Blood Sugar Test Costing Only 5 Cents To Detect 133 Million Undiagnosed Diabetics In India

Pharma companies reworking pricing policy to reduce cost of blood sugar testing kits

EVEN as the number of people with type 2 diabetes mellitus is increasing worldwide, many people living with diabetes remain unidentified. Undiagnosed diabetes may also impose substantial public health implications because these patients remain untreated and at risk for complications. Although screening for undiagnosed diabetes within general practice by measuring fasting blood glucose is feasible, it is best targeted at individuals with multiple risk factors for diabetes.

The government of India has therefore taken the lead to make available diabetes screening tests costing just 5 cents (Rs 2) across the country. The Indian Council of Medical Research (ICMR) says the test to determine whether a person is suffering from diabetes could be available in a year-and-a-half. Whether this program will be launched as part of the National Diabetes Census announced last year is not clear.

“Given the fact that India is a known as a diabetes hub, union (federal) health minister Ghulam Nabi Azad is taking keen interest in the project. We have been told that it must be completed as early as possible,” announced ICMR director-general Dr VM Katoch in Mumbai on May 12, adding the news of such an inexpensive test being introduced has already prompted some pharma companies to rework their pricing policy and reduce the cost of their blood sugar testing kits.

Katoch says the project will be a major breakthrough. “At present, the cost of the test is between around Rs 80-100 ($1.5-2). This may not be affordable to the poor. For them, the Rs 2 ($0.05) test will be a godsend,” said Katoch. “We are executing the project with the Council of Scientific & Industrial Research, Indian Institute of Technology at Kharagpur, and a private pharmaceutical company.”

A diabetes awareness campaign in Hyderabad, India

Type 2 diabetes can remain undetected for many years and the diagnosis is often made from associated complications or incidentally through an abnormal blood or urine glucose test. In developing countries, less than half of people with diabetes are diagnosed. Without timely diagnoses and adequate treatment, complications and morbidity from diabetes rise exponentially.

Individuals who are unaware of their disease status are left untreated and are thus more prone to microvascular as well as macrovascular complications. Hence, it is necessary to detect the   large pool of undiagnosed diabetic subjects in India and offer early therapy to these individuals.

In India, studies that have shown an increase in prevalence of diabetes have also reported a very high prevalence of undiagnosed diabetes in the country. According to Dr A Ramachandran, diabetes is a major health care burden in India, especially in the urban areas. Nearly 70% of urban diabetic cases are diagnosed, while in rural areas up to 70% cases remain undetected.  A long asymptomatic stage of diabetes is known to exist causing cellular damage and complications prior to clinical diagnosis. Therefore screening for diabetes is one strategy to prevent this.

Dr Shashank Joshi, vice-president, Research Society for the Study of Diabetes in India, was all praise for the initiative. “Over 60 million Indians suffer from diabetes. The ICMR project will bring hope to the poor who avoid tests because of increasing costs,” said Dr Joshi. He, however, emphasized that the government must ensure that there is no compromise on quality.

If this government-led initiative takes off, it would go a long way in combating the diabetes epidemic not only in India but in all developing countries because there a millions of people who are living with undiagnosed diabetes.

According to the World Diabetes Foundation, undiagnosed diabetes accounted for 85% of those with diabetes in studies from South Africa, 80% in Cameroon, 70% in Ghana and over 80% in Tanzania. The number of deaths attributable to diabetes in 2010 showed a 5.5% increase over the estimates for the year 2007.

80% of type 2 diabetes is preventable by changing diet, increasing physical activity and improving the living environment. Yet, without effective prevention and control programs, the incidence of diabetes is likely to continue rising globally.

An experimental study undertaken in India found that simple instructions such as advising people to walk, and sugar-free coffee/beverage had resulted in 29-30 per cent reduction in diabetes, Dr. Ramachandran said. A new research in Indian population, called the Indian Diabetes Prevention Programme, by him had shown the effectiveness of primary prevention strategies in preventing the onset of diabetes in people with high risk. It was also possible to identify those at high risk.

A national diabetes screening program based on the cheap 5-cent test would detect patients with diabetes and prevent the burden due to its long-term complications. The current figures are an indication that primary prevention is necessary and drastic steps must be taken to diagnose the disease early, provide effective management and also take steps to prevent the onset of disease in high-risk subjects.

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