New Initiative Shows Path to Better Diabetes Control

A low-cost healthcare model involving non-physician workers using computer tools can help diabetes patients double their likelihood of controlling the disease.

According to a study conducted by researchers at AIIMS, Public Health Foundation of India, and the Rollins School of Public Health, Emory University in Atlanta, the model can help patients to improve their blood sugar levels and manage the disease on their own.

A trial conducted at ten clinical centres across India and Pakistan compared the diabetes-focused quality improvement (QI) strategy versus the usual care alternatives for heart patients with poorly controlled diabetes. The results suggested that patients in the QI strategy group were twice as likely to achieve combined diabetes care goals and larger reductions for each risk factor compared to traditional care, said Nikhil Tandon, Professor and Head, Department of Endocrinology, AIIMS. “This intervention doesn’t require new or expensive drugs, but instead it enhances a patient’s likelihood of managing their disease on their own by providing individualised support and enhancing the physician’s likelihood of being responsive,” he said.

The study was published in the July 12th edition of Annals of Internal Medicine. Tandon, the senior author of the study, said the team compared the effects of multicomponent diabetes strategy (combining a non-physician care coordinator and decision-support electronic health record software) versus traditional care in South Asia, where resources are limited and diabetes is prevalent. “Approximately 1,150 patients with diabetes and poor cardiometabolic profiles were randomly assigned to a multicomponent QI strategy or usual care for two and a half years. Results suggested that patients in the QI strategy group were twice as likely to achieve combined diabetes care goals and larger reductions for each risk factor compared with usual care. “This was the first trial of comprehensive diabetes management in a low and middle-income country setting,” Tandon said.

Findings from the trial also showed that the new intervention yielded sizeable improvements in the blood sugar, blood pressure, and cholesterol profiles of participants.

Benefits were similar in public and private diabetes clinics, indicating that with structured care, health inequalities can possibly be reduced.