Cost-effective management of such conditions

The Kerala State government has come out with treatment protocols for diabetes and hypertension, which could go a long way in making the management of these conditions more cost-effective and efficient.

Senior health officials said the government would soon be issuing a ‘government order’ (GO), making these protocols the compulsory and standard treatment guidelines in government healthcare institutions for treating anyone with diabetes or hypertension.

The protocols were evolved as the State was going ahead with a well-entrenched non-communicable diseases (NCDs) control programme to tackle its huge burden of lifestyle diseases through aggressive screening, prevention, and control strategies.

“In a State, where an estimated 16 per cent of the population has diabetes and over 30 per cent hypertension, it was imperative that we evolved common treatment guidelines from a public health perspective. Diabetes management has already become a very expensive and market-driven affair and we needed to make it more cost-effective and efficient for the public,” a senior Health official told The Hindu.

The protocols were prepared by a high-level team of experts designated by the government and included physicians, cardiologists, endocrinologists, and community medicine specialists from both major private and public sector healthcare institutions.

“We approached the problem from various perspectives and after prolonged discussions, evolved a general framework within which we had to look into various aspects of managing these conditions. Our aim was to ensure an optimum level of care, using low-cost, yet effective drugs with the least side effects,” S. Sivasankaran, Professor of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, and one of the members of the core team, said.

Focus areas

The protocols focus on screening all individuals above 30 years, assessing habits like tobacco/alcohol use, setting cut-offs for various stages of the conditions and for introducing drugs. For example, in managing hypertension stage 1 (140-159 systolic and 90-99 diastolic), drug therapy is introduced only if there is any co-morbidity or if there is no control even after three months of lifestyle modification.

The general treatment goals would be to provide better quality of life and prevent acute complications like renal problems or cardiovascular issues or infections.

Management of lifestyle diseases, especially, diabetes, had become an expensive proposition because many doctors were confused about the first-line drugs they should be prescribing —the simple metformin, the third-generation drugs, insulin, or the analogue insulin?

“Most of these so-called new and advanced drug formulations are way too expensive and the additional benefits these may have over the older-generation drugs might not be very significant. When the monthly expenses over drugs go up, more people drop out of treatment, there is less prescription compliance and more of complications for the patient,” a public health expert pointed out.

The drugs supplied free-of-cost by the government under the State-sponsored NCD control programme would be in accordance with the drug list in the NCD protocol. The protocol was also clear on the fact that all complications involving co-morbidities during the management of diabetes or hypertension be referred to the secondary level of care (district hospitals).

Health officials said it was a major achievement for the State that it could get together experts to reach a consensus on such definitive and detailed protocols.

The experts will meet every year to evaluate the protocols and suggest necessary changes.