In a survey among physicians on which guidelines they follow in the treatment of diabetes, with representation from over 10 countries including from India, all of them unanimously voted for American Diabetes Association, the guidelines being the oldest, simplest to follow and meticulously revised every January, based on emerging research and evidence. The International Diabetes Federation has also formulated diabetes guidelines giving due consideration to the economic constraints in developing countries. Are these guidelines followed in India? Answer is a big NO. Though guidelines are meant to prevent complications and cost, not even 5 percent of patients receive treatment strictly based upon guidelines.
On further questioning why these guidelines cannot be followed and on challenges of treating diabetes, the following where identified as major reasons:
1. To follow treatment guidelines, patient has to undergo many investigations to identify the best therapy and to identify which all organs are affected or likely to get affected by the disease. In a resource-limited setting even this initial step becomes impossible.
2. The guideline advocates regular use of glucometer at home and lifestyle advices based on each patient's disease pattern. Obviously, to follow these guidelines, there should be multiple members in the treatment team such as dietician and diabetes educator, specially trained. The whole process will take several hours and need to be periodically repeated. Though we have India-specific guidelines for the treatment of all major illnesses, it is again hard to follow them with huge numbers of patients and with limited number of physicians to care of all.
Though following the guidelines appear to be more expensive at the first instance, with major chunk of challenge existing with more time to be spent with the patient, it will certainly bring in robust reduction in future complications and cost in the long run. The enormous increase in the number of patients can also be brought down by following protocols since more than half the patients visit the hospital for treating preventable complications from a previous illness because of lack of awareness and misconceptions.
Our population needs to be more motivated and cultivate the practice of more patients getting educated on treating chronic illnesses with modern medicine protocols which include extensive education on lifestyle and behavioural modifications. But eventually, if you consider diabetes, for example, the majority succumbs to dialysis, lower limb amputations, stroke and heart attacks while trying to save money during the initial 15 years and thus ending up spending 10-fold higher, inviting mental and physical disabilities. Following treatment guidelines will prevent such a disaster and will reduce disabilities as well.
The government can initiate the formulation of customized protocols considering the available resources and involving local, national and international research scientists who have done original research in the disease area. Unproven therapies cannot be mixed with modern medicine protocols for serious illnesses. Thanks to guidelines our lifespan has doubled in 50 years. Now it's time to debate on dying earlier rather than to live longer with disabilities.
(The author is a leading diabetologist.)
