The latest findings of India Diabetes Care Index (IDCI®) suggest that glycosylated hemoglobin or HbA1c level recorded at 8.35% during January to March 2020 and it marginally decreased from 8.47% to 8.35% as compared to the previous quarter in New Delhi. The high level of HbA1C level in Delhi comes at a time when medical studies are pointing towards an increased risk for severe complications arising from COVID-19 in people living with diabetes.[1] The India Diabetes Care Index, a part of the ‘Impact India: 1000-Day Challenge’ programme by Novo Nordisk Education Foundation studies the blood glucose levels across cities through various parameters.
The HbA1c test indicates the average blood glucose level over a period of three months and is considered as one of the best recommended indicators of long-term blood glucose control. People who were part of the assessment in New Delhi had an average age of 53 years out of which 56% were male and 44% were female.
Furthermore, the average postprandial glucose level in the quarter was 235 mg/dl and the average fasting glucose level was 167 mg/dl.
People living with diabetes are more likely to experience severe symptoms and complications if they get infected with COVID-19 and this may even worsen if their diabetes is not managed well. Also, in the long run, it should be noted that 1% reduction in HbA1c reduces the risk of diabetes-related complications including the risk of heart failure by 16% and the risk of heart attack by 14%. Older adults and people with pre-existing medical conditions like hypertension, heart disease, pulmonary disorders and obesity related conditions are also at a higher risk of experiencing serious complications due to COVID-19.[2]
Speaking on the high HbA1C level in the city and challenges faced by the patients during the lockdown, Dr Ambrish Mithal, Chairman, Endocrinology and Diabetes, Max Healthcare, said, “It is a good indicator that the HbA1c level in New Delhi has remained stable or even declined marginally in the last quarter. However, it is still clearly above desired levels, and, people with diabetes should observe all precautions as they are at a higher risk of developing complications from COVID-19. To protect themselves, people should follow a healthy diet, ensure indoor physical activity, and test their blood glucose regularly. They should also remain in touch with their doctor through mail or video consulting.
Currently, more than 77 million people in India are living with diabetes. To provide them with optimal care and help them in managing their condition better during the lockdown, the Government of India has stated that all known/ diagnosed people with diabetes will receive regular supply of medicines for up to three months through ASHAs (Accredited Social Health Activists) or SHCs (Sub Health Centres) on prescription.
Talking about the IMPACT India programme, Dr. Anil Shinde, Trustee, Novo Nordisk Education Foundation said, “Through the India Diabetes Care index, we aim to raise awareness on status of diabetes care in India. The latest findings suggest that the status of diabetes management should be paid close attention to because if diabetes is well-managed, the risk of serious illness from COVID-19 can be reduced to the same as that in general population. People with diabetes should also take strict preventive measures so that they can minimize the risk from COVID-19 and are safe in the lockdown period.”
People with diabetes should have an adequate stock of medications and supplies for monitoring blood glucose at home. They should store enough stock of simple carbohydrates like honey, jam and candies. They should also store Glucagon and ketone strips, in case of poor glycaemic control (low or high blood glucose levels). People with diabetes should also watch for emergency warning signs like difficulty in breathing or shortness of breath, persistent pain or pressure in the chest, confusion or inability to arouse, bluish lips or face. In case they develop or suspect to have COVID-19 symptoms, people with diabetes are advised to get medical attention immediately by calling the hospital or personal physician and explaining their condition.[3]
The ‘Impact India: 1000-Day Challenge’ programme was launched in 2018 to address the issue of sub optimally controlled diabetes in India. The ambition of the programme is to reduce the national average of HbA1c by 1%, which can help reduce the risk of diabetes-related complications significantly in India. Based on big data analytics, iDCI® has been providing a real-time view of the average HbA1c in India across select cities. Under the Impact India programme, digital platforms are being leveraged to partner with healthcare practitioners (doctors and paramedics) to evolve and implement an approach to diabetes care appropriate for India. iDCI® is a dynamic tool that not only tracks the status of diabetes care but also helps to increase awareness, motivate and sensitize the healthcare professionals (HCPs) and society. The IMPACT India programme will continue its three-pronged approach through interactions with healthcare practitioners (HCPs), societal/patient engagement and monitoring.
