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Progression of kidney disease in diabetics: ‘Starting insulin early checks complications’

The study was presented at the American Diabetes Association’s 79th scientific session — Bridging diabetes research with ground breaking discoveries — held in San Francisco last week.

Written by Anuradha Mascarenhas | Pune |
June 21, 2019 3:03:44 am
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A study that examined patients with diabetes over a period of 15 years found that early initiation of insulin helped retard the progression of kidney disease. Not only did it prevent diabetes-related complications, but regular telemedicine visits helped patients exercise better control on diabetes.

“This has resulted in overall reduction in the cost of treating diabetes. There were no expensive medications or new therapies. Just behaviour modification, exercise and structured monitoring of glucose and blood pressure,” Dr Jothydev Kesavadev, a Kerala-based research diabetologist and managing director of Jothydev’s Diabetes Research Centres at Thiruvananthapuram, Attingal and Kochi, told The Indian Express.

The study was presented at the American Diabetes Association’s 79th scientific session — Bridging diabetes research with ground breaking discoveries — held in San Francisco last week.

India has close to 76.5 million people suffering from diabetes. If one looks at patients with chronic kidney diseases who require dialysis, at least 60-75 per cent of them are due to diabetes. While policy makers are focussing on developing dialysis centres, this is a cost-effective way to treat it, said Dr Jothydev.

He introduced the Diabetes Telemanagement system — a cost-effective model that helps achieve targets in diabetes management — in 1997-98.

“We followed 400 patients (of whom 200 patients had started taking insulin within seven years of being diagnosed with diabetes; for the remaining 200, insulin was initiated at a later stage) and were able to successfully retard the progression of kidney disease at the end of 15 years and also demonstrate better control of diabetes with lesser doses of insulin compared to the control arm,” Dr Jothydev said.

Early initiation of insulin and close monitoring of the patients showed that at the end of 15 years, the dose of insulin remained very low, around 9 units in one group, compared to 30 units in the other group.

“Usually in India, insulin is started when diabetes is uncontrolled. However, all recommendations and studies say that insulin should be started sufficiently early. Patients are still apprehensive of an injection and this time-tested therapy. So, what we did at our end was sensitise our patients via the telemedicine project and help them, via virtual visits, manage blood pressure and sugar, resulting in reducing the insulin dose at 15 years. A multi-disciplinary team was engaged in the project, which provided continuous management, coaching, education and training of patients,” said Dr Jothydev.

“The challenge is for the initial few months. When insulin is started, it is mandatory to incorporate glucose monitoring at home and that involves time on the part of patients. It also includes a network of doctors and diabetes educators… through our programme, we have trained and empowered our patients to an extent that they need to come only for few direct hospital visits. Initially, they may find taking insulin costly but in the long run, it is saving the patient’s money. Chronic kidney disease is a huge problem in the country and today, the cost of a transplant and life-long therapies are nothing less than Rs 25 lakh,” he said.

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