Up until a few decades ago, diabetes was known as the rich person's disease. This, along with hypertension, was seen only in the wealthy, with a few exceptions here and there, of course. They could always afford insulin syringes or metformin to treat their diabetes.
But this is no more the case in 2023. Diabetes can no longer be called a rich person's disease.
In June this year, a study conducted by the Madras Diabetes Research Centre and funded by the Indian Council of Medical Research found that at least 11.4 percent of the Indian population is suffering from diabetes.
The rich have moved beyond insulin syringes – and are heavily relying on new tech advances in diabetes treatment to keep their sugar levels in check and to lead a healthier lifestyle.
What are these newer gadgets? How are they helping those who can afford them? How do we ensure that such gadgets are accessible to everyone? We asked experts.
Continuous Glucose Monitors, Insulin Pumps: What's New?
Dr Alka Jha - Senior Consultant - Endocrinology at Fortis Hospital, Vasant Kunj, says:
“We now have something called continuous glucose monitors (CGM). Earlier people would check their blood sugar multiple times a day but since it would be at specific hours, they couldn’t trace any pattern. Now, if someone is eating something that is spiking their blood sugar levels, a CGM will detect that.”
Devices like CGMs help doctors intervene at the right time and with the right information, adds Dr Jha. For the patients too, it can help them watch the effect of different food items on their health, and ultimately help plan and control a proper diet for them.
However, CGMs are not exactly new.
They’ve been around for nearly two decades now. But they’ve recently made their way to marketplaces like Amazon, thanks to which a lot more people are becoming aware of their existence.
Another device that has had a similar trajectory is the insulin pump, which is used for continuous insulin infusion.
“Conventionally, people would have to take insulin through a syringe or needle, which is difficult for some people, especially for kids. But an insulin pump can help you dissipate insulin in smaller amounts throughout the day. And you can also take smaller doses in accordance with how much you’re eating throughout the day.”Dr Alka Jha
Dr Khalid J Farooqui, Principal Consultant, Endocrinology & Diabetes at Gurugram’s Max Hospital, concurs.
He says that unlike a few years ago, when people would only focus on controlling their sugar levels, there are now devices and drugs that can help with taking care of their other organs too.
For instance, “SGLT2 inhibitors reduce the risk of heart and cardiovascular diseases, in addition to kidney problems too,” says Dr Farooqui.
He adds, “Those with type-2 diabetes might also need to be on medications for other comorbidities as well, today that is possible without any other side effects.”
But These Devices Don’t Reach Those Who Need Them
Despite being technologically advanced, these devices usually don’t reach the people who need them the most.
Dr Jha says that a CGM or an insulin pump might cost you anywhere over Rs 3 lakh, and then you’d still have to spend Rs 5,000-6,000 every week to actually use that device.
Even if you leave the tech aside, Dr Sonali Vaid, a public health expert, says that there are already many gaping loopholes present in our healthcare system when it comes to diabetes treatment.
Dr Vaid tells FIT,
"A national survey (NNMR-ICMR) shows us that if there are 100 people who have diabetes, only 45 get diagnosed. Out of those 45, only 35 might start treatment. And finally only 15 of them will have their sugar under control! And then there’d be several who would not be told about retinopathy, foot care, or other side effects that they’d have to do damage control for. So at every step in the patient journey, patients are losing out because of lacunae in the healthcare system."
She goes on to add that diabetes patients in India often lack basic resources for follow up check ups, getting tests done, or even when it comes to medications.
“Now if you insert technology in this system that’s already filled with loopholes, how would that work?” Dr Vaid asks.
Is Our Healthcare System Ready To Adjust With Technological Innovations?
The biggest question when it comes to technological advancements in diabetes treatment is whether our healthcare system will even be able to adjust to this.
Dr Vaid draws an analogy. Imagine you’ve never used a microwave, and you finally decide to buy one for your home. What are the changes you’d need to make? You’d have to buy new microwave safe plates and pots. You might have to make adjustments to what you cook, what you eat, or sometimes what utensil you cook in too.
So your budget will exceed just the microwave and so will your adjustments. There will be multifold advantages if you go ahead with the decision, but there might be some disadvantages too.
Now zoom out a little and look at the many adjustments our healthcare system might have to make in order to incorporate these devices, says Dr Vaid.
She poses some questions:
Should governments be procuring these devices to make them cost effective?
When you already have a system that’s not adequately keeping up with patients, how can you introduce something that’ll require more consultations, more follow-ups, more training on how to use it, etc?
Will the system rely on community healthcare workers to ensure that these gadgets reach more people? Who will train them?
Are these devices doing something that is not already covered by existing mechanisms?
How many people will benefit from making this accessible to the masses?
Are the same benefits possible without the device by improving access to & quality of care?
“The objective should not be introducing insulin pumps to everyone who suffers from diabetes. There should be targeted programmes to diagnose and screen diabetics, start their treatment, and then technology can be an intervention to reach that target.”Dr Sonali Vaid
So What Should Be Done?
All the three experts FIT spoke to had different answers.
Dr Jha says that there needs to be more awareness about diabetes. She adds,
“Accessibility is closely linked to awareness. Make traditional insulin pens accessible to people first. Make insurance companies cover these gadgets.”
Dr Farooqui feels that with time, these gadgets will anyway become affordable. But for now, he says, “What we require more than innovations in treatment are innovations in prevention.”
Dr Vaid takes a more cautionary approach. She firmly believes that we first need to fix our existing healthcare system before diving deep into something we might not be ready for.
“The promise of any technology, no matter how effective in theory, will remain unrealised & inequitable, unless we make a revolutionary commitment to a stronger public health system.”Dr Sonali Vaid