Impacting lives of people with diabetes: lessons learnt in India may be applicable to other low- and middle-income countries.

Delivering optimal care to people with diabetes in low- and middle-income countries (LMICs) such as India presents several challenges. The magnitude of the population affected by diabetes is considerable. Providing quality diabetes care to all people with diabetes is therefore not easy given the resource constraints, including inadequate numbers of trained specialists, diabetes educators and nurses, and lack of specialist clinics. Moreover, a large percentage of people with diabetes have to pay 'out of pocket' for their treatment, as the majority of healthcare in LMICs, especially in urban areas, is privately managed. Thus, tackling the problem of diabetes requires multiple approaches and local solutions. In this review, I provide an overview of our work in India over the last four decades and its impact. This includes capacity building, such as training of doctors in basic diabetes care, and task-shifting, by producing a cadre of diabetes educators or community health workers who can assist physicians. Setting up of low-cost models of care is essential if care is to reach remote underserved areas. In this context, use of telemedicine, digital technology and various apps have been found to be of great value. Using mobile vans fitted with laboratory and other equipment to screen for diabetes and its complications has helped deliver diabetes care even to remote villages, where specialist care is unavailable. More recently, home care models have also been successfully implemented. Research into the heterogeneity of diabetes has enabled development of local solutions that are low-cost and scalable. Lessons learnt from the management of diabetes in India can potentially be applied to other LMICs with local adaptation.