Screening: India

In India screening for diabetes is mostly recommended in community health schemes by way of opportunistic or selective testing. The Indian Council of Medical Research has laid down important guidelines for health care providers on screening individuals for diabetes based on their risk profile[1].

Annual re-screening is suggested for those testing normal or with impaired glucose regulation. The ICMR recommends screening for hypertension and dyslipidaemia for those with established diabetes. Recently, the government of India has set up the National Programme for Prevention and Control of Diabetes, Cardiovascular Diseases and Stroke. This programme aims to control non-communicable diseases by early diagnosis of chronic diseases using opportunistic screening of people aged ≥ 30 years at the point of primary contact with any health care facility, be it the village, Community Health Centres (CHC), District hospital, tertiary care hospital etc.[2]

The programme will have built-in components of mass awareness creation, self- screening and training of health care providers. Screening will involve a simple clinical examination comprising of relevant questions (such as history of tobacco use) and easily conducted measurements (such as blood pressure) to identify those individuals who are at a high risk of developing diabetes and cardiovascular disease and thus warrant further investigation/ action. Non-Communicable Diseases (NCD) clinics are also established at CHC and District Hospitals where comprehensive examination of patients referred by lower health facility / health workers will be conducted to rule out complications or advanced stages of common NCDs.

India faces several challenges in managing diabetes including rising prevalence in urban and rural areas, lack of awareness, suboptimal glycaemic control, increasing prevalence of diabetic complications and limited economic and human resources. Previously, in Southern India community screening was carried out in cities and periurban areas among individuals above the age of 20 using fasting and 2h post glucose values with point of care glucose testing[3]. For primary prevention programmes screening has been completed in large organisations among workers using the oral glucose tolerance test[4]. More recently, HbA1c was introduced to reduce time and avoid inconvenience of multiple testing, in screening for participants for prevention trials. Screening procedures for prevention trials have include the use of a risk assessment questionnaire, anthropometric measurements, blood pressure and biochemical tests. Individuals diagnosed with diabetes are referred to their physicians for further management.

References

  1. ^ Shah B, Menon G. Burden of non-communicable disease in India. New Delhi, India: Indian Council of Medical Research;2005

  2. ^ A new initiative for a healthy nation National programme for prevention and control of diabetes, cardiovascular and stroke (NPDCS). Available at: http://health.bih.nic.in/Docs/Guidelines/Guidelines-NPCDCS.pdf

  3. ^ Ramachandran A, Mary S, Yamuna A, Murugesan N, Snehalatha C. High prevalence of diabetes and cardiovascular risk factors associated with urbanization in India. Diabetes Care 2008;31:893–898.

  4. ^ Ramachandran A, Snehalatha C, Mary S, Mukesh B, Bhaskar AD, Vijay V. Indian Diabetes Prevention Programme (IDPP). The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1). Diabetologia 2006; 49: 289– 297.

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