Together on Diabetes Asia

Comprehensive action for metabolic health and wellbeing - Integration of a Diabetes intervention with a liver health program

Partnership objectives

1. Planning and Implementation of an integrated intervention to improve awareness, increased early diagnosis leading to improved care, in diabetes and liver disease as a comprehensive metabolic package.

2. Creation of a health care workforce that forms the nidus of such intervention and can serve as a model to be replicated in subsequent national public sector initiative – if found useful.

3. To carry out operational research in the interface of diabetes and liver diseases – that can serve as a template for planning future interventions in the community as well as clinic based care.

4. Development of an overall scientific and perceptual environment that facilitate action and care in metabolic diseases as an integrated entity.

Overall the aim of this research project is the assessment of the prevalence of diabetes in the rural area, promotion of metabolic health and assessment of liver disease in relation to diabetes.

The frequency of liver disease in diabetics is high The frequency of liver disease in diabetics is high Copyright BMS

What are the health needs and challenges?

The frequency of liver disease in diabetics is high. NAFLD, of varying stage, is present in nearly one-third of diabetics and more so, when obese. NAFLD contributes to morbidity of diabetics, increases the need for clinical care and hospitalizations and predisposes diabetics to the development of cardiovascular, cerebrovascular disease and strokes. Apart from NAFLD, prevalence of Hepatitis C amongst diabetics is also higher than amongst non-diabetics. Outcome of liver disease worsens with diabetes and diabetes is a factor for faster progression of liver disease of any etiology, including adversely influences on treatment outcomes in Hepatitis C. Diabetics also develop Hepatocellular carcinoma more frequently than non-diabetics. All these highlight the need for tight diabetic control and an integrated approach targeting metabolic homeostasis in diabetes patients.

In the light of the above, development of a “metabolic health port” that acts, fosters and disseminates necessary information seems to be a viable and sustainable initiative for a concerted action in metabolic health.

Non-communicable diseases (NCDs) contribute nearly half of all deaths in India and significant morbidity and disability. Prevalence of NCDs is also increasing in rural India. As ‘the risk factors of today are the diseases of tomorrow’, therefore identification of such factors and periodical assessment are very important to prevent NCDs at the present time.

Description of partnership activities and how they address needs and challenges

The project envisages the following components:

An awareness and action component

Central of which is the creation of “metabolic ports” that provide integrated function in metabolic diseases namely – diabetes, liver disease and hypertension.

The projects implement community level awareness and screening for diabetes, blood pressure and liver disease – as critical, interrelated metabolic health determinants. Each port is staffed with trained rural health care providers (RHCP) (in rural areas) and by other category of health providers – suitably trained - in urban areas.  Since the vast majority of people live in rural areas, the primary focus is the rural habitations. Each peripheral metabolic is equipped with a glucometer, blood pressure equipment, a weighing machine and informative tools for awareness generation. We have screened 125,000 individuals by November 2016. 

An operational research component

1. An appraisal of the “perception” of people and providers guides this intervention as a flagship: This first part is to have an appraisal of the existing perception, knowledge and practice amongst the people as well as the providers of different category – both formal and informal – regarding the metabolic diseases, focusing on diabetes and liver disease.

2. A clinic based multi centric research is undertaken to investigate the intricate relationship between diabetes and liver disease. The aims of this research are to capture the ways that diabetes and liver disease interfere in each other’s natural history, in the short term.

Two groups of patients will be included in the documentation and short term follow up study:

  • Patients with Chronic Viral liver Diseases and diabetes.
  • Patients with Chronic Viral Liver Diseases and no diabetes.

Summary of impact and forward looking information

 1. Increased awareness amongst people in metabolic health as an integrated platform.

2. Improved detection of diabetes, hypertension and abnormal liver tests amongst asymptomatic people – who otherwise would have gone undetected /detected late in the course of life. This would create a permissive motivational situation for the need of intervention in “asymptomatic metabolic ill health” at the individual and community level.

3. Encouraging behaviour change to embrace a habit for regular monitoring in management of diabetes and hypertension in individuals as well as in the overall culture of the society.

4. Non pharmacological modalities in lifestyle diseases such as exercising, healthy cooking and eating is encouriaged.

5. Better possibility of integration of the RHCPs and strengthening their role as an enriched clan of health worker in the mainstream health care delivery system.

6. Better understanding of the level of awareness amongst people and providers – finding out the key areas warranting attention in intervention.

7. The “liver – diabetes interface” research will bring forth the critical operational issues in planning management of diabetes in liver disease – a common and evolving problem.

Partnership information

Company(ies) Bristol-Myers Squibb

Partner(s) All India Institute of Diabetes and Research, Institute of Post Graduate Medical Education & Research, Kolkata (IPGME&R), Liver Foundation West Bengal

Type of Partner(s) Academia / Hospitals, NGOs

Therapeutic Focus Non-Communicable Diseases

Disease(s) Diabetes

Program Type(s) Health System Infrastructure - Outreach & Medical Services, Prevention Programs - Awareness & Outreach, Research & Development - Operations Research

Region(s)

Research Country(ies) India

Start Date 2012

Anticipated completion date Ongoing

« There is a rapidly up moving urban society in India and this society is a perfect breeding ground for the metabolic syndrome phenotype – having to do more desk work, unbalanced diet »

Dr. Abhijit Chowdhury, Secretary, Liver Foundation, West Bengal.