Patients with diabetes can outlive nondiabetics,-Dr V Mohan
August 9, 2019
New Delhi: Around 50 million people are protected from getting diabetesand that is a huge victory for India, said Dr V Mohan, in ETHealthworld’s webinar on the topic “Preventing Clinical Inertia in Diabetes”. Dr Mohan is the chairman and Chief of Diabetology at Dr. Mohan’s Diabetes Specialities Centre.
of treatment intensification in a patient not at evidence based goals for care. Traditionally it is defined as “Failure of heath care providers to intensify treatment when it is indicated”.
In 2017, India had the second highest number of people (20-79 years) with diabetes with 72.9 million and due to the rising burden it is expected to surpass China as it is expected to rise to a shocking tune of 134.3 million diabetes patients by 2045. China and India alone contribute around 40 percent of the all the people with diabetes in the world.
The webinar shed light on frightening reality of the diabetes burden in India and how clinical inertia plays key role in the management and prevention of this non communicable disease.
In his presentation, Dr V Mohan talked on how physicians had low expectations for their patients despite the belief that good glycemic control through healthy lifestyle and pharmacological interventions had been adequately conveyed.
The webinar also discussed on glycemic control (HbA1c) among subjects with self reported diabetes in India on the basis of urban and rural population and stated how with poor glycemic control, HbA1c and the risk of complications increases. According to Dr V Mohan, the main complication of diabetes can be prevented with HbA1c test and the target to achieve everyone’s A1Cs should be below 7 %.
Dr Mohan said, “You can reverse the diabetes in an early stage. Negative impact of treatment failure in type 2 diabetes is avoidable and treatment to near-normoglycemia could avoid this burden.”
Assuming that a third of people with diabetes would ultimately develop complications and several million people are at the risk of developing eye, kidney, heart and feel complication of diabetes. It would be virtually impossible for any health system to provide treatment to millions of people with these complications.
n type 2 diabetes, one passes through a stage of normal glucose tolerance, then goes on to the pre-diabetes stage before developing diabetes and then finally to the stage of complication . However there is ample window of opportunity for us (physicians) to intervene at each stage and yet.
During the webinar, Dr Mohan presented the levels and consequences of clinical inertia at each stage of natural history of diabetes. Starting from the population level which included not taking steps like improving the physical activity and healthy eating, the consequence were increased risk of type 2 diabetes in the population. In the severe levels, long duration of diabetes and early complications resulting from ignorance of annual screening and aggressive treatment ultimately leading to end stage complications like renal failure amputation, heart attacks and strokes.
Discussing on the levels of clinical inertia, Dr Mohan in his presentation showed that 50% contributed to physicians’ level factors followed by 30% patient level factors and 20% structural system level factors. “Over 200 potential barriers to guideline adherence have been identified”, he quoted. Lastly, Dr Mohan highlighted the effects of insulin therapy in diagnosis of type 2 diabetes. He said “Insulin is not an enemy rather a life saver. It should be considered as the ultimate saviour and must not be feared.
“Physicians need to convince the patients about why they need insulin and help them overcome their fear”, he concluded.