An on-going study on the quality of care for diabetes has found that even people who have access to good healthcare in urban areas do not have full control over the disease.
The International Diabetes Management Practices Study (IDMPS), a five-year survey that documents the changes in diabetes practices in developing countries, found that quality of care even in urban areas did not meet the guidelines of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes.
Poor control of diabetes could be attributed to lack of motivation on the part of the doctor, the patient and the system, said diabetologist A. Ramachandran, who is also a global steering committee member of the IDMPS. The survey, whose results will be discussed next month at the meeting of the International Diabetes Association in Montreal, covered 27 countries in Asia, Africa, Eastern Europe, the Middle East and Latin America.
The study, started in 2005, included physicians and adult patients who had been treated by a doctor for at least one year and were not on insulin for acute conditions. The results found that about 34 per cent were paying out of their pocket for treatment.
Everyone to blame
According to the ADA, three parameters, LDL, BP and HbA1c levels must be monitored constantly. The patient must be treated with the necessary medication even if one of the parameters does not conform to the recommended levels. But the study in India found that the physician’s perception that the patient’s diabetes condition was under control was far from the truth.
Dr. Ramachandran said about 31 per cent of the 1,755 persons chosen for the study did not have an HbA1c test result. Only in 3.6 per cent of those with Type 2 diabetes had all the three parameters under control. “Doctors are under the false impression that their patients were under good care. There is complacency on the part of the patient, doctor and society,” he said.
While the patients’ tendency to postpone aggressive treatment was an important reason for poor control, doctors and the system must also share half the blame, Dr. Ramachandran said. Even those who needed to be put on insulin often postponed it. “Most of the time doctors blamed patients as not willing,” he said. There was a misconception that insulin was addictive or that its use could lead to hypoglycaemia, which could be addressed by trained paramedics, he said.
Dr. Ramachandran called for a change in the MBBS curriculum, which now includes only one chapter on diabetes, create a band of paramedics to teach diabetics to care for themselves and ensure that every employer has a regulation that each and every employee is insured for health treatment.