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Diabetes guides add to medicine benefits

New Delhi, July 13: Simple but well-crafted, periodic guidance to diabetes patients from non-physician care coordinators, when added to standard treatment, may help them achieve better blood sugar control than medications alone, a multi-city study from India suggests.

The findings demonstrate an intervention that does not require any new or expensive drugs but enhances patients' likelihood of managing their diabetes better through support from trained non-doctor health workers, the doctors who conducted the study say.

Patients who received such guidance showed significant improvements in blood sugar, blood pressure and cholesterol levels that would reduce their risk of developing serious diabetes complications such as heart disease, kidney failure, eye disease and limb amputations.

"This was a real-life study. It shows a pragmatic intervention relevant to India's burgeoning diabetes problem and replicable on a large scale," Nikhil Tandon, professor of endocrinology at AIIMS, New Delhi, and one of the study's coordinators, told The Telegraph.

Endocrinologists estimate that India has over 60 million patients with diabetes, a figure expected to rise above 80 million by 2025. Medical studies suggest that only three in 10 diabetes patients in India manage to keep their sugar levels at desired levels.

"Glucose control (even among patients with diagnosed diabetes who take regular medications) is poor and there have been no major improvements in this situation over the past 10 to 15 years," Tandon said.

In their study, doctors from diabetes clinics in Bangalore, Chennai, Mumbai and other cities picked 1,146 patients and offered 575 of them special non-physician intervention in addition to standard care. They then compared these patients' progress with the remaining 571 who had received only standard care.

Their results, published this week in the Annals of Internal Medicine, showed that twice as many patients who had received non-physician intervention achieved the desired blood sugar levels compared with those who received only standard care.

"We've not added anything new. What needs to be done was implemented in an efficient way," said Dorairaj Prabhakaran, a senior cardiologist and director of the New Delhi-based Centre for Chronic Disease Control who was another coordinator of the study.

"The non-physician care coordinators serve as the interface between doctors and patients," Prabhakaran said. "Doctors are often busy and unable to provide adequate and detailed lifestyle guidance to patients, which the care coordinators were tasked to do."

The care coordinators used a computer-based system to track patients' records, document their needs and remind them of future follow-up visits with doctors, and provided regular guidance on diet, exercise and tobacco reduction, among other advisories.

The researchers say their results are all the more significant because the study did not financially support any component of diabetes care. This ensured that the patients were not in any way incentivised to play along with their care coordinators.

"The patients were expected to come on their own for blood tests and review by doctors; they had to pay for their blood tests, medication and, for those attending private clinics, the consultation fees of doctors," Tandon said.

The care coordinators were non-physicians, trained in allied health fields such as dietetics or social work with less than six months' experience in the health-care sector. They were able to join the study with only three days' training.


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