Diabetes In India

Government Initiatives

India is home to over 60 million adults with diabetes (7.8% of the population), and another 30
million adults who are believed to be undiagnosed or untreated (Nation Health Portal). In
spite of growing incidences of diabetes and the risks around leaving the disease untreated,
there is no pan India government program focused exclusively on diabetes prevention/
management. The government initiatives directed towards addressing diabetes are:

The National Programme for Prevention and Control of Cancers, Diabetes,

Cardiovascular Diseases and Stroke (NPCDCS) –

The NPCDCS was launched in the year 2009 and it presently covers more than 200 districts
(out of 707) in the country. The NPCDCS integrates non-communicable disease (NCD)
interventions in the National Health Mission (NHM) framework for optimization of scarce
resources.

Under NPCDCS, NCD Cells are established at National, State and District levels for
programme management, and NCD Clinics are set up at District and CHC levels, to provide
services for early diagnosis, treatment and follow-up for common NCD. The programme
aimed to cover the entire country by March 2017. However there has been no circular issued
by the government about the completion/ progress made.

 During 2015-2016, about 12.9 million (1% of population) people had been screened
in the designated NCD Clinics. Among these NCD Clinic attendees, around 8% were
diagnosed to be Diabetics.
 For early detection of Diabetes, Hypertension and common Cancers in the
community, guidelines are being issued to the States for initiating “Population-based
Screening of common NCDs” utilising the services of the Frontline-workers and
Health-workers under the existing Primary Healthcare System

mDiabetes ( By National Health Portal)

The Ministry of Health and Family Welfare in collaboration with the WHO Country Office
for India and other partners, has launched a mobile health initiative for the prevention and
care of diabetes – mDiabetes.

mDiabetes hopes to contribute to improving awareness about diabetes and promoting healthy
diets and active lifestyle, which are vital to the prevention of diabetes. mDiabetes will also
enhance health care seeking and early diagnosis, contribute to better adherence to drug or
dietary control, self-care, as well as prevention of complications among patients with
diabetes. mDiabetes is based on proven algorithms for diabetes prevention and care, and
builds on previous international experiences in using mobile technologies to deliver these
interventions. (National Health Portal)
Major NGOs

Though there is no NGO with a pan India presence that is working towards addressing
Diabetes, the few small NGOs and a few research bodies attached to hospitals that are
working in the field of Diabetes are:

1. World Diabetes Foundation

 WDF conducts programs that can be divided by the purpose of the activity: either to
stimulate Accress to Care, Prevention or Advocacy and Stakeholder Engagement
(Interventions) or by the disease state addressed within diabetes: Type 2, Diabetes
foot care, diabetes eye care, Hyperglycaemia in pregnancy, Type 1 and TB and
Diabetes. ( World Diabetes Foundation)
 WDF doesn’t always organize projects by itself, rather assesses projects, funds them
and evaluates them against the set benchmarks.
 From 2002 to 2017, the WDF provided USD 137 million in funding to 535
projects in 116 countries of which 23% was spent in Southeast Asia. (World Diabetes
Foundation)

2. Indian Council for Diabetes Care

 ICDC is a Funding Agency and only organisation in India to provide doorstep

diabetes care to the patients.
 ICDC implements National Doorstep Diabetes Identification and follow-up
programme through Grass Root Level NGOs all over India
 ICDC provides Free Glucometer and 100 Strips to the NGOs to start identifying the
Diabetes Patients even in villages.
 NGOs need to pay Rs.5/- Per Patient per month towards the Patient welfare &
Promotional charges to ICDC. ICDC will start funding by paying one staff salary @
Rs.1500/- per month after three months if the NGO registers at least 600 patients &
above within a period of 3 months and continue to register a minimum of 250
patients per month and do monthly follow-up through their staff. ( Indian Council for
Diabetes Care)

3. Research organisations such as Madras Diabetes Research Foundation.

 MDRS has strengths in basic, clinical and epidemiological research

 MDRS also focuses on the definition of individuals at risk of diabetes and its
complications by identification of risk markers

Issues with Treatment and Affordability

A study involving Indian patients by (Ramachandran et al,2007) analyzed the urban-rural

expenditure on diabetes. The study indicated that the economic burden of diabetes care on
families in developing countries is rising rapidly, even after accounting for the inflation. The
annual family income was higher in urban subjects [rupees (Rs) 100,000 or $2,273] than in
the rural subjects (Rs 36,000 or $818) (P < 0.001). Total median expenditure on health care
was Rs 10,000 ($227) in urban and Rs 6,260 ($142) in rural (P0.001) subjects. Treatment
costs increased with duration of diabetes, presence of complications, hospitalization, surgery,
insulin therapy and urban setting.

Observations from a Point of care testing Study in India (Engel N, et al, 2015)

 In the Indian context, the onus is on the patient to ensure successful point-of-care
testing across homes, clinics, labs and hospitals, amidst uncoordinated providers with
divergent and often competing practices, in settings lacking material, money and
human resources.
 Even if tests can be conducted on the spot and infrastructure challenges have been
resolved, relationships among providers and between patients and providers are
crucial for successful point-of-care testing. Furthermore, these barriers do not act in
isolation, but are interlinked and need to be examined as such.
 A test alone has only limited power to overcome those difficulties. Test developers,
policy-makers, healthcare providers and funders need to use these insights in
overcoming barriers to point-of-care testing programs.

Citation List-

1. National Health Portal [online] Available from : http://mdiabetes.nhp.gov.in/

[Accessed 14 March]
2. World Diabetes Foundation [online] Available from
https://www.worlddiabetesfoundation.org/who-we-are [Accessed 14 March]
3. Indian Council For Diabetes Care [online] Available from :
http://icdc.org.in/about.php [ Accessed 14 March]
4. Ramachandran et al, (2007) Increasing expenditure on health care incurred by diabetic
subjects in a developing country: a study from India, Diabetes Care 2007 Feb; 30(2):
252-256.
5. Engel N, et al, (2015) Point-of-care testing in India: missed opportunities to realize
the true potential of point-of-care testing programs BMC Health Serv Res. 2015 Dec
14;15:550.