Chennai: A recent study entitled ‘Temporal changes in diabetes prevalence and achievement of care goals in urban South Asia from 2010 to 2016 – The Center for Cardio-metabolic Risk Reduction in South Asia Study’, was recently published online in the prestigious British journal Diabetic Medicine. This project is coordinated by CoE-CARRS (Center of Excellence – Center for cArdio-metabolic Risk Reduction in South Asia) based at Public Health Foundation of India (PHFI), New Delhi, India in collaboration with Centre for Chronic Disease Control (CCDC), New Delhi, All India Institute of Medical Sciences (AIIMS), New Delhi, Madras Diabetes Research Foundation (MDRF), Chennai, India, Aga Khan University, Karachi, Pakistan and Emory University, Atlanta, USA. CARRS involves population-based surveys from three large metropolitan cities in South Asia – Chennai and New Delhi in India and Karachi in Pakistan.
What are the salient features of this study?
· In this study, two representative samples of South Asian adults were recruited using identical methods from Chennai and New Delhi in India and Karachi in Pakistanin 2010-11 (n=16,288) and in 2015-16 (n=14,587).
· The aim of this study was to look at changes in prevalence of diabetes and the achievement of the goals and treatment of diabetes, ie quality of diabetes care over two consecutive independent survey periods at least 5 years apart ie., from 2010–11 to 2015–16.
What are the novel findings from this study?
· We report that the prevalence of diabetes in these three mega cities in South Asia, increased from 19% in 2010–11 to 20% in 2015–16.
· We next examined attainment of four diabetes care goals, namely, 1) glycaemic control (HbA1c <7.0%), 2) blood pressure control (BP<140/90 mmHg), 3) lipid control (LDL cholesterol <100 mg/dl) and 4) absence of smoking status. These were denoted as ABCD (A–A1c glycemic control, B–blood pressure control, C–cholesterol (lipid) control and D–smoking status). We analysed how many individuals with diabetes met these four targets, individually and together.
· We observed that there were improvements in achieving glycaemic goals (an increase from 25% in the year 2010–11 to 30% in the year 2015–16). Similarly, the lipid goal also increased from 34% to 45%over the period. However, there were no notable improvements in blood pressure control or smoking status. The findings were not different by sex, age, or wealth status of participants.
· Our study also reports that a greater number of individuals with diabetes met two, three, or four treatment goals in 2015–16 compared to 2010–11.However, overall, only 7% of individuals met all 4 treatment goals.
· Thus, while admittedly there have been some improvements in glycemia and lipid control, large gaps still exist, particularly with respect to key cardiovascular risk factors like blood pressure and smoking.
What is the significance of this study?
· Our results underscore the urgent need for concerted policy, system, clinical, and individual efforts to improve the quality of diabetes care. If this is not done urgently, there could be serious consequences with respect to health of individuals and risk of blindness, heart disease, kidney disease, and amputations, more pressure on health care systems, and could ultimately affect the economies of these South Asian countries.
Quotes from authors:
Dr.R.M.Anjana, the Managing Director of Dr.Mohan’s Diabetes Specialities Centre and Vice President of Madras Diabetes Research Foundation and the first author of the study said, “The findings of this study are significant as they emphasize the need for intensive and comprehensive management of cardio-metabolic risk factors rather than controlling a single risk factor. It is worrying that only less than 7% of individuals attained all four diabetes care goals. This underscores the need for comprehensive management of diabetes and not just aiming for glycemic control”.
Dr.V.Mohan, Chairman of Dr.Mohan’s Diabetes Specialities Centre and President of Madras Diabetes Research Foundation said “In this study, we report that the number of people with diabetes has grown rapidly in these three South Asian mega-cities and affects nearly one in five adults. Another interesting observation is that there was some improvement in the number of people with self-reported diabetes attaining the target goal. The possible reasons for this improvement could be the increase in the awareness for tight glycemic control among both the caregivers and people with diabetes, and availability of a wider range of therapeutic options”.
Dr.Mohammed K. Ali, Associate Professor of Global Health and Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA and senior author of the study adds “In this study, we observed improvements in lipid control (LDL cholesterol levels), which can be explained to a great extent by more widespread use of statins. Though some improvements have been observed, it is of concern that, over 50% of people with self-reported diabetes had their lipid levels above the recommended target. Furthermore, these findings highlight that diabetes is not just about sugar; we need to think of diabetes more holistically and evidence-based care models need to be scaled up for the broader population”.
Dr.K.M.Venkat Narayan, Ruth and O.C. Hubert Professor of Global Health and Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA and the Principal Investigator of the CARRS Study emphasizes that “Suboptimal control of the cardiovascular risk factors, paralleled with the rapidly rising prevalence of diabetes, is likely to increase the cardiovascular and microvascular disease burden in this region in the near future. This in turn, could have serious consequences for health care systems and economies of these South Asian countries. Concerted policy, systemic, clinical and individual efforts are needed to close these care gaps. Next year is the 100th anniversary of the discovery of insulin, and is a great opportunity to set targets for diabetes detection and control, and to rally resources to achieving such targets.”
