ABSTRACT
INTRODUCTION: The impact of IMPROVE Control Training program was evaluated by a non-interventional study and validated by a physician perception questionnaire. From a survey on 1086 physicians providing diabetes care in India, we report their practices and perceptions about diabetes care and insulin therapy. MATERIALS AND METHODS: The responses were collected using a questionnaire validated by the IMPROVE Control Steering Committee. RESULTS: Majority [558 (51.4%)] of the physicians accepted the ADA defined HbA1c target of <7% as the standard for good glycemic control in their practice. However, 541 (49.8%) of the physicians agreed that only 20-40% of their patients were able to achieve this target. For patients who do not achieve the glycemic control with oral anti-diabetic drugs (OADs) within 6 months of initiation of therapy, initiation of an optimal insulin regimen was the preferred choice for 492 (45.3%) of the participating physicians. Premixed insulin was preferred for initiating insulin therapy in patients with type 2 diabetes, by 676 (62.2%) of the participants [as compared to basal by 375 (34.5%) participants]. Once daily premixed insulin, intensified to twice daily was preferred as most optimal insulin regimen for initiation and subsequent intensification of insulin therapy [487 (44.8%) participants]. Most of the participants preferred adopting a multi-targeted approach for treating diabetes, hypertension, and dyslipidemia. CONCLUSIONS: Physicians prefer treatment goals similar to those recommended in the current guidelines of the American Diabetes Association for managing their patients with diabetes. Premixed insulin is preferred for initiation and intensification of insulin therapy.
ABSTRACT
INTRODUCTION: Diabetes is the fourth leading cause of disease-related death and almost 80% of diabetes-related deaths occur in developing countries. Optimal glycemic control, in particular HbA1c level less than 7% with effective management of dyslipidemia and hypertension can reduce development of diabetes-related complications. Delay in initiating/or optimizing appropriate anti-diabetic therapy including insulin could be a possible cause of the increase in complications. METHOD: Improving management practices and clinical outcomes in type 2 diabetes (IMPACT) was a prospective, open-label, 26-week, comparative, multi-center study to compare efficacy and safety of the Indian insulin guideline (IIG) group versus routine clinical practice (RCP) group in type 2 diabetes patients. A total of 20,653 subjects from 885 centers across India were enrolled. RESULTS: A total of 4695 patients (22.7%) (IIG, 4113 [22.6%]; RCP, 582 [23.5%]) had macrovascular complications and 8640 patients (41.8%) (IIG, 7486 [41.2%]; RCP, 1154 [46.6%]) had microvascular complications. Of 4695 patients with macrovascular complications, 2850 patients (60.7%) had coronary heart disease followed by 1457 patients (31.0%) with peripheral vascular disease. Of all the microvascular complications recorded, 5627 patients (65.1%) had peripheral neuropathy followed by 3313 patients (38.3%) with retinopathy. CONCLUSION: The rates of complications were high in patients with type 2 diabetes at the time of being initiated on insulin therapy in India.
ABSTRACT
A survey was conducted in Bangalore district of south India between February 1984 and January 1986 to study the tuberculosis infection rate. The data from this survey, along with the information derived from the earlier ones in the same area conducted between 1961-1968, have been used in the report to study the trend of tuberculosis. Tuberculin test results in 0- to 14-year-old unvaccinated children from each survey were distributed, and based on the antimode, infected persons were identified. The standardized prevalence rates in population from the surveys were converted into risk rates by using the TSRU methodology and compared. The average annual risk of infection of 1.1% observed in 1961 declined to 0.61% in 1985, representing a decline of approximately 37% in nearly 23 years. This amounted to an average decline of 3.2% per annum over the period. The trend probably represented a natural dynamics. Whether organized intervention played some role could not be commented upon. Similar studies in other parts of the country are recommended in order to have information on the trend in the country as a whole.
