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Time 2 Do More in India

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Dr Ambrish Mithal, New Delhi and Dr Paivi Maria Paldanius    17 November 2018

  1. Time 2 Do More in Diabetes Project Mission: To identify barriers in improving the treatment of type 2 diabetes mellitus (T2DM) and understand ways these can be overcome; understand clinical inertia and to what extent it constitutes a barrier to improving care in T2DM or chronic disease management, and to explore perceptions on treating earlier and more aggressively and identify areas of unmet needs.
  2. Time 2 Do More in Diabetes India survey results: About 30% of patients are being told of complications at diagnosis consultation. Doctors discuss a variety of topics. Only about 40-50% of patients are able to understand these topics well.
  3. While the upper class seems to be distraught with the prospect, the lower classes, although more accepting, feel that their chances of developing complications are remote. While 3 out of 4 patients claim to be compliant towards their medication, doctors have low confidence in them. Hypoglycemia is not accurately reported because of: Lack of patient awareness about its seriousness; Lack of patient awareness/seriousness about dosage adjustment/potential treatment change; Lack of time to explain about hypoglycemia among doctors as well as not seeing patient frequently enough to get an accurate reporting of hypoglycemia.
  4. Key reasons for not achieving HbA1c targets – Patients find it difficult to make the necessary changes to their diet; patients find it difficult to do enough exercise; patients are often taking concomitant medications and there is concern about drug-drug interactions; many patients have had diabetes for a long time and -cell function is already compromised.
  5. Conclusions and way forward: Customization of consultation; Creating awareness to help patients identify hypoglycemia episodes and also inculcate the seriousness; Greater emphasis on HbA1c testing; Commitment to lifestyle and dietary changes; Need to initiate treatment at diagnosis in patients with high blood sugar level, which could enhance overall outcomes.

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