India's battle with diabetes has reached its peaks, with over 10 crore individuals now living with the condition. This huge number highlights the urgency of addressing the country's approach to diabetes management, particularly in adopting new and effective treatment options. Despite the availability of advanced medications, India is behind in prescribing these newer therapies, leaving many patients at risk of complications that could be better managed or even prevented.
For an example, consider the case of Priya Rao, a 56-year-old schoolteacher, whose experience reflects the challenges many diabetics face in India. Diagnosed with type 2 diabetes just weeks before, Rao's life took a frightening turn when she fainted unexpectedly at a wedding reception. The incident left her family shaken and Rao herself questioning the efficacy of her treatment. Initially, her doctor prescribed Dapaturn (dapagliflozin), a sodium-glucose cotransporter-2 (SGLT2) inhibitor known for its benefits in reducing cardiac and renal risks. However, after the fainting episode, Rao took a second opinion and was prescribed Glycomet (metformin) instead, a medication long considered the gold standard for first-line treatment of type 2 diabetes.
Rao's story is not unique. Many diabetics in India face similar dilemmas, often caught between differing medical opinions and treatment protocols. The contrast between the two prescriptions Rao received highlights a significant issue within the Indian healthcare system: the slow adoption of newer, potentially more effective diabetes medications. While her first doctor followed international guidelines that favored the early use of SGLT2 inhibitors, her second doctor adhered to the more conservative Indian approach, prioritizing metformin as the first-line treatment.
This reluctance to consider newer therapies stems from several factors. Metformin's popularity is largely due to its affordability, costing around ₹1 per tablet compared to a minimum of ₹8 for an SGLT2 inhibitor. Moreover, metformin is backed by decades of data, giving it a strong foothold in the Indian medical community. However, this attachment to traditional treatments comes at a cost. Recent studies have shown that while metformin effectively lowers blood glucose levels, it offers no significant benefits in protecting against heart or kidney disease—two common complications of diabetes. In contrast, SGLT2 inhibitors have proven effective in managing these risks, making them a valuable tool in the fight against diabetes.
The broader implications of this lag in adopting new medications are concerning. As the diabetic population in India continues to grow, the failure to integrate advanced treatments into mainstream practice could lead to a public health crisis. Doctors like Awadhesh Kumar Singh, a leading diabetologist in Kolkata, argue that India must catch up with global standards to provide its diabetic population with the best possible care. Singh and other experts believe that while metformin has its place, the benefits of SGLT2 inhibitors in preventing complications make them a critical option that should be more widely prescribed.
The problem is not just about preference but also the structural challenges within India's healthcare system, unlike in the US or Europe, where guidelines are regularly updated and strictly followed, Indian doctors often rely on experience rather than scientific evidence. This approach results in inconsistent treatment practices, with some doctors hesitant to adopt newer therapies despite their proven benefits. The lack of long-term epidemiological data on Indian patients further complicates the situation, making it difficult to make treatment protocols for the specific needs of the population.
Experts are calling for a stronger approach to diabetes management in India, one that incorporates the latest research and treatment options. The 2022 clinical practice recommendations by the Research Society for the Study of Diabetes in India (RSSDI) represent a step in the right direction, advocating for the use of a range of medications, including SGLT2 inhibitors, particularly for patients at risk of cardiovascular and renal complications. However, more needs to be done to ensure that these guidelines are widely adopted and that patients receive the most effective care available.
Many diabetics, like Priya Rao, are left to navigate their treatment options with little guidance, leading to confusion and potentially harmful decisions. By prioritizing the integration of advanced medications and ensuring that doctors are equipped with the latest knowledge, India might be able to better manage its diabetic population and prevent the complications that threaten the lives of millions.
(Input from various media sources)
(Rehash/Pothana Boyina Venkata Sai Vara Prasad/MSM)