Intelehealth’s study in Nashik District aims to tackle Severe Acute Malnutrition (SAM) through an innovative app-based plan.
For children under five who suffer from Severe Acute Malnutrition(SAM), the mortality rate goes up by 5-8 times compared to well-nourished children. Yet, parents of 54% of such children who had been referred to a hospital or Nutritional Rehabilitation Centre (NRC) in India were unable to follow through with the referrals. In the absence of specialised care within the community, the role of such care centres and government hospitals remains essential in improving the health of these children. These are the first set of resources for low-income families in both rural and urban areas.
Nashik, a district in the western state of Maharashtra, has one of the highest numbers of severely malnourished children. Right since its inception, Intelehealth has been working in the region with communities that have little or no access to healthcare. The challenge of creating a community-based solution in these forested, hilly terrains spoke directly to its mission and so was born a research study to examine the role of telemedicine in improving outcomes for children with Severe Acute Malnutrition(SAM).
For families living in remote regions, accessing NRCs is an ordeal. Usually, such centres are attached to district hospitals and have 10-20 beds. Each such centre is meant to serve hundreds if not thousands of care-seeking families. Vast swathes of land can fall under a district and families that are willing to travel have to often spend considerable amounts of time and money to get here. Occupied beds at the centre translates to additional wait times. That aside, parents have also to consider how to attend to the needs of their other children back home. Who will cook for them? Will the relatives be able to take good care of them? If one is a daily-wage worker, travelling these distances can also mean a loss of income – income that directly impacts their daily meals. It is not surprising then that even among the 46% who sign up for the treatment provided at such centres, 23% return without getting any service. That means a staggering 78% of children with severe malnutrition are not getting the care they need.
The telemedicine-based SAM pilot intervention and research study by Intelehealth is being carried out in 30 remote villages in the region. The first step is to link the community with a health worker, also known as Sakhi or friend, who is suitably trained and supported by a medical supervisor and usually resides in the community. They assess and understand nutritional requirements of these children and put the families in touch with doctors and nutrition experts via teleconsultations. If the doctor recommends supplementary food or medicines, these can be easily availed directly or through government provisions. Similarly, linkages to local medicine supplies and diagnostic labs can also be arranged.
The clinical protocol of the application plays a vital role in managing the health of these children and assessing their comorbidities. With consistent telemedicine services and linkages to the government centres, one can easily address emergencies over time. The app makes it possible to geographically locate the cases with higher precision, manage more SAM cases at the community level and refer only the most severe ones to the nearest NRC.
Further, a control group is essential to understand the efficacy of such a programme. To accurately assess the effectiveness of such a Community-based Management of Acute Malnutrition Intervention (CMAM), part of the study focuses especially on children in two blocks in Nashik. One group will receive tech-enabled nutritional intervention and the control group will continue to receive standard medical care (referral to an NRC). We will follow both groups to assess if the CMAM intervention is as clinically effective as in-person care at an NRC while being more accessible, affordable for patients, as well as more cost effective for the health system.
According to UNICEF, South Asia is home to roughly half of the world’s severely malnourished children. With a telemedicine-based care mechanism that is rooted in the community, one can shift the current burden away from the NRCs and district hospitals and truly bring the solution home.
Mahakali is home to one of the more notable tea estates of the Tinsukia District of Assam. Much like other tea estates, these too are looked after by the tea-tribes- a community of tea plantation workers who were originally brought to these lands by the British from Odisha, Jharkhand and West Bengal. Times may have changed but accessing good healthcare still remains a challenge.
Rani Urang is a part of this community and with the help of Ekal Abhiyan and the Arogya Foundation of India is changing that dismal story. She is an Arogya Sevika and works with the Telemedicine Enhanced Arogya program (supported by technology from Intelehealth). She has been an eager learner and today she can carry out various kinds of diagnostics for all age-groups within her community. These tests and her role in conducting them becomes critical in availing primary healthcare through the telemedicine app. Technology can make a notable difference to the healthcare landscape but not until it is supported and adopted by inspired individuals who are willing to add that human touch- individual like Rani Urang. Do listen to this slice from her daily life.
About the project:
This project is a collaboration between the Arogya Foundation of India (AFI) and Intelehealth (IH) The Ekal Arogya Telemedicine Project is implemented in the tribal communities in Assam, Gujarat, Jharkhand, Madhya Pradesh, Odisha, Uttar Pradesh, and West Bengal. This project enables community health workers, also known as Sevikas, who use smartphones and telemedicine kits to collect patient histories, and conduct teleconsultations with remote doctors. The Sevikas counsel, screen, and follow up on the treatment plan, thus tracking patient health outcomes.
The Sevikas are community-based frontline healthcare providers who have completed at least secondary school. They are fluent in the local language, both reading and writing, and have been collaborating with the Arogya Foundation of India (AFI) on health-related issues, primarily preventative health care with a focus on hygiene and nutrition, home remedies, and developing a kitchen garden. AFI has thus empowered and motivated community women to participate in community engagement activities.
Abstract: Telemedicine offers a method to bridge the healthcare access gap in low and middle-income countries (LMICs) by connecting providers with patients using appropriate technology. Here we describe the design and development of a novel modular telemedicine platform, Intelehealth, that would enable health systems to connect remote doctors with patients in rural clinics using a customizable Android-based platform and a cloud-based electronic health record system at the backend (OpenMRS). This open source platform enables task shifting of medically relevant information gathering by a local health worker, the transmission of this information to a remote doctor, and a telephonic conversation between the doctor and the patient that subsequently allows for the delivery of an appropriate therapeutic plan. Intelehealth is designed to operate on a low bandwidth internet environment and will be tested and validated in rural health clinics in India.
N. A. Goel, A. A. Alam, E. M. R. Eggert and S. Acharya, “Design and development of a customizable telemedicine platform for improving access to healthcare for underserved populations,” 2017 39th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC), Jeju, Korea (South), 2017, pp. 2658-2661, doi: 10.1109/EMBC.2017.8037404.
Telemedicine is commonly understood as the delivery of healthcare services with the use of information and communication technologies, and its potential was unlocked during the COVID-19 pandemic. It acts as a viable and efficient alternative healthcare delivery model to conventional in-person care. However, there may be a need to formalize telemedicine in many jurisdictions and establish norms and guidelines around its privacy, ethical and legal concerns.
With the aim to understand the regulatory framework around telemedicine across Asia, Intelehealth and PSA undertook a comparative study of 51 Asian regions to identify the prevalent norms, implementation status, key components, and limitations. While comprehensive telemedicine regulations in most Asian jurisdictions continue to be a work in progress, there is consensus that they are integral for building resilient healthcare delivery systems.
Based on the study, it was identified that only 15 Asian countries have binding telemedicine laws, and 5 have non-binding guidelines, some of which were only effective during the pandemic. Despite this, there has been a rise in the use of telemedicine, and most Asian countries have enabled use of telemedicine systems through public-private partnerships and international collaborations. The study also revealed that most telemedicine laws have certain common themes around practitioners, kind of tech tools that can be deployed, patient consent, compliance with ethical standards, and data protection. It also emerged that there are ambiguities in existing frameworks around the manner of implementation, limitations on the scope of telemedicine, permissible technology standards, qualifications, funding and reimbursement aspects.
Over a few decades, women are constantly encouraged to give birth in health care facilities so they may have access to skilled health care professionals and should the need for additional care arise the measures can be taken. However, accessing skilled and professional care in health facilities may not completely guarantee respectful, good, and quality care. Every woman has the right to have a positive and pleasant childbirth experience with Quality care. Ideally the expected quality care includes respectful care of the woman in labour, good and respectful communication, and making sure she feels emotionally and socially supported in the way that she desires.
Worldwide, maternal health efforts are shifting from an emphasis on boosting service utilization to improving quality of care. This change has been accompanied by a growing body of work on how women are treated during facility-based childbirth, which was first brought to global attention in 2010 by Bowser and Hill’s landscape analysis. This chilling quote from the report highlights how women may experience physical abuse during labour.
“When a woman goes into the second stage of delivery, you don’t want her to close her legs, so you’re beating her” [Kenya] (Center for Reproductive Rights & Federation of Women Lawyers–Kenya (FIDA), 2007)
Respectful maternity care (RMC) provides meaningful experiences of childbirth as a basic element of quality health, which includes knowing their self-worth, feelings, and preferences. RMC is globally recognized. Every woman around the world has a right to receive respectful maternity care. The concept of “respectful maternity care” has evolved and expanded over the past few decades to include diverse perspectives and frameworks. Advocates emphasized the need to humanize birth, taking a more holistic approach.
What it takes
Respectful maternity care (RMC) is not only a crucial component of quality of care; it is a human right. In 2014, WHO released a statement calling for the prevention and elimination of disrespect and abuse during childbirth, stating that “every woman has the right to the highest attainable standard of health, including the right to dignified, respectful care during pregnancy and childbirth.”WHO also called for the mobilization of governments, programmers, researchers, advocates, and communities to support RMC. In 2016, WHO published new guidelines for improving quality of care for mothers and new-borns in healthcare facilities, which included an increased focus on respect and preservation of dignity. In addition to the eight domains of quality of care, the framework also includes six strategic areas to help build a systematic, evidence-based approach for providing quality care: Clinical guidelines, Standards of care, Effective interventions, Quality measures, and Relevant research and capability building.
The ‘Holistic Way’
RMC is an approach centered on the individual, based on principles of ethics and respect for human rights, and promotes practices that recognize women’s preferences and women’s and new-borns’ needs.
Understanding a woman’s perspective and her needs during childbirth and addressing them as part of quality-improvement programmes can make delivery care safe, affordable, and respectful. The patient’s judgement on the quality and goodness of care is indispensable to improving the management of healthcare systems.
Respectful Maternal Care (RMC) is defined as “care organized for, and provided to all women in a manner that maintains their dignity, privacy and confidentiality, ensures freedom from harm and mistreatment and enables informed choice and continuous support during labor and childbirth.”
The Real Plight
It is a human right for every woman to deserve respectful maternity care, yet many women abstain from obtaining professional maternity care due to the lack of respect and being abused during labour. As per research and reports this leads to birth injury, and maternal and new-born deaths. Despite such severe impacts, these issues remain under wraps and especially so in developing nations.
Disrespectful and undignified care is prevalent in many facility settings in India, particularly for underprivileged populations, and this not only violates their human rights but is also a significant barrier to accessing intrapartum care services.
Bowser and Hill categorized disrespect and Abuse (D&A) faced by pregnant women into seven major categories – physical abuse, they are non-consented clinical care, non-confidential care, non-dignified care (including verbal abuse), discrimination based on specific patient attributes, abandonment, denial of care, and detention in facilities.
Improving the quality of health–care services by providing respectful maternity care (RMC) could lead to further reduction in Maternal mortality rate (MMR). Adopting a patient–centric approach and training of providers focused on respectful care would significantly improve the quality of care, promote institutional births, and protect the fundamental right of women to equity, dignity, and respect.
A Pathway Towards Respectful Maternity Care…
Several studies have documented the ubiquitous nature of disrespectful care and its adverse effects on care-seeking behaviour, and calls to action on quality of maternal health care have prioritised women’s experiences.
The findings from a study with an objective to estimate the prevalence of Disrespect and Abuse (D&A) and its determinants during pregnancy, childbirth, and immediate postpartum period among women in India provide crucial information to widen the scope of research on the effects of socioeconomic status on Respectful Maternal Care.
A study was conducted at Jamtara district in Jharkhand, with an objective to understand the aspects of care that women consider important during childbirth6\. Jharkhand is a state in eastern India with poor maternal and child health indicators.
Aspects of care most cited by women to be important in facility-based childbirth were – the availability of health providers and appropriate medical care (primarily drugs) in case of complications, emotional support, privacy, clean place after delivery, availability of transport to reach the institution, monetary incentives that exceed expenses, and prompt care. While some other factors include kind interpersonal behaviour, cognitive support, faith in the provider’s competence, and overall cleanliness of the facility and delivery room.
A low cost RMC-promoting interventions recommended by the WHO is the presence of a birth companion during labour and delivery. A birth companion is not only a key component to fulfil the objective of RMC, but, is also vital in improving the quality of care during labour and delivery.
Presence of a Birth companion during labour in a labour ward usually was not a regular practice in the past, hence there was an unmet need to implement this initiative to improve the quality of maternity care and to ensure a positive pregnancy outcome for every woman. Despite the known benefits, allowing birth companions is not in practice in government set-ups and in most private healthcare facilities in India. There is also a dearth of literature focusing on the method of implementation of a birth companion, which is a major challenge in busy labour and delivery wards.
A study was conducted in the Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi with the objective to establish a practice of allowing a companion during labour and delivery. It followed the principles of Quality Improvement (QI), which included analysis of the problem and implementation of Plan-Do-Study-Act (PDSA) cycles for a step-by-step approach to provide quality care. A QI team was formed, and after obtaining the baseline data, problems were analysed using fish bone chart. A new policy of allowing birth companion was made and efforts made to sensitise and train the doctors and nurses posted in labour ward.
Simple interventions such as dress code for birth companions, curtains for ensuring privacy, display of posters and frequent reminders on WhatsApp groups were planned. The results of the study were the median value of women accompanied by birth companion marginally increased to 25% after the first PDSA cycle. Implementation of further changed ideas led to increase in median, which reached 66.6%. Thereafter, there was a decline, but by the end of 6 months, it was possible to attain the goal to establish a practice of allowing a companion during labour and delivery by using the principles of quality improvement (QI)and sustain it.
The findings revealed a direct relationship between respectful maternity care and positive childbirth experience7. Therefore, it is recommended that mangers and policy makers in childbirth facilities reinforce facilitating respectful maternity care to improve women’s child birth experience and prevent potential adverse effects of negative childbirth experiences.
A simple tool that standardizes and measures whether best practices in RMC are being followed in the labour ward is the new WHO Labour Care Guide. The Labour Care Guide replaces the WHO partograph. It places an importance on not just adherence to process, but also the quality of the service delivery and person-centered care.
Intelehealth along with several clinical partners is working on a digital health solution, called eZazi, that adapts the WHO Labour Care Guide to a digital tool with integrated telemedicine support to improve the quality of care delivered in labour wards. This new product is another step towards achieving our vision of ethical, evidence-based and dignified healthcare for every woman.
The Need of the Hour
Raising awareness and strengthening the capacity of the interested parties regarding concepts and practices related to respectful maternity and new-born care; identifying the legal frameworks which support it; recognizing and describing the use of some of these tools to plan, implement and monitor quality improvement initiatives for maternity and new-born care in health care services.
The need of the hour is collaboration and investment that include diverse donors, partners, and experts with an interest in RMC for a sizeable impact.
The government of Jharkhand has adopted a web-based comprehensive telemedicine solution – eSanjeevani – to extend the reach of specialized healthcare services to masses in both rural areas and isolated communities. eSanjeevani Jharkhand is supported by two models of implementation – eSanjeevani OPD and eSanjeevani AB-HWC (Ayushman Bharat – Health and Wellness Center).
Intelehealth (IH) as a technical partner of Transforming Rural India Foundation (TRIF) and Jharkhand State Government’s Health Department, are the key implementation agencies for eSanjeevani with a focus on strengthening the eSanjeevani AB-HWC model with the following activities: 1) Network creation 2) Supply side strengthening 3) Demand side strengthening and 4) Quality assurance
The following report shares the impact of the implementation support extended by the TRIF – Intelehealth team from May 2021 to March 2022. The inputs provided were:
Registration, activation and monitoring of hubs and spokes with teleconsultation analytics
Capacity building of health providers, CHOs (community health officers) and doctors, on eSanjeevani and allied modules to strengthen the teleconsultation service provision
Post training support to the health providers – technology, clinical and public health
Provider engagement to motivate and encourage the health providers to initiate and invest in eSanjeevani and increase acceptability of telemedicine
External doctors’ support through a public private partnership model as an initial catalyst
Advocacy, review and timely reporting for robust discussion, brainstorming and decisions taken by the government officials to further strengthen teleconsultation services
Key results:
Total teleconsultations enabled during the evaluation period of this report was 1,75,490 with a 1000x increase in teleconsultations from 50 teleconsultations per month in May 2021 to more than 50,000 teleconsultations per month (as of June 2022).
Overall, we estimate that the presence of the telemedicine facility saved 21.59 km in distance travelled and INR 941.51 on money saved on average per visit per health visit
Treatment compliance was 96.5% among those with a prescription or medical advice
87.61% clients received medicine at the health and wellness center (HWC)
60% patients reported having entirely recovered from their health problems, 25% reported partial recovery
The CHO was the main driver for opting into the teleconsultation with 36.2% clients choosing to do so on advice of the CHO
The acceptability of providers towards telemedicine was high, Overall score of 4.01 out of 5 among community health officers and 3.9 out of 5 among doctors from the system
This report focuses on overall activities and results of the implementation support provided by Intelehealth – TRIF partnership to the government of Jharkhand to strengthen teleconsultation services in Jharkhand. The report presents the inputs, activities, outputs, and outcomes of our implementation strategy to further strengthen eSanjeevani teleconsultations.
A number of existing challenges were identified along with recommendations for strengthening the program overall. The key recommendations moving forward include community demand generation and promoting acceptability of telemedicine through ASHAs, Pachayati Raj Institutions and Civil Society Organizations; resolving shortages of doctors through public-private partnerships; improving digital infrastructure at HWCs such as availability of tablets, laptops and internet connectivity; and monitoring & improving the quality of services delivered over telemedicine. In addition, further health impact and outcome evaluation studies need to be planned to better understand the impact of eSanjeevani. Scope for future work includes to assess the social return on investments, impact of the eSanjeevani telemedicine platform on various public health programs for non-communicable diseases, tuberculosis, nutrition and maternal & child health.
Intelehealth awarded at the HDFC Parivartan SmartUp Grants 2022
Intelehealth has been chosen as one of the top 85 grantees of the HDFC Parivartan SmartUp Grants 2022 for its innovative and high-impact solutions to key challenges in Indian healthcare.
Intelehealth, a tech-for-impact organization was recently named the 5th annual HDFC Parivartan SmartUp Grants 2022 winner. Along with Intelehealth, HDFC bank awarded grants to 85 other innovative start-ups from a pool of over 150 applicants from across the country working in various sectors. The grants were awarded following a rigorous screening process that focused on addressing environmental, healthcare, and gender diversity issues.
These grants received will help Intelehealth to expand its reach in rural India, launch new telemedicine projects, and develop and strengthen technology that aims to bridge the gap between rural populations and healthcare providers.
Neha Verma – CEO & Co-Founder, Intelehealth: “We would like to thank the HDFC Parivartan SmartUp Grants 2022 team for recognizing and believing in our work and awarding us the grant. This grant money will be extremely beneficial in assisting us in meeting our current objectives. With this grant, the organization will expand and scale up the Telemedicine projects in areas where access to healthcare remains a barrier. We look forward to this valuable partnership and are grateful for your belief in the mission that we strive for”.
These grants are intended to support startups that provide one-of-a-kind solutions to bring about long-term change in society and the environment. The grants were made available through Parivartan, the HDFC bank’s flagship CSR program for social initiatives.
About Inteleheath : Intelehealth is a tech-for-impact organization: A team of engineers, clinicians, management and public health experts. We’ve developed an innovative open source telemedicine platform connecting the last mile population with affordable and quality healthcare services.
Our mission is to “Deliver quality healthcare where there is no doctor”.
Our vision is “Health for all”, we believe in the vision of universal health coverage – that you should be able to receive the health services you need, when and where you need them, without facing financial hardship.
To know more about Intelehealth, log on to www.intelehealth.org
Intelehealth partners with ACT for the deployment
of eSanjeevani in Odisha
Intelehealth receives a grant from ACT which will be used to enhance the eSanjeevani telemedicine program in the state of Odisha in partnership with the National Health Mission.
Intelehealth has collaborated with ACT for the implementation of the eSanjeevani Telemedicine programme across the state of Odisha’s Health & Wellness Centres (HWCs), Primary Health Centres (PHCs), and Urban Primary Health Centres (UPHCs).
The implementation of the national telemedicine programme in Odisha aims to promote comprehensive primary health care while also strengthening systems by making them more resilient and accessible. This project will benefit 1,600 health care facilities in 30 districts.
Neha Verma – CEO & Co-Founder, Intelehealth: “We would like to thank ACT Grants for recognizing and believing in our work and awarding us the grant. This grant money will be extremely beneficial in assisting us in meeting our current objectives. With your support, the organization will deploy eSanjeevani in the remotest parts of Odisha where access to healthcare remains a barrier. We look forward to this valuable partnership and are grateful for your belief in the mission that we strive for”.
Intelehealth aims to improve capacity building, and skill development for the frontline health workforce and mobilize the community to create and increase awareness of the eSanjeevani telemedicine program in the state of Odisha.
About Inteleheath : Intelehealth is a tech-for-impact organization: A team of engineers, clinicians, management and public health experts. We’ve developed an innovative open source telemedicine platform connecting the last mile population with affordable and quality healthcare services.
Our mission is to “Deliver quality healthcare where there is no doctor”.
Our vision is “Health for all”, we believe in the vision of universal health coverage – that you should be able to receive the health services you need, when and where you need them, without facing financial hardship.
To know more about Intelehealth, log on to www.intelehealth.org
July 04, 2022: Intelehealth was added to the Digital Public Goods Alliance DPG Registry last week. This underscores Intelehealth’s commitment to developing and championing digital public goods that will help achieve ‘Health for All’ and contribute to the Sustainable Development Goals (SDGs).
Intelehealth is a non-profit delivering high-quality healthcare for the last -mile population where there is no doctor through telemedicine. Using our open-source technology platform that’s driven by an innovative digital health assistant, we connect patients and frontline health workers at the last mile with qualified doctors, diagnostics & medications. Intelehealth is on track to provide healthcare for 10 million women over the next three years in partnership with Ministries of Health in India & Kyrgyzstan. Intelehealth has been recognized by the World Economic Forum, UNICEF, and NITI Aayog as an impactful Digital Public Good.
Our mission is to “Deliver quality healthcare where there is no doctor through Telemedicine”
Our vision is “Health for all” we believe in the vision of universal health coverage – that you should be able to receive the health services you need, when and where you need them, without facing financial hardship.
For us, being recognized as a digital public good – defined as open source software, available data, open AI models, open standards and content that adhere to privacy and other applicable laws and best practices- does no harm and help attain the SDGs.
“Intelehealth’s addition to the DGP registry recognizes its commitment to providing high-quality healthcare for last-mile populations where there is no doctor through Telemedicine and for closing the digital divide between urban and rural populations by providing affordable access to healthcare using our digital public good platform”, said Intelehealth CEO & Co-founder, Dr. Neha Verma.
The Digital Public Goods Alliance is a multi-stakeholder initiative endorsed by the United Nations Secretary-General, working to accelerate the attainment of the Sustainable Development Goals in low- and middle-income countries by facilitating the discovery, development, use of, and investment in digital public goods.
Diabetes is one of this century’s most significant global health emergencies, ranking among the ten leading causes of mortality and cardiovascular disease (CVD), respiratory disease, and cancer. According to the World Health Organization (WHO), non-communicable diseases (NCDs) accounted for 74% of deaths globally in 2019, of which Diabetes resulted in 1.6 million deaths, thus becoming the ninth leading cause of death globally.
[Data source WHO https://www.who.int/data/gho/data/themes/topics/topic-details/GHO/ncd-mortality]
According to ICMR’s guidelines, India is home to the world’s second-largest adult diabetes population, and every sixth person with Diabetes in the world is an Indian. The past three decades witnessed a 150 percent increase in the number of people with Diabetes in the country. The progressive lowering of the age at which type 2 diabetes is being diagnosed, with the disease prevalence becoming apparent in the age group of 25-34 years in both urban and rural areas.
Multifactorial pathogenesis in which metabolic, behavioral, lifestyle and environmental factors precipitate disease in genetically predisposed persons
The combination of insulin resistance increased hepatic gluconeogenesis, and relative defects in insulin secretion promote metabolic dysfunction.
Overweight or obese body habitus is a significant factor contributing to insulin resistance, which is a precursor to glucose intolerance and diabetes development.
A hypercaloric diet and sedentary lifestyle also worsen insulin resistance
Hyperglycemia develops when progressive impairments in insulin secretion render pancreatic β-cells unable to maintain euglycemia
Vital hereditary component contributes to the manifestation of the disease, with complex polygenic inheritance pattern underlying most cases
Risk factors of Diabetes
Age
Incidence increases with age, owing in part to age-related reduced glucose tolerance but also reduced physical activity and increased adiposity
Gender: Women with a history of the following are at greater risk for diabetes:
Polycystic ovary syndrome (PCOS)
Delivery of an infant weighing more than 4 kg
Previous diagnosis of gestational diabetes (Diabetes during pregnancy)
Genetics
Most cases of type 2 diabetes have a complex multifactorial polygenic basis, with over 100 loci identified as contributing to a higher risk.
Genetic risk for type 2 diabetes is primarily expressed in environmental factors such as obesity and a sedentary lifestyle.
Ethnicity/race
Increased prevalence in African American, Latino, Native American, Pacific Islander, and Asian American populations
Overweight or obesity (2-fold elevated risk if overweight; risk rises proportionately with a higher class of obesity)
Sedentary lifestyle
Medications that worsen glucose tolerance or exacerbate hyperglycemia, such as:
GlucocorticoidsThiazide diuretics
Atypical antipsychotics
Sleep disorders (eg, obstructive sleep apnea, chronic sleep deprivation, night shift work schedule) in conjunction with glucose intolerance
What is Type 1 Diabetes?
Type 1 diabetes (previously known as insulin-dependent, juvenile, or childhood-onset) is characterized by low insulin production and requires daily administration of insulin. In 2017 there were 9 million people with type 1 diabetes; most of them live in high-income countries. Neither its cause nor the means to prevent it are known.
Symptoms include excessive excretion of urine (polyuria), thirst (polydipsia), constant hunger, weight loss, vision changes, and fatigue. These symptoms may occur suddenly.
What is type 2 Diabetes?
Type 2 diabetes (formerly called non-insulin-dependent or adult-onset) results from the body’s ineffective use of insulin. More than 95% of people with Diabetes have type 2 diabetes. This type of Diabetes is primarily the result of excess body weight and physical inactivity.
Symptoms may be similar to type 1 diabetes but are often less marked. As a result, the disease may be diagnosed several years after onset, after complications have already arisen.
Until recently, this type of Diabetes was seen only in adults, but it is now also occurring increasingly frequently in children.
Prevention
Simple lifestyle measures are effective in preventing or delaying the onset of type 2 diabetes. To help prevent type 2 diabetes and its complications, people should:
Achieve and maintain healthy body weight;
Be physically active – doing at least 30 minutes of regular, moderate-intensity activity on most days. More activity is required for weight control;
Eat a healthy diet, avoid sugar and saturated fats; and
Avoid tobacco use – smoking increases the risk of Diabetes and cardiovascular disease.
Diagnosis and treatment
Early diagnosis can be accomplished through relatively inexpensive testing of blood sugar.
Treatment of Diabetes involves diet and physical activity along with lowering blood glucose and the levels of other known risk factors that damage blood vessels. Tobacco use cessation is also important to avoid complications.
Interventions that are both cost-saving and feasible in low- and middle-income countries include blood glucose control, particularly in type 1 diabetes. People with type 1 diabetes require insulin. People with type 2 diabetes can be treated with oral medication but may also require insulin, blood pressure control, and foot care (patient self-care by maintaining foot hygiene; wearing appropriate footwear; seeking professional care for ulcer management; and regular examination of feet by health professionals).
Other cost-saving interventions include screening and treatment for retinopathy (which causes blindness), blood lipid control (to regulate cholesterol levels), and screening for early signs of diabetes-related kidney disease and treatment.
[Data source – WHO https://www.who.int/news-room/fact-sheets/detail/diabetes)
Intelehealth and MSF India Response
Diabetes is rising in India, with the second-highest diabetics due to increased sedentary lifestyles, unhealthy diets, tobacco use, and obesity. Nearly 50% of the population are unaware that they have Diabetes.
Intimidated by the stats showing India has the second highest number of diabetics in the world, MSF India launched the telemedicine Diabetic Management Helpline, powered by Intelehealth, to provide primary-level diabetes care and manage the disease and encourage healthy living.
A pan-India toll-free helpline would improve access to standardized and uniform helpful information about diabetes care which would be customized to their needs. This would significantly help the underprivileged, who would otherwise postpone or even forgo needed healthcare due to non-affordability. Such digital technology platforms motivate the patients for diabetes self-management through constant follow-ups, counseling and access to a diet plan.
The helpline would allow the patients to seek consultations at their convenience. By providing appropriate counseling on healthy meal plans and lifestyle modifications by an accredited dietician, increasing awareness, and promoting self-monitoring of health and routine follow-ups, the helpline could minimize the risks of future complications. Additionally, the helpline would also support the patients in seeking psychological healthcare, which is crucial to the overall management of Diabetes, without the fear of stigmatization.
If you have Diabetes and need medical assistance, contact the Diabetic Management Helpline. Call 1800 309 4144 and connect with a team of nurses, doctors & nutritionists and learn how to manage your diabetes effectively.
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10. Telemedicine Cost–Effectiveness for Diabetes Management: A Systematic Review:Jun Yang Lee and Shaun Wen Huey Lee
11. Telemedicine Application in the Care of Diabetes Patients: Systematic Review and Meta-Analysis : Milena Soriano Marcolino, Junia Xavier Maia, Maria Beatriz Moreira Alkmim, Eric Boersma, Antonio Luiz Ribeiro
Intelehealth’s study in Nashik District aims to tackle Severe Acute Malnutrition (SAM) through an innovative app-based plan.
Intelehealth’s study in Nashik District aims to tackle Severe Acute Malnutrition (SAM) through an innovative app-based plan.
