Diabetes care is not presently available, accessible, or affordable to people living in rural areas in developing countries, such as India. The Chunampet Rural Diabetes Prevention Project (CRDPP) was conceived with the aim of implementing comprehensive diabetes screening, prevention, and treatment using a combination of telemedicine and personalized care in rural India.
Methods:
This project was undertaken in a cluster of 42 villages in and around the Chunampet village in the state of Tamil Nadu in southern India. A telemedicine van was used to screen for diabetes and its complications using retinal photography, Doppler imaging, biothesiometry, and electrocardiography using standardized techniques. A rural diabetes center was set up to provide basic diabetes care.
Results:
Of the total 27,014 adult population living in 42 villages, 23,380 (86.5%) were screened for diabetes, of which 1138 (4.9%) had diabetes and 3410 (14.6%) had prediabetes. A total of 1001 diabetes subjects were screened for complications (response rate of 88.0%). Diabetic retinopathy was detected in 18.2%, neuropathy in 30.9%, microalbuminuria in 24.3%, peripheral vascular disease in 7.3%, and coronary artery disease in 10.8%. The mean hemoglobin A1c levels among the diabetes subjects in the whole community decreased from 9.3 ± 2.6% to 8.5 ± 2.4% within 1 year. Less than 5% of patients needed referral for further management to the tertiary diabetes hospital in Chennai.
Conclusions:
The Chunampet Rural Diabetes Prevention Project is a successful model for screening and for delivery of diabetes health care and prevention to underserved rural areas in developing countries such as India.
ZargarAHWaniAIMasoodiSRLawayBABashirMI, Mortality in diabetes mellitus — Data from a developing region of the world. Diabetes Res Clin Pract.1999;43: 67–74.
2.
MohanVShanthiraniCSDeepaMDeepaRUnnikrishnanRIDattaM. Mortality rates due to diabetes in a selected urban south Indian population — The Chennai Urban Population Study (CUPS-16). J Assoc Physicians India.2006;54: 113–7.
3.
AnjanaRMPradeepaRDeepaMDattaMSudhaVUnnikrishnanRBhansaliAJoshiSRJoshiPPYajnikCSDhandhaniaVKNathLMDasAKRaoPVMadhuSVShuklaDKKaurTPriyaMNirmalEParvathiSJSubhashiniSSubashiniRAliMKMohanV.Prevalence of diabetes and prediabetes (impaired fasting glucose or/and impaired glucose tolerance) in rural and urban India: Phase 1 results of the Indian Council of Medical Research-INdiaDIABetes (INDIAB) study, Diabetologia.2011;54: 3022–7.
4.
UnwinNWhitingDGuariguataLGhyootGGanD, (editors). International Diabetes Federation, Diabetes Atlas. Fifth Edition, International Diabetes Federation, Brussels, Belgium. 2011, 11–74.
5.
SharpPSMohanVLevyJCMatherHMKohnerEM, Insulin resistance in patients of Asian Indian and European origin with non-insulin dependent diabetes. Horm Metab Res.1987;19: 84–5.
6.
RamachandranASnehalathaCViswanathanVViswanathaMHaffnerSM, Risk of noninsulin dependent diabetes mellitus conferred by obesity and central adiposity in different ethnic groups: A comparative analysis between Asian Indians, Mexican Americans and Whites. Diabetes Res Clin Pract.1997;36: 121–5.
7.
ChandaliaMAbateNGargAStray-GundersonJGrundySM, Relationship between generalized and upper body obesity to insulin resistance in Asian Indian men. J Clin Endocrinol Metab.1999;84: 2329–35.
8.
IyerSRIyerRRUpasaniSVBaituleMN, Diabetes mellitus in Dombivli-an urban population study. J Assoc Physicians India.2001;49: 713–6.
9.
MisraAPandeyRMDeviJRSharmaRVikramNKKhannaN.High prevalence of diabetes, obesity and dyslipidaemia in urban slum population in northern India, Int J Obes Relat Metab Disord.2001;25: 1722–9.
10.
PrabhakaranDShahPChaturvediVRamakrishnanLManhapraAReddyKS, Cardiovascular risk factor prevalence among men in a large industry of northern India. Natl Med J India.2005;18: 59–65.
11.
RamachandranASnehalathaCKapurAVijayVMohanVDasAKRaoPVYajnikCSKumarKM PrasannaNairJD, Diabetes Epidemiology Study Group in India (DESI). High prevalence of diabetes and impaired glucose tolerance in India: National Urban Diabetes Survey. Diabetologia.2001;44: 1094–1101.
12.
RamachandranASnehalathaCLathaEVijayVViswanathanM.Rising prevalence of NIDDM in urban population of India. Diabetologia.1997;40: 232–7.
13.
MohanVShanthiraniCSDeepaR.Glucose intolerance (diabetes and IGT) in a selected South Indian population with special reference to family history, obesity and lifestyle factors-The Chennai Urban Population Study (CUPS 14). J Assoc Physicians India.2003;51: 771–7.
14.
RamachandranASnehalathaCBaskarADMarySKumarCKSelvamSCatherineSVijayV.Temporal changes in prevalence of diabetes and impaired glucose tolerance associated with lifestyle transition occurring in the rural population in India. Diabetologia.2004;47: 860–5.
15.
MohanVDeepaMDeepaRShanthiraniCSFarooqSGanesanADattaM.Secular trends in the prevalence of diabetes and glucose tolerance in urban South India-the Chennai Urban Rural Epidemiology Study (CURES-17). Diabetologia.2006;49: 1175–8.
16.
RamachandranAMarySYamunaAMurugesanNSnehalathaC.High Prevalence of Diabetes and Cardiovascular Risk Factors Associated with Urbanization in India. Diabetes Care.2008;31: 893–8.
17.
BaiPVKrishnaswamiCVChellamariappanM.Prevalence and incidence of type-2 diabetes and impaired glucose tolerance in a selected Indian urban population. J Assoc Physicians India.1999;47: 1060–4.
18.
KodaliVRRAlbertiKGMM, Diabetes mellitus and hypertension among rural-rural migrants in South India. Ecol Food Nutr.1995;33 (3): 149–61.
19.
DeoSSZantyeAMokalRMithbawkarSRaneSThakurK.To identify the risk factors for high prevalence of diabetes and impaired glucose tolerance in Indian rural population. Int J Diab Dev Countries.2006;26: 19–23.
20.
ChowCKRajuPKRajuRReddyKSCardonaMCelermajerDSNealBC, The prevalence and management of diabetes in rural India. Diabetes Care.2006;29: 1717–8.
21.
MohanVMathurPDeepaRDeepaMShuklaDKMenonGRAnandKDesaiNGJoshiPPMahantaJThankappanKRShahB.Urban rural differences in prevalence of self-reported diabetes in India-The WHO-ICMR Indian NCD risk factor surveillance. Diab Res Clin Pract.2008;80: 159–68.
22.
GreenAHirschCNPrammingSK, The changing world demography of type 2 diabetes. Diabetes Metab Res Rev.2003; 19, 3–7.
23.
DeepaMDeepaRShanthiraniCSDattaMUnwinNCKapurAMohanV.Awareness and Knowledge of Diabetes in Chennai-The Chennai Urban Rural Epidemiology Study (CURES-9). J Assoc Physicians India.2005;53: 283–7.
24.
JoshiSRDasAKVijayVJMohanV.Challenges in Diabetes Care in India: Sheer Numbers, Lack of Awareness and Inadequate Control. J Assoc Physicians India.2008;56: 443–50.
25.
RamachandranASnehalathaCVijayVKingH.Impact of poverty on the prevalence of diabetes and its complications in urban southern India. Diabet Med2002;19: 130–5.
26.
KapurABjorkSNairJKelkarSRamachandranA.Socio-economic determinants of the cost of diabetes in India. Diabetes Voice.2004;49: 18–21.
World Health Organization: Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia. Report of a WHO/IDF Consultation (2006). World Health Organization, International Diabetes Federation. Geneva, pp 39.
30.
Early Treatment of Diabetic Retinopathy Study Research Group. Grading diabetic retinopathy from stereoscopic color fundus photographs—an extension of the modified Airlie House classification. ETDRS report number 10. Ophthalmology.1991;98: 786–806.
31.
PradeepaRRemaMVigneshJDeepaMDeepaRMohanV.Prevalence and risk factors for diabetic neuropathy in an urban south Indian population: The Chennai Urban Rural Epidemiology Study (CURES-55). Diabet Med.2008;25: 407–12.
32.
RoseGABlackburnHGillumRFPrineasRJ, Cardiovascular survey methods. 2nd ed.Geneva: World Health Organization; 1982.
33.
PremalathaGShanthiraniSDeepaRMarkovitzJMohanV.Prevalence and risk factors of peripheral vascular disease in a selected South Indian population. The Chennai Urban Population Study (CUPS). Diabetes Care.2000;23: 1295–1300.
34.
VargheseADeepaRRemaMMohanV.Prevalence of microalbuminuria in type 2 diabetes mellitus at a diabetes center in Southern India. Postgraduate Med J.2001;77: 399–402.
35.
MossGBondarRBuzzelliD.Kinetic Enzymatic Method for Determining Serum Creatinine. Clin Chem.1975;21: 1422–26.
36.
The DECODE-DECODA Study Group on behalf of the European Diabetes Epidemiology Group and the International Diabetes Epidemiology Group. Age, body mass index and Type 2 diabetes- associations modified by ethnicity. Diabetologia.2003;46: 1063–70.
37.
RamanRMahajanSPadmajaRKAgarwalSGnanamoorthyPPaulPGKrishnaMSKumaramanickavelGSharmaT.Tele-health program for diabetic retinopathy in rural South India: A pilot study. E-Health. Int. J.2005;2: 13–8.
38.
RaniPKRamanRChandrakantanAPalSSPerumalGMSharmaT.Risk factors for diabetic retinopathy in self-reported rural population with diabetes. J. Postgrad. Med.2009;55: 92–6.
39.
VazNCFerreiraAKulkarniMVazFSPintoN.Prevalence of diabetic complications in rural Goa, India. Indian J Community Med.2011;36: 283–6.
40.
RathiS.Public Health needs modified strategy. Healthline.2010;1: 49–52.
