India: Diabetes Capital of the World

India, the land of mystic cultures, bearing the second-highest population of the world, famous for her rich heritage, and her enormous contribution in fields of technology and innovation, is also home to more than 66 million people living with diabetes in 2014. It is estimated to cross 109 million by 2035. Therefore, India is called the ‘Diabetes Capital of the World’ by many experts in the diabetes field.

Rule of Halves: Lacking patient awareness

What is interesting in diabetes in India is the high lack of awareness among people that they are diabetic. Of the 66 million people living with diabetes in the country, nearly 35 million people are undiagnosed. According to industry experts, the rule of halves applies in diabetes care—of the total diabetes population, nearly half are undiagnosed, of those, only half receive care, half of those are able to achieve treatment targets, and half of those are able to achieve their desired outcomes in diabetes management. This rule of halves presents myriads of opportunities for pharma and medtech companies. These companies are investing enormous amounts of resources to create patient awareness so that more patients get added in the patient pool, contributing to their overall topline. In this direction, companies are launching several diabetes education programs, and screening campaigns, especially with a splurge of activities during World Diabetes Day on the 14th of November every year. For example, on World Diabetes Day in 2013, Novo Nordisk Education Foundation (NNEF) along with the Diabetic Foot Society of India (DFSI) organized the World's largest 'Foot Screening Programme' spanning 28 locations across India. They screened a total of 1660 patients for foot problems on one single day, earning a Guinness World Record for the highest number of foot screenings done in India.

Lagging behind in effective diabetes management

Despite the various attempts being made at educating people with diabetes, comprehensive care of the diabetic population is still far off. This is partly owed to the lack of compliance among patients due to a social stigma attached with the disorder in India, which makes management of diabetes more difficult. Instances where people have refrained from taking insulin injections in flights, offices, restaurants, or family gatherings have been very common in India. Apart from regular medication, ensuring complete diabetes care involves regular self-monitoring of blood glucose. However, fear of injections is another common bottleneck in effective diabetes monitoring. Pricking by needles each time screening is required seems uncomfortable for most patients. These factors lead to a lack of complete and comprehensive diabetes care.

Existing market on diabetes education apps and dashboards

Because of the situation in India, many companies have started to focus on providing a tech savvy solutions for diabetes care. Companies have launched a number of diabetes management and patient education apps that can be easily downloaded on Androids and iPhones. For example, Lifespan in India has launched a diabetes care app that allows patients to keep a log history of glucose readings, diet and exercise details, and graphical details of clinical data, and also set reminders for medications and connect with family members. Another company in India has launched a novel device called Diabeto, which allows communication between a glucose monitor and a smartphone. It is especially helpful for older, visually impaired patients.

Some companies, especially the IT giants, have also launched dashboards in the form of wearables, as well as websites that can connect patients and their doctors. These dashboards are connected to apps installed in patients’ smartphones and collect data on amounts of food intake, their medication regimen, and their level of physical activity. This entire patient story generated is then shared with the doctor, who is connected at the other end of the dashboard. Additionally, if at any time there is a drop or a spike in glucose readings, an alert is sent to doctor through the dashboard, which allows immediate action to be taken.

Limitations of implementation in India and the way forward

With advancements in IT and its integration into management of diabetes care, there is a rapid increase in the number of companies offering these types of tech savvy patient care services now in India. Of course, there are some limitations, like a lack of network infrastructure, especially in rural areas where there are more diabetics than in urban areas.
But, nevertheless, with the government’s aspirational motives to build smart cities and take healthcare to rural areas through broadband connectivity by means of telemedicine, the impact of these limitations will lessen over time.

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