India has a very large population which is stricken by poverty. Maternal malnutrition is rampant and the adverse effects of malnutrition in utero are evident by the appearance of metabolic disorders at a very young age. There is an urgent need for the government to address these issues and provide adequate healthcare facilities, particularly for the lower economic status of the society. An integrated national system for early detection and prevention of diabetes must be developed in order to minimise an individual’s risk of Type 2 diabetes and its complications.

Here are three key goals for healthcare policymakers that are crucial for building an integrated national system. 

Policy Goal 1: Improve disease management for people with diabetes to reduce complication rates.

The starting point for policymakers is to ensure continual improvements in disease management for their population with diabetes. Such improvements will enhance the quality of life for those with the disease and reduce complication rates. In turn, this will ease the pressure on the health system and reduce overall spend. Improving diabetes care lies firmly in the control of health ministries. These types of interventions, rather than initiatives aimed at prevention, have the potential to produce a fast return on investment.

The basic means to achieve improvements are well-evidenced in global and national clinical guidelines. These include:

  • Access for people with diabetes to medicines and medical treatment.
  • Deliver comprehensive screening for people with diabetes.
  • Provide comprehensive patient education and self-management programs.

In addition, there are standards for low-resource environments, research into the cost-effectiveness of interventions and policymaker guides and toolkits. To get diabetes care right, it may be necessary to make adjustments to traditional healthcare systems. This could involve:

  • Creating incentives for healthcare providers to achieve improved outcomes.
  • Improving the efficacy and cost-effectiveness of self-management.
  • Delivering interventions to hard-to-reach patients by exploring innovative low-cost models of delivery.

Policy Goal 2: Establish effective surveillance to identify and support those at risk of Type 2 diabetes.

Intuitively, screening for diabetes makes sense. Up to 80 per cent of cases of Type 2 diabetes can be prevented through lifestyle or drug treatments, creating a clear opportunity to reduce the number of people with diabetes and the cost burden that diabetes imposes. Screening for diabetes has been proven to be cost-effective.

However, some communities are hard to reach and even where the screening is readily available and convenient, the take-up rate is often low. There are a range of tools and approaches that can support policymakers in their efforts to increase screening. The key for policymakers is to make screening more accessible and appealing for people and at a sustainable cost. Some of the innovative ways to achieve this aim can include:

  • Providing incentives for people to be screened.
  • Targeting healthcare providers to encourage take-up.
  • Tailoring screening to cultural circumstances.
  • Sharing the cost and inconvenience by creating screening mechanisms for other diseases at the same time.
  • Targeting high-risk populations.

Offering incentives to healthcare providers can succeed in increasing screening rates. Clinicians tend to be in contact with high-risk patients through the normal course of their work and are therefore in a strong position to influence them. Patients too will respond positively to incentives, if the incentives outweigh the time, effort, discomfort and perhaps money that the patients must put into being screened.

Policy Goal 3: Introduce a range of interventions to create an environment focused on prevention.

A critical contribution to slowing or even reversing the tide of Type 2 diabetes comes from achieving population-level behaviour change aimed at encouraging societies to attend more conscientiously to their health, be less sedentary and have better nutrition. To influence the population and bring about the desired behaviour change, policymakers need to commit to creating an environment focused on prevention – one that supports healthy choices and encourages healthy behaviours. The benefits extend beyond diabetes to other non-communicable diseases (NCDs) including cardiovascular diseases, respiratory diseases, cancers and dementia. The core-steps and innovative action steps for policymakers may include:

  • Articulating a clear case of change – including both health and economic consequences.
  • Committing to ambitious targets and timescales.
  • Assigning responsibility for leading and coordinating initiatives to create an environment focused on prevention.
  • Exploring the full range of preventive interventions- from information to nudges and legislation.
  • Building a cross-disease coalition to support a preventive health and wellbeing approach.

Creating an improved prevention-focused environment is not an easy task. People have hundreds of opportunities to make less healthy choices every day at home, work, school and while travelling, shopping or engaging in leisure pursuits. Each decision is shaped by a wide range of factors viz., the information available, incentives, peer pressure and social norms.

A call to action

The growing epidemic of Type 2 diabetes demands urgent and coordinated attention. Primary prevention of Type 2 diabetes is a logical strategy considering the scale and the cost of ongoing medical treatment for the diabetes epidemic and the inevitable increase in diabetes incidence together with obesity.

Given the size of the diabetes epidemic and the number of people at high risk, approaches aimed exclusively at individual behaviour changes in clinical settings will likely prove inadequate for diabetes control at the population level. On the other hand, improvements in policy and the environmental factors would predispose, enable and reinforce more healthy diets and more active lifestyles for widespread and sustained behaviour changes.

These will require development of infrastructure, environment and policy changes and ongoing funding of a multilevel, multidisciplinary approach and an experimental attitude at the state and local levels to allow public health researchers to evaluate the ingredients of successful innovations that constitute natural experiments in diabetes prevention.

Here are three key goals for healthcare policymakers that are crucial for building an integrated national system. 

Policy Goal 1: Improve disease management for people with diabetes to reduce complication rates.

The starting point for policymakers is to ensure continual improvements in disease management for their population with diabetes. Such improvements will enhance the quality of life for those with the disease and reduce complication rates. In turn, this will ease the pressure on the health system and reduce overall spend. Improving diabetes care lies firmly in the control of health ministries. These types of interventions, rather than initiatives aimed at prevention, have the potential to produce a fast return on investment.

The basic means to achieve improvements are well-evidenced in global and national clinical guidelines. These include:

  • Access for people with diabetes to medicines and medical treatment.
  • Deliver comprehensive screening for people with diabetes.
  • Provide comprehensive patient education and self-management programs.

In addition, there are standards for low-resource environments, research into the cost-effectiveness of interventions and policymaker guides and toolkits. To get diabetes care right, it may be necessary to make adjustments to traditional healthcare systems. This could involve:

  • Creating incentives for healthcare providers to achieve improved outcomes.
  • Improving the efficacy and cost-effectiveness of self-management.
  • Delivering interventions to hard-to-reach patients by exploring innovative low-cost models of delivery.

Policy Goal 2: Establish effective surveillance to identify and support those at risk of Type 2 diabetes.

Intuitively, screening for diabetes makes sense. Up to 80 per cent of cases of Type 2 diabetes can be prevented through lifestyle or drug treatments, creating a clear opportunity to reduce the number of people with diabetes and the cost burden that diabetes imposes. Screening for diabetes has been proven to be cost-effective.

However, some communities are hard to reach and even where the screening is readily available and convenient, the take-up rate is often low. There are a range of tools and approaches that can support policymakers in their efforts to increase screening. The key for policymakers is to make screening more accessible and appealing for people and at a sustainable cost. Some of the innovative ways to achieve this aim can include:

  • Providing incentives for people to be screened.
  • Targeting healthcare providers to encourage take-up.
  • Tailoring screening to cultural circumstances.
  • Sharing the cost and inconvenience by creating screening mechanisms for other diseases at the same time.
  • Targeting high-risk populations.

Offering incentives to healthcare providers can succeed in increasing screening rates. Clinicians tend to be in contact with high-risk patients through the normal course of their work and are therefore in a strong position to influence them. Patients too will respond positively to incentives, if the incentives outweigh the time, effort, discomfort and perhaps money that the patients must put into being screened.

Policy Goal 3: Introduce a range of interventions to create an environment focused on prevention.

A critical contribution to slowing or even reversing the tide of Type 2 diabetes comes from achieving population-level behaviour change aimed at encouraging societies to attend more conscientiously to their health, be less sedentary and have better nutrition. To influence the population and bring about the desired behaviour change, policymakers need to commit to creating an environment focused on prevention – one that supports healthy choices and encourages healthy behaviours. The benefits extend beyond diabetes to other non-communicable diseases (NCDs) including cardiovascular diseases, respiratory diseases, cancers and dementia. The core-steps and innovative action steps for policymakers may include:

  • Articulating a clear case of change – including both health and economic consequences.
  • Committing to ambitious targets and timescales.
  • Assigning responsibility for leading and coordinating initiatives to create an environment focused on prevention.
  • Exploring the full range of preventive interventions- from information to nudges and legislation.
  • Building a cross-disease coalition to support a preventive health and wellbeing approach.

Creating an improved prevention-focused environment is not an easy task. People have hundreds of opportunities to make less healthy choices every day at home, work, school and while travelling, shopping or engaging in leisure pursuits. Each decision is shaped by a wide range of factors viz., the information available, incentives, peer pressure and social norms.

A call to action

The growing epidemic of Type 2 diabetes demands urgent and coordinated attention. Primary prevention of Type 2 diabetes is a logical strategy considering the scale and the cost of ongoing medical treatment for the diabetes epidemic and the inevitable increase in diabetes incidence together with obesity.

Given the size of the diabetes epidemic and the number of people at high risk, approaches aimed exclusively at individual behaviour changes in clinical settings will likely prove inadequate for diabetes control at the population level. On the other hand, improvements in policy and the environmental factors would predispose, enable and reinforce more healthy diets and more active lifestyles for widespread and sustained behaviour changes.

These will require development of infrastructure, environment and policy changes and ongoing funding of a multilevel, multidisciplinary approach and an experimental attitude at the state and local levels to allow public health researchers to evaluate the ingredients of successful innovations that constitute natural experiments in diabetes prevention.

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Dr Wasim Ghori
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Dr Ghori is is a Consultant Diabetologist and currently the Medical Director for a chain of Specialty Heart & Diabetes Clinics, Mumbai. He holds an MBA in International Health Services & Hospital Management from London South Bank University where he spent considerable time studying the National Health Service (NHS, England). The British Council appointed him as the Brand Ambassador for Education UK highlighting his outstanding achievements as a healthcare leader.

By Dr Wasim Ghori

Dr Ghori is is a Consultant Diabetologist and currently the Medical Director for a chain of Specialty Heart & Diabetes Clinics, Mumbai. He holds an MBA in International Health Services & Hospital Management from London South Bank University where he spent considerable time studying the National Health Service (NHS, England). The British Council appointed him as the Brand Ambassador for Education UK highlighting his outstanding achievements as a healthcare leader.

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