetes will continue to haunt. The date is coming up in just a couple of days. The people should keep an eye for an event (online) to participate with the aim to improve health outcomes and to understand and manage the condition. The Department of Endocrinology SKIMS is celebrating the event on 13th at SKIMS auditorium and on 17th November in collaboration with Departments of Lifelong Learning, and Students Welfare University of Kashmir. Online sessions will cover the various aspects of Diabetes with series of offline discussions by eminent clinicians relevant to the theme. A mass screening of Diabetes will also be held on the day.

Dr M Ashraf Ganie is Professor of Endocrinology and Head Department of Clinical Research at SKIMS Soura.

He was previously working as Associate Professor at AIIMS, New Delhi.

Disclaimer: The views and opinions expressed in this article are the personal opinions of the author. The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.

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