Diabetes in India is fast approaching endemic proportions and The country is also faced with the herculean task of managing this disease effectively. According to the International Diabetes Federation (IDF), India is home to more than 65.1 million people with the disease, compared to 50.8 million in 2010. These increasing numbers drive home the point that urgent measures are imperative. Healthcare providers have realised that being a lifestyle disease, managing diabetes would need an integrated approach. Hence they are moving beyond just treatment and are adopting measures which would aid their diabetic patients to lead a healthy lifestyle – a must to cure or curb diabetes. As a result, apart from awareness campaigns and corrective action, healthcare players are investing significantly on setting up diabetes management clinics and fitness centres to promote healthy living which would prevent the advent of diabetes in the long run. Express Healthcare, in its diabetes special, showcases the examples of three leading hospitals and their measures for managing the malady which has become a serious public health concern
‘Hospitals should focus on forming support groups for those suffering from diabetes’
Protection from pain
We are investing in pain management clinic which will also focus on diabetic neuropathy – a major complication in diabetic patients. Our dedicated pain management specialist will determine a comprehensive plan of care including, but not limited to, procedures such as nerve ablation. Also, we have invested in a dialysis department to provide reliable and expert care for patients suffering from diabetic nephropathy (kidney failure as a complication of diabetes.)
Fitness is the key
At our hospital, our team of doctors, nutritionists and physiotherapists together manage patients suffering from diabetes with an integrated approach. However, in the near future we are setting up a special fitness centre managed by a qualified diabetologist. Nutritionist and physiotherapist would work in collaboration with the diabetologist at this fitness centre. Our centre would primarily focus on orientation, fitness assessments, personal exercise plans, group exercise classes, regular monitoring of blood sugar pre/post exercise etc. To begin with, the emphasis of the programme will be on type 2 diabetes which usually occurs later in life and is mostly a lifestyle disease that results from obesity and lack of exercise. Insulin may be insufficient or the cells that take up glucose may be resistant to the action of insulin. Ultimately, the result can be the same as in type 1 diabetes, that is, a complete failure of the beta cells and insulin supply.
Trials have shown that attention to lifestyle with nutrition and exercise, and a weight loss of 7 to 10 per cent of body weight, can reverse pre-diabetes. Other than weight loss, for people with diabetes and pre-diabetes, formal exercise programmes help manage blood glucose by making insulin action more efficient and by using and enhancing the storage of blood glucose in muscle, thereby lowering abnormal blood glucose levels. Hence aerobic exercise and strength training will be main focus of fitness centre, coupled with orientation and awareness about diabetes management and nutrition recommendation to members.
Uniting to fight diabetes
Hospitals should focus on forming support groups for those suffering from diabetes. Through these groups, hospitals can educate patients suffering from diabetes in a group setting, covering diabetes self-management topics and training. Sharing success stories of those living with diabetes can inspire other diabetics and encourage them to fight the disease and not succumb to it.
Hospitals should also set up neighbourhood sugar clinics equipped with necessary expertise, diabetologist, nutritionist, physiotherapist, diabetes educators and technology. These clinics should focus on individually-tailored customer profile including annual assessment, as well as plan of care including lifestyle and diet modifications. To go a step further, the hospitals can engage employees suffering from diabetes to work at these clinics.
Utilising technology effectively
With technology increasingly impacting our lifestyle we strongly believe in utilising it effectively to not only treat but also for prevent diabetes. Hospitals, in association with pharma companies, can design smartphone applications to help people make healthy lifestyle choices at home or on the job so that they can effectively manage the various aspects of diabetes. It is of utmost importance to customise these apps to suit Indian culture and food habits. These apps can also help keep track of not only blood glucose levels but also carbohydrates, medication doses and exercise. They can also help educate about nutritional value or calorie counts of foods you eat at home or at restaurants. Exercise being a key component of lifestyle modification, the apps can also help keep a track on the amount of calories burnt. Children can be engaged by designing interactive games through which they can learn about carbohydrate counting and living with diabetes. Hospitals should design an interactive diabetes website to help support people who have diabetes and their family and friends.
– K Sujatha, Centre Head, Wockhardt Multispeciality, Nagpur
‘Kohinoor Hospital aims to focus on holistic prevention and treatment plan’
Kohinoor Hospital has a Diabetes Specialities Centre offering comprehensive diabetic services. The unique selling point of this centre is Total diabetes care under one roof which treats all the problems related to diabetes that result in blindness, kidney disease, heart attacks and amputations. The aim of this centre is to provide state-of-the-art, efficient and comprehensive care at affordable costs. The number of people with diabetes is increasing due to population growth, aging, urbanisation, and increasing prevalence of obesity and physical inactivity. We at Kohinoor Hospital aim to focus on a holistic prevention and treatment plan for such patients.
The treatment of diabetes at Kohinoor Hospital follows well-established protocols with ample scope for individualisation depending on the type of diabetes, whether the patient has other active medical problems, whether the patient has complications of diabetes, and age and general health of the patient at time of diagnosis. Care is delivered by a diabetes management team comprising different cadres of staff – medical registrars, consultant diabetologist, consultant endocrinologist, diabetic educators – specialised dieticians , diabetic foot surgeon, ophthalmic technicians and surgeons, specialised diabetes nursing team, cardiologists, nephrologists, neurologists, bariatric surgeons, Physiotherapists, Intensivists, dental care unit and Counsellor cum stress management unit.
High level of care
Comprehensive care is provided at three levels- primary, secondary and tertiary. At primary level, people with family history of diabetes and anyone with symptoms of diabetes are offered preliminary screening with blood tests. At the secondary level, people with known diabetes are offered blood tests, urine tests, eye examination, X-ray, scan, Doppler, ECG, Biothesiometry, dental and foot examination at regular intervals. The types of tests to be undergone at different intervals are presented to patients in a chart which is very informative. At the tertiary level, patients with high sugar, or with one or several of the serious complications of diabetes, are admitted in the hospital for evaluation and further management. Laser procedures and amputation surgeries are performed for diabetic retinopathy patients and patients with foot ulcer respectively. A team of diabetic educators take the complete diet history of patients and depending upon the diabetologist’s prescription, individualised diet advice is given to the patients. We have a dialysis centre and renal transplant centre for diabetes induced end -stage renal disease.
The whole process is standardised in the form of SOPs and a team of people is responsible for each area. Once the patient registers, he/she will be seen by the junior doctors for preliminary screening, followed by diabetic counsellor who takes patient history and sends them to diagnostic area where the blood samples are collected. Based on the condition, necessary examinations are done before they see the senior consultants. Following the consultants’ advice the counsellors explains the diet procedures and follow up details to the patient. Since the work load is divided among many cadres of staff, and diabetic counsellor shares the major work of communicating to the patient, on any given day a consultant may see 20 to 30 patients.
Since diabetic retinopathy is considered one of the leading causes of blindness after cataract, Kohinoor Hospital has developed special expertise in the treatment of diabetic retinopathy under the specialised ophthalmic surgeons. The hospital has a set of unique protocols for screening diabetic retinopathy patients. Every patient who visits the diabetic centre is advised to undergo routine eye screening. If a patient is found to have diabetic retinopathy, they will be evaluated for further intervention using specialised tests. Based on the results of these tests, laser procedure is advised for the retina.
Kohinoor Hospital has state -of-the-art laboratory facilities for diagnosis. It does routine bio-chemistry investigations and performs special tests such as thyroid, insulin and C-peptide. The laboratory is equipped with auto analysers and provides round the clock service. Since kidney disease is a well-known complication of diabetes, Kohinoor Hospital does micro albuminuria test to diagnose this. A foot pressure measurement system is used to detect areas of high pressure under the foot which is a major cause for diabetic ulcer.
Counselling and education
Diabetic counsellor is a unique cadre that is developed at Kohinoor Hospital. Those who have completed their bachelor’s degree in nutrition and diet are recruited for this. They are given training on diabetic related diet procedures. Their role is history taking and educating the patient on the life style changes they need to make. They explain to the patient about insulin administration, diet guidelines, self-monitoring of glucose and physical exercises. Since they do part of the consultant’s job, it saves the patient’s time and makes them efficient.
In addition to providing services, Kohinoor Hospital gives great emphasis on educating the patients. It has a separate department called corporate communication which is dedicated to creating awareness among the public. It educates patients through awareness camps, mass exhibitions and organises events during World Diabetes Day and World Health Day. Apart from this, it also educates general physicians about the checkups that diabetic patients need to undergo. This will enable them to educate their patients. We publish a newsletter called “K-Lifeline” every three months which is circulated amongst the general population and is a tool for health education activities in general.
Focus on fitness
Our physiotherapists run a specialised fitness centre for controlling diabetes and other life style diseases. It guides patients on the type of exercises that are individualised for specific needs of the patient. In addition, we have a “Fit Friday” every week where anybody can walk in and avail of free consultation advice and diagnostic tests.
– Dr Rajeev Boudhankar, Vice- President, Kohinoor Hospital
‘Rockland hospital focuses on the promotion of preventive care’
The group organises regular weekly health awareness camps in the rural areas with the help of the village heads, RWAs and inside the factory and office complexes in the Delhi NCR.
Rockland group has initiated a campaign by the name of Rockathon to promote running as a part of our lifestyle. Over 2000 participated in a 5Kms Marathon and a 1 Km Power Run in the first event itself. Rockathon will be followed by a series of events to promote the concept of preventive healthcare through various forms of sports, life style correction and exercising. Running benefits almost every part of the body, and costs nothing so it became the first choice for the Rockland team.
Research shows that a long period of physical inactivity raises the risk of developing heart disease, diabetes, cancer, and obesity. Human beings evolved by exploring the world on their feet so spending a full day in a chair is against our basic nature. It’s a form of physical arrest.
The Rockland team has been propagating a simple three-step formula to stay free from diabetes:
- Choose whole foods and cooked at home instead of buying pre-packaged food which are high in fat and salt. Choose a variety of yellow, red and green fruits, limit sugar intake by drinking green tea and avoid sugary drinks. This one step alone can help you lose or maintain a healthy weight and will reduce the risk of heart disease, obesity and diabetes.
- Walking to someone else’s desk rather than sending an e-mail, parking farthest from the building, taking the stairs more often, walking, cycling or playing with the kids and engaging in house cleaning or gardening will burn calories and give you enough exercise.
- To sleep well, remove the television, computers, and gadgets from your bedroom and avoid large meals before bedtime. Set firm bedtimes and wake up times. Make sure that heavy reading, text messaging, video games or social networking are restricted to mornings.
– Rajiv Tewari, Director, Health & Wellness Rockland Hospitals Network