Category: Diabetes/Prediabetes/Hypoglycemia

Diabetes care, economics and health outcomes: Experiences from the 3 decade FREE diabetes clinic for the poor

Monday, Apr 8
1:00 AM – 2:00 AM

Objective :

Over last 3 decades, focusing on adult and childhood diabetes, we have implemented several programs to provide best possible care to all socioeconomic segments of society.


Methods :

 


Project DOSTI [“friendship”]: D iabetes   O rganization    S upport    T raining and    I nteraction [1994 – current]:


Type II diabetes[5000 +]; Oral medicinesfor diabetes (metformin= 91%, sulfonylureas glibenclamide, glipizide, glimepiride = 60%), hypertension (atenolol 14%, amlodipine= 34%, ramipril= 7%, telmisartan= 42%, hydrochlorothiazide= 6%), dyslipidemia (atorvastatin= 62%, fenofibrate= 4%), cardiovascular prophylaxis (aspirin= 85%, clopidogrel= 7%); human insulins (regular, NPH, premixed)= 16%].


Project DISHA [“direction”]: D iabetes    I nteraction   S upport   H ealth   and    A chievement [1987 – current]:


Type I diabetes [386 since 2011]; Insulin [Basal bolus(meal time regular + bedtime NPH) 100%], syringes, counselling, 24h help lines, BG meters, 30 BG strips/ month, limited biochemical evaluations [TSH, quarterly HbA1c, annual UACR].


Results :

Type 2 DM [N=355]: Males= 32%; DM Duration= 10.3 y; DM Age Onset= 46.4 y; BMI= 26; Pulse Rate= 87; BP= 129/76; Hemoglobin Hb= 12.8 G/dl; HBA1c= 8.7%; Serum Albumin S Alb= 4.1 mg/dl; Urine Albumin Creatinine Ratio UACR= 54 mcg/mg; Serum Creatinine= 0.72 mg/dl; eGFR= 93 mL/min/1.73 m2; T Chol=173 mg/dl; LDLc=90 mg/dl; HDLc= 44 mg/dl; TG= 221 mg/dl. Hypertension= 78.4% [Cf Non-DM adults= 29.6%].


Type 1 DM [N=120]: Males= 39%; DM Duration= 7.8 y; DM Age Onset= 10.4 y; BMI= 20.7; Pulse Rate= 100; BP= 113/70; Hemoglobin Hb= 12.9 G/dl; HBA1c= 9.5%; Serum Albumin S Alb= 3.9 mg/dl; Urine Albumin Creatinine Ratio UACR= 59 mcg/mg; Serum Creatinine= 0.61 mg/dl; eGFR= 122 mL/min/1.73 m2; T Chol= 190 mg/dl; LDLc=99 mg/dl; HDLc= 56 mg/dl; TG=175 mg/dl.  Hypertension= 12.5%; Retinopathy: Non-proliferative: 3%; Proliferative 1%. On ACEI/ARB = 25%.


 


Discussion : Hypertension: Hypertension groups had elevated UACR and S Creatinine [decreased eGFR], more significantly in T1DM [Cf T2DM].  Also, subjects with hypertension [and associated renal dysfunction], tended to have significantly lower HbA1c [likely due to: (a) decreased renal insulin clearance and gluconeogenesis; and (b) increased hypoglycemia].

CKD Stages: Higher CKD Grades were associated with longer diabetes duration, later age of diabetes onset, higher systolic BP, lower hemoglobin, lower HbA1c and higher UACR.


Conclusion :

On a foundation of philanthropy, with “minimum - best possible” medical care, we have tried to “bridge” the disease burden gap, between economically 'underprivileged' versus 'privileged' [improvements in glycemic control, decrease of acute/chronic complications].

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Nidhi Garg

Consultant Faculty Endocrinology Diabetes
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center
bangalore, Karnataka, India

Designation: Senior Consultant and Faculty
Specialties: Diabetes and Metabolism
Clinical Interests: Comprehensive diabetes care, In-patient diabetes and metabolic care, Perioperative diabetes management, Diabetes and endocrine emergencies – Metabolic Intensive Care, Obesity management, Lipids and preventive cardiology, Gestational diabetes, Thyroid disorders, Type 1 diabetes across ages

Muralidhara Krishna

Consultant Faculty Endocrinology Diabetes Biochemistry
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center
Bangalore, Karnataka, India

Designation: Consultant and Faculty: Endocrinology Diabetes Metabolism; Associate Professor: Clinical Biochemistry and Laboratory Medicine
Specialties: Endocrinology Diabetes Metabolism; Clinical Biochemistry
Clinical Interests: Diabetes mellitus; Thyroid Disorders; Obesity; Dyslipidemia.

Madhumati S Vaishnav

Scientist Faculty
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center; CENSE Indian Institute of Science, India

B.Sc (Microbiology), University of Pune, India.
M.Sc (Microbiology), University of Pune, India.
Post Graduate Diploma in Clinical Research and Clinical Data Management, University of Pune, India
CDE (Certified Diabetes Educator - Counselor), Samatvam Institute of Medical Sciences, India

Vasanthi Nath

Consultant Faculty Endocrinology Diabetes
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center
Bangalore, Karnataka, India

Designation: Consultant and Faculty
Specialties: Endocrinology, Diabetes, Internal Medicine, Geriatrics
Clinical Interests: Neuroendocrinology and Neurometabolism, Metabolic Myopathies; Thyroid tumors, Geriatric Endocrinology, Inpatient Diabetes Care and Endocrine Emergencies; Type 1 diabetes across ages

Chandraprabha S

Consultant Faculty Endocrinology Diabetes
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center
Bangalore, Karnataka, India

Designation: Consultant and Faculty
Specialties: Endocrinology Diabetes Metabolism
Clinical Interests: Pregnancy Diabetes, Pregnancy Thyroid Dysfunction, Women Health, Geriatric Endocrinology, Diabetes mellitus and Mental Health, Spiritual Medicine

Kavitha Muniraj

Consultant Faculty Endocrinology Diabetes
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center
Bangalore, Karnataka, India

Designation: Consultant and Faculty; Director Medical ; Director Research; Trustee
Specialties: Endocrinology Diabetes; Clinical Research
Clinical Interests: Pituitary Adrenal disorders; Bone health; Cardiovascular Health; Thyroid dysfunction; Diabetes Pharmacotherapy; Clinical Pharmacology; Pharmacovigilance; Clinical research Safety and Audits

Babitha D. T

Consultant Faculty Endocrinology Diabetes
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center
Bangalore, Karnataka, India

Designation: Consultant and Faculty
Specialties: Endocrinology, Diabetes
Clinical Interests: Endocrine disorders of pregnancy, Pregnancy Diabetes, Cardiovascular Health, Thyroid, Inpatient diabetes care and endocrine metabolic emergencies

Reshma B. Vijay

Consultant Faculty Endocrinology Diabetes
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center
Bangalore, Karnataka, India

Designation: Consultant and Faculty
Specialties: Endocrinology Diabetes and Metabolism
Clinical Interests: Pediatric Endocrinology; Diabetes mellitus; Insulin Pumps, Continuous Glucose Monitoring and Artificial Pancreas; Growth and Puberty; Thyroid; Pituitary Adrenal disorders

Jayalakshmi T

Consultant Faculty Endocrinology Diabetes
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center
Bangalore, Karnataka, India

Designation: Consultant and Faculty

Specialties: Endocrinology, Diabetes, Internal Medicine,
Clinical Interests: Diabetes mellitus, Cardiovascular Health, Thyroid, In Patient Diabetes Care, Endocrinology Metabolic emergencies and critical care

Apoorva Govind

Consultant Faculty Endocrinology Diabetes
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center
Bangalore, India

Designation: (a) Fellow: Endocrinology Diabetes Medicine, Samatvam Endocrinology Diabetes Centre and Jnana Sanjeevini Medical Centre and Diabetes Hospital ; (b) Co Investigator – Clinical Research, Samatvam Science and Research Center

Specialties: Endocrinology, Diabetes, Internal Medicine

Sri Srikanta

Thummala Kamala

MD Chitra

Consultant Faculty Endocrinology Diabetes
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center

Designation: Consultant and Faculty; Trustee
Specialties: Endocrinology Diabetes; Clinical Research
Clinical Interests: Diabetes, Obesity, Dyslipidemia, Osteoporosis, Pituitary Adrenal disorders; Bone health; Cardiovascular Health; Thyroid dysfunction;

Vasudha Srikanth


India

Keerthana Haridas

Sathvik Reddy Chinna Bainagari

Resident Doctor
Samatvam jnana sanjeevini Diabetes hospital and medical center
Chittoor, Andhra Pradesh, India

Namya Gaekwad