Times of India
23 March 2011
By Pushpa Narayan
Chennai, India

Most diabetics get substandard care for their disorder, even if they visit a specialty centre, a study on healthcare provided for diabetes in the city has found.

The inadequate treatment leads to needless complications and deaths, says diabetologist Dr Vijay Vishwanath, an author of the study published in the International Journal of Diabetes Mellitus in February.

If the health system does not improve, thousands of diabetics will be at risk. "We must make a tremendous change in the way we manage people with diabetes," says Dr Vishwanath, who heads MV Hospital For Diabetes.

In a house–to–house study, his research team quizzed 180 people with diabetes from across the city. They were divided into three groups according to place of treatment– those who visited diabetes specialty clinics (31%), private clinics (56.3) and government hospitals (12.7%).

Analysis of the data they collected from a 45–minute interview with each candidate showed 59% of the patients had developed at least one complication of the disease. The study found inadequacies in periodic screening of patients, administration of drugs and counselling for lifestyle modifications.

At government hospitals, where treatment is free, diabetics were not periodically screened for complications of eye, foot or heart ailments. Patients visiting government hospitals were not on insulin but were given oral tablets. Less than 1% of them received cardio–protective drugs at government hospitals. The percentage went up to 4% in the private hospitals and 17.6% in specialty centres.

However, the situation wasn’t perfect at private clinics or even specialty centres. The World Diabetes Federation and the World Health Organisations recommend a test called the HbA1C for all diabetics once every three months. The test gives the four–month blood sugar average. But the study shows less than 31% of those in specialty centres and 6% of those visiting private clinics took the test. Those visiting government hospitals weren’t recommended it at all.

The test is seven times more expensive than the commonly done fasting and post–prandial test, which cost 50 at a diagnostic laboratory. "HbA1c is a better tool to decide on whether a drug can be continued or changed," says diabetologist A Ramachandran.

The motivation for selfmonitoring of glucose was also low among diabetics. Less than 26% of those visiting specialty centres and 10% of those visiting private clinics monitored their sugar levels at home or nearly by laboratories without doctor’s recommendations.

According to the Diabetes Atlas, India has 50.8 million people with diabetes. In Chennai, 17% of the population is diabetic. "Some time ago it was a rich man’s disease. Today, it’s common among all sections of people," says diabetologist Dr V Mohan, who heads the Madras Diabetes Research Foundation. "Prevention and management of the disorder is the key," he says.

Live, Eat Healthy

• Test for blood glucose level every month
• Test average three–month blood glucose at least four times a year
• Check eyes, heart & liver function every year. Also check for nerve damage and undergo foot examination
• Regular exercise
• High fibre and protein in diet