Diabetes Prevalence -The Burden of a Global Epidemic
Diabetes, and particularly the type 2 is positioned to be one of the largest epidemics in human history and certainly, it is one of the major threats to human health in the 21st century. According to the International Diabetes Federation in official relations with the World Health Organization and the United Nations (UN) (representing over 190 diabetes associations in more than 150 countries), diabetes is a global killer rivalling HIV/AIDS in its deadly reach. The disease kills some 3.8 million people a year. Every 6 seconds a person dies from diabetes-related causes. Diabetes hits all populations, regardless of income. It is becoming increasingly common. More than 240 million people worldwide now have diabetes. This will grow to more than 380 million by 2025.
India- The Expanding Diabetes Capital
India, crowned appropriately as Diabetes capital of the world, next only to China has the largest diabetic population and one of the highest diabetes prevalence rates in the world. Based on a compilation of the studies from different parts of the world, the World Health Organization have projected that, the maximum increase in diabetes would occur in India. The prevalence rates for type 2 diabetes in India are still increasing sharply with the number of sufferers predicted to rise from 72 million currently to 100 million in 2030. Considering the large population and high prevalence of the diabetes, the burden of diabetes in India would become enormous.
There is also a large pool of individuals with impaired glucose tolerance (IGT), many of who will develop type 2 diabetes later in life. The largest increases in the diabetic population in developing countries including India are projected to be in the most economically productive age groups. Indians are more prone to develop diabetes and its complications at a younger age. With the current high mortality and morbidity rates associated with diabetes, this represents a real threat to the economic productivity of countries such as India.
Unmet Healthcare Needs in India
Looking at the diabetes epidemic, as healthcare givers it becomes imperative that medical fraternity train and equip itself with the necessary expertise to deal with this epidemic at primary, secondary and tertiary levels. The care in diabetes is becoming increasingly complex, at a time when numbers are rising rapidly and patients are affected at a steadily younger age. It is interesting to know that 90% of the Diabetic population is covered by Post MBBS doctors (GPs), about 7-8% by Physicians only about 2% by specialists comprising of Diabetologists & Endocrinologists. A Changing Demand of Physicians/ post MBBS doctors with a rising epidemic
The general practitioners or Physicians are the first contact (primary) health care providers to most of the people with diabetes and other co-morbid conditions. Their responsibility in this role will be more demanding in the time to come, when a fiercely growing diabetes epidemic in our country will need early treatment with changing paradigms to address tight Glycaemic control.
However, the undergraduate medical curriculum and the internship training in medical colleges across India do not provide adequate education and clinical training to the post MBBS doctors to provide quality diabetes care. Physicians with Internal Medicine as their specialty also suffer from inadequate training as their curriculum is not structured toward any one specialty. Quality diabetes care is structured, follows established protocols and is amenable to audit and continuous quality improvement. It is very essential that post MBBS doctors / Post MD doctors be trained in quality diabetes care as the burden of diabetes is so huge that not all people can be cared for by specialist centers.
In several states in India, many eminent specialist diabetes practitioners with qualifications in endocrinology/Diabetology have been imparting structured education programs for general practitioners (with/without affiliation of professional bodies). It was high time that we in Karnataka too developed a course to train our doctors. Past experiences in the private sector by few colleagues demonstrates that such care is entirely feasible in our state too. It will be a boon to persons with diabetes in our state as they will have easier access to quality diabetes care. Even though we are conducting a “Fellowship” training programme at Diacon Hospital, the recognition from RSSDI & PRIMER Academy of Medical Sciences will now give a stamp of authority, Respectability & acceptability for these doctors to Practice Diabetology.
This course covers theoretical, clinical, administrative and practical aspects of good diabetes care, to enable rapid improvement in the quality of care being delivered in practice.
The course features new, innovative formats for peer and tutor support and evaluation; implementation in practice is encouraged by the completion of tasks throughout the course. It is suitable for any primary care professional (Physicians & Post MBBS) currently providing or preparing to provide routine care for their patients with diabetes.
After completing the course, participants should be able to:
The training period is designed to meet the maximum requirement for training in Diabetology prior to certification. Clinical Diabetology will include :
Doctors selected for the course will have to work in 3 shifts.
1st shift (7.30 am to 4 pm) : This period involves seeing New patients coming as Out Patients. Taking of detailed medical History, Examination, writing of investigations, Dietary History, Education, Fundus examination & final counseling of each new patient goes on during this period. Review patients are also examined & counseled when education session goes on for the new patients. Selected Candidates will learn the work under the supervision of the senior consultant & over a period of 3 months will start working independently.
2nd shift (12 noon to 8 pm) : This period involves Ward work, coordinating with the Cardiologist, ECHO, TMT, working in the Foot clinic & ward rounds with the consultants. This period also gives adequate scope to interact with the radiologist when procedures are being done by them.
3rd shift (8pm to 8am) : Involves ward work, writing of Discharge summary, attending to the emergencies at night & reading in the Library. Morning work ends with ward rounds with the consultant.
Rajiv Gandhi Health University has recognized the Certificate Course in Diabetology which is the first of its kind to get university recognition in the country.
First Exclusive Hospital for Patients with Diabetes related problems in the state.
First Private Hospital to get the Medical University recognition for Post graduate courses in Diabetology.
First Private Hospital to have a EMEA audited research facility for clinical trials.
RSSDI has recognized the Fellowship course from the year 2009. 4 candidates are going to be selected each year. This "Advanced course in Diabetology" is now recognised by Jaipur National University from 2017 batch.