Says disease has to be self-managed through behavioural, lifestyle changes
Kerala needs to look at other models for managing its huge burden of diabetes as the traditional health system will not be able to cope when its current population of those in the pre-diabetic stage goes on to develop diabetes in the next decade, says Brian Oldenburg, professor and chair of International Public Health, School of Public Health and Preventive Medicine, Monash University, Australia.
“Diabetes is a chronic condition and its management can be quite complicated because this is one disease which has to be self-managed through the adaptation of many behavioural and lifestyle changes. Unless those affected are really motivated, it is very difficult to achieve the desired treatment goals. It is indeed a challenge for health systems to find ways in which they can be equipped to help those with the disease manage their condition better,” says Dr. Oldenburg.
Dr. Oldenburg, who is leading a large prospective diabetes prevention trial in the State, in cooperation with the Achutha Menon Centre for Health Science Studies (AMCHSS) here, was talking to The Hindu.
The project, fully funded by Australia, is an attempt to see if cost-effective and community-based programmes can bring about behavioural changes in people and bring down the incidence of diabetes.
He says that one of the key interventions should be to improve people’s knowledge of diabetes at the grassroots level—information which is tailor-made for communities and targeting different age groups—so that there is better understanding of the ways in which diabetes can be managed.
Australia has had some success in utilising technology and peer group support programmes such as the Peers for Progress to help those with diabetes self-manage their disease.
TLC Diabetes—Telephone-Linked Care—is one such programme which has been developed using information and communication technologies to better manage conditions such as diabetes and heart disease. This tele-health programme is a collaborative effort of four Australian universities
“This is a programme in which people can call and talk to an intelligent computer. Every caller will be given a password. The computer will ask questions about the caller and record all readings such as the latest blood glucose levels or blood pressure. It asks questions about their lifestyle and gives structured advice on lifestyle modifications, tailored to the individual’s response. Or it will ask the caller if he/she would like to learn about any aspect of diabetes in particular,” says Dr. Oldenburg.
When the patient calls again, the programme will follow up on the previous week’s glucose levels or other parameters, compares them with the current readings.
“It analyses your test results systematically, plans strategies to improve your glycaemic control and offers diet advice. One advantage is that you need not wait for your next doctor’s appointment to clear any doubts you may have,” he says.
The programme had been on trial run in a small community of a few hundred diabetics in Australia for a year. It is now ready to be made available to all persons with diabetes and adopted as a supporting tool to Australia’s National Diabetes Services Scheme.
The programme uses a voice-recognition software and the voice quality is so human that those who participated in the trial said that they had developed a relationship with the voice and that it was like talking to a real doctor.
“People said that TLC gave them not jut social and emotional support, but the confidence that they can always pick up the phone and seek advice and care whenever they felt worried. They said that they felt empowered and in better control of their condition,” Dr. Oldenburg pointed out. The trial reported an average improvement of 10 per cent in diabetes management, apart from better quality of life.
The programme was quite simple and the concept could be adapted culturally to suit low resource settings, he says.
Keywords: diabetes awareness