President of India's Diabetes & Obesity Centre, Dr Brij Mohan has an extensive background in the field of diabetes, having served on the board of Diabetes India and as president of the Research Society for the Study of Diabetes in India (RSSDI). He outlines the significant diabetes burden in a country where some 101.4 million adults are affected by the disease but only half of them are diagnosed, and discribes initiatives like universal screening for diabetes at healthcare centres to improve early detection and care.
Could you start by introducing your background and current focus and priorities?
I have a rich and extensive background in the field of diabetes, spanning almost 30 years, my focus has always been my passion for diabetes and obesity. My journey began with active involvement in the local Indian Medical Association, where I played a pivotal role in driving the initiatives of Academy X. Subsequently, I joined Diabetes India, where I have been serving as an executive board member for over two decades. Additionally, I co-founded the Daily Diabetes Forum around 1990 and later transitioned to the Research Society for the Study of Diabetes in India. During my tenure, I contributed significantly to the growth of the organization, starting from the Delhi chapter to assuming national leadership roles such as treasurer, secretary, and president. Currently I am the President of of the Research Society for the Study of Diabetes in India (RSSDI).
Simultaneously, I maintain my own practice as a specialist in diabetes and obesity. My passion for combating obesity led me to run international education programs, initially in collaboration with the Cleveland Clinic and now with the European Association for the Study of Diabetes (EASD). I also hold advisory positions with major diabetes and obesity companies, actively participating in shaping their strategies. For example, I have worked with Sanofi, Sun Pharma, Mankind, and many other companies. Furthermore, I engage with academic content providers and collaborate with start-ups developing healthcare technologies.
As per a 2021 study, there were 101 million people in India living with diabetes and 136 million with pre-diabetes. Can you tell us more about the impact of diabetes in India?
As a developing country, the dynamic landscape of healthcare in India has unique challenges and opportunities. Historically, individuals primarily relied on government-provided healthcare, but accessing it was often challenging due to overwhelming demand. Private healthcare emerged as an alternative, allowing those with financial means to pay out-of-pocket for services. This dual system, though advantageous for those who could afford it, presented challenges for those with limited financial resources.
Private healthcare in India is notable for its affordability on a global scale, making quality healthcare accessible to a broader demographic. However, the flip side is the out-of-pocket expense, limiting the extent to which individuals can access premium healthcare services. On the other hand, the government plays a crucial role in providing free healthcare services to the poorer population. This includes consultations, medications, investigations, surgeries, and hospitalizations—all without any financial burden on the patient. While this ensures healthcare for all, the challenge lies in the capacity of government facilities, leading to crowded conditions and delayed treatment depending on the severity of the case.
Despite the disparities, healthcare in India is undergoing transformative changes. Remote areas face challenges in healthcare accessibility due to geographical constraints, but current advancements within healthcare are bridging these gaps. Individuals can now seek medical advice and assistance remotely, revolutionizing healthcare delivery in remote regions.
What are the biggest challenges when it comes to awareness and diagnosis of diabetes in India?
India faces a significant diabetes burden, with the latest estimates indicating that approximately 101.4 million adults, or 11 percent of the population, are affected. Urban areas report a higher prevalence, with 16 percent of the population having diabetes, while rural areas show an 8 percent prevalence. An alarming statistic is that half of the individuals with diabetes remain undiagnosed. Moreover, Indians tend to develop diabetes a decade earlier than their Western counterparts, leading to a longer duration of living with the condition and increased risks of complications.
Half of those who are diagnosed, do not receive treatment. For those receiving treatment, only half of them receive optimal treatment and another half of them achieve targets. Consequently, the proportion of well-controlled diabetes patients stands at around 13-15 percent of the diabetic population. Recognizing this gap, organizations like the Research Society have played a crucial role. They have issued clinical practice recommendations since 2015, regularly updating them every two years. These recommendations are acknowledged globally, with some concepts influencing international societies.
India’s advantage lies in being a pharmaceutical manufacturing hub, producing medications at significantly lower costs compared to other countries. India manufactures one-third of the global requirement for Metformin, the primary drug used to treat diabetes. Despite challenges, such as the vast undiagnosed population the country’s pharmaceutical capabilities and research initiatives are instrumental in addressing the diabetes epidemic.
Addressing diabetes in a diverse country like India is a complex and ongoing process. Recognizing the enormity of the challenge, efforts are being made to reach the estimated 101 million people with diabetes across 23 states and 8 union territories. Many of these individuals prioritize making money to survive rather than prioritizing their health. Therefore, efforts are underway through various initiatives, including a disease program. It involves universal screening for diabetes at healthcare centres, ensuring that individuals have access to early detection and care. The Ayushman Bharat program has also been implemented, providing free healthcare services, especially in remote areas where accessibility is challenging. Various organizations, including societies like ours, are actively involved in reaching out to different regions. We have a presence in 900-plus districts, currently our efforts are concentrated on training local healthcare workers, paramedics, and multipurpose healthcare staff to enhance awareness and facilitate screenings.
How have India’s academic and research capabilities around diabetes evolved in the last few years, and how do they compare internationally?
The landscape of medical research in India presents a mixed picture. Research efforts, particularly in clinical domains, are present but limited. When compared to the vast population and the potential pool of researchers, the overall research engagement remains limited. Despite these challenges, India is making strides in clinical research, with drug trials being conducted across the nation. There is a positive trajectory in the evolution of research structures.
In terms of diversity within research, the Asian Indian population remains largely homogenous, with slight variations. Much of the population falls under the category of Asian Indians, encompassing various cultures, eating patterns, and regional diversities. But the real challenge of successful research lies in the sheer magnitude of the population. Undertaking comprehensive research necessitates considerable time and resources, particularly in terms of data collection, storage, and analysis. The daily demands of attending to a substantial number of patients leave limited room for research efforts unless a robust research infrastructure is in place.
In government healthcare setups, although there is a commitment to research, the overwhelming patient numbers often strain the system. In contrast to some international practices where clinicians may allocate specific days for research. The Indian healthcare system typically requires continuous engagement with patients, leaving little dedicated time for research activities. The workload is high on healthcare professionals in India working six days a week and dealing with high patient volumes.
What is your assessment of the contribution of the pharmaceutical industry to the fight against diabetes in India?
Pharmaceutical companies excel at providing high-quality medications at more affordable prices, significantly enhancing healthcare accessibility across India. These medications’ widespread availability, coupled with cost-effectiveness, address a crucial aspect of healthcare. Large diabetes-focused companies play an important role in community health by emphasizing screening initiatives, educational programs, and distributing informative materials in doctors’ offices.
Collaborative efforts with medical professionals and associations are evident through various programmes and training sessions for paramedics, addressing existing gaps in healthcare. These companies also contribute to the ongoing training of nutritionists and diabetes nurses, recognizing the need for comprehensive care. Their multifaceted approach, whether viewed as a commercial engagement or a patient support programme ultimately converges towards the common goal of enhancing patient care.
What form does digitalization take in this country within the diabetes landscape?
The Indian government has established strong e-platforms for accessing information on healthcare. Platforms such as MedFlix, contribute significantly to health awareness. MedFlix, an open platform hosting discussions by renowned specialists across various medical fields. Similarly, pharmaceutical companies conduct patient awareness programs on platforms like Facebook, reaching tens of thousands of people. Even private centers, like ours at RSSDI, engage in regular Facebook Live sessions on diabetes and obesity, demonstrating a commitment to social responsibility.
We conduct Live streams on Facebook every day at 3pm IST that reach 10-15 thousand people weekly. Moreover, various organizations, such as the Diabetes Technology Society and the Research Society, actively contribute to technological advancements and research initiatives. For instance, the Research Society conducts an annual research retreat, facilitating collaboration between researchers, learners, and mentors. While these efforts may seem small in the context of the vast population, they represent significant strides in addressing healthcare needs. Moreover, given India’s status as a tech hub, technological advancements are integral to the evolving healthcare landscape.
