Are we Satisfactorily Managing Type-2 Diabetes Mellitus Patients?
Authored by Munnichoodappa C
Opinion
The prevalence of Type-2 Diabetes Mellitus (DM) is on
the rise world over particularly in China and India. Over the years
awareness of Type-2 DM has improved amongst the public as well as in
those who deliver healthcare and policy makers. However, considering the
ground reality the patients do not appear to be receiving the required
treatment. With the increased prevalence of DM, there have been more
number of Diabetes specialists and Diabetes Care Centers often
unethically advertising that the ‘patients are getting half treatment
elsewhere, we know the best about Diabetes and we are number one in
Diabetes Management etc’ thus misleading the public for commercial gain.
Since DM is a chronic, incurable but effectively
treatable disorder, the care should be regular and lifelong. Therefore
particularly considering our country’s Socio Economic situation the cost
should be kept low and reasonable, whether the patients choose the
Government or private sector. We organize conferences and Continuing
Medical Education (CME) often where only the specialists participate. We
hardly see Family Physicians/General Practioners who take care of the
majority of diabetes patients. Such conferences and CME’s serve no
purpose in improving the quality and standard of healthcare.
It has become fashionable to have foreign (western) speakers sponsored by pharma companies in most of the conferences. These are generally clinicians who probably have less experience than we do and their main purpose is to propagate use of new molecules. What we need are basic scientists to come and tell us the new developments in the field. But such people are rarely sponsored.
The eminent speakers travel all over the country and
keep on talking about western guidelines in the management of DM which
considering the socio economic situation and prevailing unorganized
health care, we can hardly follow it. There had been attempts to bring
out Indian guidelines, but again mostly they are replica of western
guidelines. Our guidelines should be commensurate to the facilities
available and affordability of our people. For want of facilities and
resources no meaningful research is happening in the country. Some
private institutions undertake so called research and publish only for
publicity and commercial gains. It rarely helps in day to day care of
patients. When the patients visit the doctors especially in the private
sector before the specialists see the patients, they are asked to
undergo various wanted and unwanted laboratory tests and investigations
at great cost. In situation like this there is more of commercial
interest than the interest of the patients. This is unfortunate. Whether
it is a Primary Physician or Family Physician or a Specialist what
needs to be done is in keeping with the traditional teaching to interact
with patients and their family and ask for essential investigations
which help to manage patients. In the absence of complications of DM
there is hardly any need for expensive Laboratory tests and equipments
for other investigations.
Counseling about the healthy life style, proper diet,
preventive foot care and use of inexpensive medicines (insulin or Oral
Hypoglycemic Agents (OHA)) with no or manageable adverse effects are
important. In addition looking for complications of diabetes during
every visit and early referral to the concerned specialist will go a
long way to lessen the expenses and suffering of patients.
Unfortunately, even though there is awareness of DM amongst the public
and fact that it is not curable, majority of patients fail to follow
regular treatment especially when they are told that they need insulin
injection. At this juncture either they change the doctors or resort to
alternate system of treatment.
Further, patients keep on spending money frequently
for un- on macrovascular complications resulting in suffering, loss of
necessary and unwanted investigations which they themselves capacity to
work and economic crippling. The National Health decide to get at
diagnostic centers, place it before the doctors Policy (2017) hopefully
will enable for early detection and better but fail to follow the
doctors’ advice. With the result they management of DM. invariably
develop microvascular Complications and worsening
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