Medical Research Foundation

Tamilnadu Diabetic Microangiopathy Prevention and Treatment Project Highly Ranked

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Project Summary

Tamilnadu (population 85 million) has one of the highest diabetes prevalences in India, half are undiagnosed and a third have microvascular complications including eye and kidney disease. These complications cause disability rate twice the global rate for diabetes with blindness and kidney failure having huge societal and financial implications. We will screen the at-risk rural population with poor access to care at their doorstep for diabetes, and those with diabetes for microangiopathies, through a network of 51 diabetes-care centers supported by 51 specially equipped tele-screening vans. Diabetes, hypertension and the microangiopathies will be managed using a proven holistic approach that include lifestyle modification and appropriate treatment Targeting long-term glycemic control in the population (reducing glycated hemoglobin-HbA1c levels by 2% in 5 years) would lead to 50% reduction in diabetic retinopathy and 66% reduction in kidney disease, the legacy effect aiding in reduction of preventable blindness and other disabilities.

Problem Statement

Non Communicable Diseases (NCDs) account for over 55% of all deaths in India. Diabetes represents one of the important NCDs and Tamil Nadu, a state with a population of over 80 million is home to nearly 12 million people with diabetes and 9.9 million people with pre- diabetes. A third of them have complications involving the eyes, kidneys or nerves. Blindness and kidney failure place a huge burden on society since they requires extensive support from thefamily and the community. Both complications require complex and expensive treatment in advanced disease which is not available in rural communities. Knowledge and awareness about diabetes in India, particularly in rural areas, is abysmally low. Nearly 70% of people with diabetes fail to meet the recommended diabetes control goals in India. Despite the efforts by the Government to tackle the problem, the projections suggest that problem will be worse in coming years. Few of the reasons for this are the lack of awareness regarding disease and its complications, lack of a holistic approach in the management of the complications of diabetes, concentrated efforts in urban areas and lack of dedicated manpower and resources for diabetes care in the rural areas. Even modest improvements in diabetes control, early detection and timely treatment would translate into significant benefits in terms of preventing blindness and kidney disease and reducing disability and healthcare costs.

Solution Overview

We propose to screen for diabetes and holistically manage those with diabetes in rural Tamil Nadu. We will employ a hub and spoke model, of 51 care centres supported by 51 well equipped vans with point of care tests to screen for diabetes, fundus cameras with built in artificial intelligence (AI) technology to detect disease to take screening and primary care to the doorstep, and 6 treatment centers for specialized care for diabetes and eye complications,. The estimated at risk population is 23 million people with poor access to care. Screening them for diabetes will reduce those with undetected diabetes who are at the greatest risk of diabetes related complications. Improved detection and earlier treatment will help reduce diabetes related complications such as blindness and kidney disease. Providing affordable accessible care for diabetes will also reduce the development and progression of complications..A holistic approach that includes awareness dissemination and lifestyle changes could potentially reduce diabetes rates in the rural community. This would have long term benefits for the entire population. With periodic screenings of diabetics for complications and disease control we will be able to assess our impact. Over 5 years, we aim to reduce glycated hemoglobin-HbA1c levels by 2% across the population which would potentially lead to a 50% reduction in diabetic eye diseases and a 66% reduction in kidney disease; thus significantly having an impact on morbidity and mortality. This will have a broad impact in a large south-Indian population and could be a template which can

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