Advocacy and Adoption of Technology and Disparities in India

ABSTRACT

The number of people with diabetes globally, is rising at an alarming rate. South Asia is one of the hot spots of the diabetes epidemic. In India alone, there are over 74 million people with diabetes today. Unfortunately, 70% of the doctors in India practice in urban areas while 70% of India's population lives in rural areas. This mismatch between the availability of health care professionals and the rapid spread of diabetes in rural areas, provides an opportunity to use technology to deliver the diabetes care to remote rural areas. The first part of this presentation will talk about a model of successful delivery of diabetes health care in rural India. The Chunampet Rural Diabetes Program was carried out in a group of 42 villages in Kancheepuram District in Tamilnadu. Using a Mobile van, a population of 27,014 individuals (86.5% of the adult population) were screened for diabetes. All those detected with diabetes were offered a follow up care at a rural diabetes centre which was set up during the project. The results were very impressive and led to good improvement in A1c levels using low cost generic drugs. The second use of technology was during the COVID - 19 pandemic and the lock down which was enforced in India and many other countries. Thankfully, Telemedicine was also legalized in India at that time. Using technology, a system was created whereby the doctor and the patient stayed at home but blood tests were arranged at home for the patient.With the results, teleconsultation was done by doctors using the Electronic Medical Records which were made available on their mobile phones. Thus, despite the lockdown, patients managed to get their tests and diabetes consultations done remotely. The third use of technology is through our network of diabetes clinics across India. Even at centres where there was no ophthalmologist, retinal photographs were obtained using a lowcost retinal camera and were uploaded for centralized diabetic retinopathy grading unit where the images were read by trained retina specialists. The eye reports were sent back to the peripheral clinics in real time. Over one year period, 25,316 individuals with diabetes could have their eyes screened for diabetic retinopathy. Only 11.4 % needed referral to an ophthalmologist for further management. Finally, the use of mobile Apps has revolutionized diabetes treatment. Recently, we have developed three diabetes related tools. 'DIA' - an AI powered chatbot to assist people through automated digital conversations, 'DIALA' - a patientfriendly mobile app and 'DIANA' - a healthcare application for precision diabetes care. The details of these three tools are briefly described below DIA The Conversational AI Virtual Assistant 'DIA' can interact in English with its unique conversational AI technology and intuitive interface, it has proved to be a useful solution for patients, providing complex dialogues, with quick response time and offers comprehensive solutions for patients with diabetes. DIA's uses range from scheduling appointments and reminders for visits, lab tests and teleconsultation, to addressing enquiries on available medicines, treatments, and facilities.During an emergency, health crisis or in pandemic situations, it connects with caregivers and patients to take proper action as per the seriousness of their conditions. Further, it shares notifications, updates patient engagement and special offers. In addition to this, DIA can assist patients through reminders on their medicine refill via WhatsApp or SMS notifications and even facilitate purchase and tracking of medicine orders. DIALA 'DIALA' is a DIAbetes Lifestyle Assistant Mobile Application. This app helps deliver superior and positive patient outcomes with weight tracking, step counts, diet plan adjustment, prescription refilling, availing reports of tests done, glucose monitoring data, scheduling appointments and sends reminders. It can help to monitor one's health and manage diabetes effectively. It is currently available in Android. DIANA An advanced machine learning tool DIANA (DIAbetes Novel subgroup Assessment) is used to classify individuals with newly detected type 2 diabetes into specific subgroups such as insulin deficient or insulin resistance forms. This tool also gives the estimates of the risk for developing diabetes complications like eye or kidney disease. This machine learning approach has been developed based on published real world clinical data and will help the clinician offer individualized care for people with diabetes. In conclusion, judicious use of technology can help to bridge the socioeconomic and geographical challenges in delivering diabetes health care in developing countries.