siliconindia | | September 20199er (Rs.19,020) than that for a patient without foot ulcers (Rs.4493). When the cost of diabetes as a percent of GDP was compared in five different countries, India had the highest (2.1 percent) ­ much higher than US, UK, Den-mark and China. Challenge-3: Translating Evidence into PracticeThere is strong evidence that primary prevention of dia-betes in those with prediabetes is possible. In the D-CLIP (Diabetes Community Lifestyle Improvement Program), we showed that through a step-wise program on lifestyle modification like diet, exercise and weight reduction, we could reduce diabetes incidence by 32 percent in those with prediabetes. We have to therefore screen for predia-betes and advise lifestyle modification. Challenge-4: Burden Due to Diabetes Related ComplicationsIn the Chennai Urban Rural Epidemiology Study (CURES) carried-out by us, we showed that at least 20 percent of people with diabetes in Chennai have diabetic eye, kidney, heart or nerve complications, and many have more than one complication. The good news of course is that with early detection and good control of diabetes, these compli-cations can be prevented. Hence, all efforts must be made to achieve good control of diabetes, right from the time of diagnosis of diabetes. Challenge-5: 50 Percent of People with Diabetes Remain UndiagnosedIn the CURES study, we also showed that more than 50 percent of people with diabetes remain undiagnosed. Even among those detected, 50 percent do not take treatment. Finally among those who take treatment, over 50 percent are not under control. This means that 88 percent of peo-ple in the community do not have adequately controlled diabetes. Thus, there is an urgent raise in awareness about diabetes in the community at large. Challenge-6: Opposing Industry ForcesHighly processed `junk' foods, high in sugar and fats are mass-produced cheaply while healthier options like vegetables and fruit have become unaffordable to the common man. Advertisements promoting unhealthy foods and habits have become the norm. Restaurants offer super size meals of unhealthy foods. Industry can help to offer healthier lifestyle choices to people, which besides improving the health of people, can also be a profitable business. Challenge-7: Lack of Availability, Ac-cessibility & Affordability of Healthcare in Rural IndiaWhen 70 percent of the Indian population lives in villag-es, 75 percent of doctors practice in urban areas. To ad-dress this problem, we introduced the Chunampet Model for Rural Diabetes Care. A population of 50,000 people living in 42 villages in & around Chunampet in Kanchi-puram district in Tamil Nadu were screened free of cost using a mobile van fitted with telemedicine facilities. In addition, a rural diabetes centre was setup to provide fol-low-up diabetes care. Within three years, the whole popu-lation was screened for diabetes, over 90 percent of those with diabetes underwent screening for diabetic complica-tions and control of diabetes dramatically improved. All this was achieved with staff who were hired locally and at very low cost. The Chunampet Rural Diabetes Model can be scaled-up to reach-out to the rural poor in India.Challenge-8: Rising Costs of TherapyThe last challenge is that the therapy is getting expensive. Newer drugs, insulins and technologies are undoubtedly welcome, but they come at exorbitant prices which are out of reach of the common man who usually pays `out of pocket'. It is essential to keep prices of life saving drugs and devices (eg., insulin syringes, pens, glucose meters and strips) low by exempting them from customs or other duties so that they are affordable. Medical in-surance must be extended to people with diabetes, which should also cover costs of preventive checkups and costs of medication. Undoubtedly, diabetes presents huge challenges to India. However, there are simple solutions such as those outlined in this article which if adopted, will ensure that despite the huge burden due to diabetes that our country is currently facing, a long and healthy life despite diabetes is possible for everyone. The time for action is NOW! It is essential to keep prices of life saving drugs and devices low by exempting them from customs or other duties so that they are affordable
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