Diabetes care lacking even among rich patients of Delhi: survey

New Delhi, Nov 9 (UNI) Even though the incidence of diabetes is increasing among the people here, care and managment of the disease is lacking or very poor thereby increasing the already high risk of eye, kidney, foot and cardiovascular diseases among diabetics according to a recent survey.

The Delhi Diabetes Community suvey conducted by Dr Jitendra Nagpal and Dr Abhishek Bhartiya of Sitaram Bhartia Institute of Science and Research has revealed that a wide gap between effective diabetes management practices and their implementation, even among those from the higher income groups, exists.

This is significant in view of the increasing incidence of diabetes among Indians and the possibility of the country emerging as the diabetes capital of the world by 2020. Sedentary lifestyle and changing food habit and obesity has contributed to diabetes assuming epidemic proportion in the country, according to experts.

A cross-sectional survey conducted on 819 patients from 20,666 houses, showed that known diabetes patient from high income groups in Delhi have poor glycemic, lipid and blood pressure control.

Diabetes self management education, nutrition counselling, exercise prescription and screening evaluations recommended for early detection of complications were infrequently advised and complied with.

Only 13 per cent of the tested patients have Glycosylated Haemoglobin tested even once a year which is mandatory. Only 16 per cent had gone for mandatory eye check up in the last one year and just 3 per cent had foot check up and a mere 32 per cent had a cholesterol and lipid profile examination in the past one year.

About 63 per cent of the patients had an abnormally high blood pressure of 140/90 mmHg while lipid profile was uncontrolled in over 74.5 per cent patients. Over 42 per cent patients had Glycosylated Haemoglobin level of more than eight as against the normal of six.

Half of the patients had a routine urine examination in the last one year to check traces of protein to indicate kidney damage. One fifth were taking aspirin and 3.1 per cent were taking lipid lowereing drugs, the survey added.

About 92 per cent patients were visiting physicians but only 21.7 per cent had heard of the word glycosyulated haemoglobin or any investigation estimating glycemic control over the past months.

Awareness of the need for regular testing of blood glucose, eye examination and electrocardiogram was reported by 89.1, 61.1 and 48.1 per cent respectively.

Projection form the study indicated that of the current 600,000 diabetes patients in Delhi, there is a risk of 84000 new cases of heart disease and nearly 34,000 cases of stroke as well as 60,000 deaths in the next ten years.

These could be prevented by a mere one per cent reduction in Glycosylated Haemoglobin as evidence have shown that one per cent reduction in it could reduce the diabetic patient's risk of heart attack by 16 per cent, a slight 10mmHG reduction in systolic blood pressure could reduce his chances of diabetes releated death by 18 and stroke by 44 per cent. Improving the patient's lipid profile could reduce the risk of heart diseases by 25 to 55 per cent.

All this highlight the fact that patients are not receiving adequate diabetes self-management education which is the cornerstone of successful treatment. Patients are also not receiving timely screening investigations for early detection of eye, kidney and foot disease and control of risk factors like high blood sugar, blood pressure and blood cholesterol. Consequently a large number of individuals are likely to suffer from avoidable complications including early death.

''Diabetes is a major public health problem in Delhi with about 15 per cent of the city's adult population affected by the disease.

Our study shows that diabetes care is inadequate even among those from the higher income group. We advocate that all patients educate themselves about diabetes management and use a checklist to help ensure they receive adequate care,'' said Mr Abhishek Bhartia of the Institute.

UNI