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Spotlight
Seeking the 'Sweet' Truth
WHO collaborating centre for research, education and training
in diabetes— MV Hospital for Diabetes, Chennai has been conducting some
unique research projects in diabetes. Rita Dutta reports about the significance
of some of the projects
 With
over 30 million diabetics, India bears the burden of being the 'diabetes capital'
of the world. And the 'not-so-sweet' news is that many of the people with diabetes
are developing multiple complications. In such a gloomy situation, it's heartening
to know that MV Hospital for Diabetes, located at Royapuram in Chennai, has
put diabetes research on its radar.
The MV Story
MV Hospital for Diabetes, which was started by late Dr M Viswanathan, began
functioning as Vijaya Nursing Home in 1954. The name of the nursing home was
Vijaya after its founders— Dr Viswanathan and his friend and surgeon Dr
Jay Singh. It was only in 1971, that MV Hospital was founded. Today, the hospital
has expanded to become a 100-bed unit and the reins of the hospital is in the
hands of Dr Viswanathan's able son —renowned diabetologist Dr Vijay Viswanathan.
To promote diabetes research, Dr Viswanathan founded another organisation Diabetes
Research Centre (DRC) under the Department of Science and Technology in 1972
from the premises of MV Hospital for Diabetes. However, the major boost in research
occurred when the hospital was acknowledged as WHO's collaborating centre for
diabetes research since 2002. Under this, the hospital organises awareness campaign,
conducts screening programmes and provides training to doctors. The WHO sponsors
fellows including doctors and nurses for training at the centre.
Community-based Research Projects
Special shoes for diabetics at MV Hospital |
Childhood obesity: With an endeavour to arrest diabetes
at an early age, MV Hospital has charted out a unique project targeting childhood
obesity. Says Dr Shabana Tharkar, Head, Department of Epidemiology, MV Hospital,
"Research suggests that in urban India, the prevalence of obesity among
children and adolescence ranges from 8.5 to 29 per cent and 1.5 to 7.4 per cent,
respectively. However, research data on behavioural intervention studies on
children is sparse. Hence, a study was designed with the aim of assessing the
impact of intensive intervention by lifestyle modification among obese children."
Started last year, the prevalence of childhood obesity was
assessed in a sample size of 1,193 school children aged between 8-15 years.
Three schools (two private and one corporation) were selected by stratified
cluster-sampling technique. The prevalence rates were calculated using WHO-BMI
for age percentile chart 2007. Regression analysis was done to determine risk
factors associated with overweight. "The study found the prevalence of
overweight was 12.1 per cent among children and 15.5 per cent among adolescents.
Both overweight (22 per cent) and obesity (13.7 per cent) were higher among
girls from affluent families. The mean anthropometric measurements, prevalence
of overweight and obesity were higher among urban affluent children," says
Dr Tharkar. The findings suggested the need for early intervention programme,
targeting children from affluent society. Taking a cue from the findings, the
hospital is conducting the second phase of the study, whereby a comparative
study of two schools is being done. In one school, the hospital would go only
once to create awareness about obesity and in another it would monitor the subjects
every two months with lecture on dietary modifications and physical education.
After two years, the study would compare both the schools to assess the impact
of intervention.
 "Severe
hyperglycemia interferes with TB
treatment—causing delay in management
of the disease"
- Dr Vijay Viswanathan
Managing Director
MV Hospital for Diabetes
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 "A
diabetic patient with hypertension spends 1.4 times more than a
diabetic without
hypertension"
- Dr Shabana Tharkar
Head, Department of Epidemiology
MV Hospital for Diabetes
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Comparing COPS with GPs: To address the paucity of
data on prevalence of metabolic syndrome and diabetics in different occupational
categories in India, MV Hospital for Diabetes has conducted a study involving
the policemen. The study, which was recently published in a paper in Volume
56- November 2008 edition of JAPI, aimed to determine the prevalence of metabolic
syndrome and associated cardio vascular risk factors among police personnel
and compare that with the General Population (GP). Two populations (719 men
aged 30 and more from Chennai) with similar demography were selected for this
study. Explains Dr Vijay Viswanathan, MD, MV Hospital, "The prevalence
of metabolic syndrome was significantly higher among police as compared to GP.
The police had a higher prevalence of individual cardio metabolic abnormalities
and diabetes in comparison with GP."
In another study, north and central police stations of Chennai were included
in the study for a span of two years. "Motivation and re-inforcements are
done once in three months regarding lifestyle modification to intervention group,
while basic advice is given to the control group. The expected outcome should
be a decrease in IGT to diabetes in intervention group and changes in prevalence
of metabolic syndrome and its parameters at the end of two years," says
Dr Viswanathan.
Cost of Care
The cost of diabetes care often leaves a hole in the pocket
of the patient, but there was no study that documented this. Thus, a unique
study was conducted to estimate the cost of medical care among hospitalised
diabetic patients and to assess the influence of an additional co-morbind condition-
hypertension. The study took into consideration 443 hospitalised diabetic patients.
Details of cost of inpatient and out patient care and expenditure on hospitalisation
for the previous two years were obtained. "The prevalence of hypertension
among the study was 39.3 per cent. Prevalence of hypertension made a significant
impact on expenditure pattern. On an average, a diabetic patient with hypertension
spent 1.4 times more than a diabetic subject without hypertension. Median cost
per hospitalisation, length of stay during admission, cost of two years on inpatient
admission were all significantly higher for diabetic patients with co-morbid
condition. Thus, we found that there is a need to develop a protocol on cost
effective strategy for diabetes care. Strict control of hypertension should
be targeted to avoid excess treatment cost on diabetes care," says Dr Tharkar.
Diabetes &TB: For a country leading in both diabetes
and TB, targeting both the diseases through a joint programme, especially when
both are inter-linked, is a significant step towards curbing the dual menace.
"Severe hyperglycemia interferes with TB treatment, thereby causing delay
in effective management of the disease. This malaise can be addressed by training
doctors and paramedics for prevention, screening and effective management of
diabetes among TB patients," explains Dr Viswanathan. Keeping this in mind,
the World Diabetes Foundation is funding a project 'Education and Training in
prevention of diabetes for TB health personnel' at MV Hospital for Diabetes.
The project, which started in February, 2009, would impart training doctors
and paramedics in selected areas of Chennai, Kanchipuram and Thiruvallur. "The
main purpose of the project is to develop an effective model for prevention
of diabetes among TB patients and to contribute to the National TB control programme,"
says Dr Viswanathan.
The project is slated to train 1,000 doctors in prevention and management of
diabetes, 300 paramedics on screening and diagnosis of diabetes and 300 health
workers in prevention. Around 50 screening camps would be conducted for a period
of three years (2009-2011).
 There
are various ongoing clinical studies being carried out by the department
of biochemistry and genetics. Commenting on the importance of the genetics
study, Dr Vijay Viswanathan, MD, MV Hospital, says, "The genetic studies
being carried out are used for identifying patients who are susceptible
to develop complications like kidney disease, coronary heart disease etc.
We are conducting genetic studies among the offspring of patients with diabetes
to find out the pattern of genetic transmission of Type 2 diabetes."
On the significance of biochemical studies, he says, "The results of
biochemical related studies to diabetes will make us understand the patho-physiology
of the disease and to find out the matters for diagnosis purpose."
The biochemistry department is conducting a study to
determine the efficacy of GA with gyclated haemoglobin among type II diabetic
subjects without any complications. Some of the other on-going studies
are to determine the eye changes in diabetic nephropathy using gold standards
tests for diagnosis (FFA and 24-hour protienuria) and to investigate whether
significant renal impairment can develop in diabetes in the absence of
a history of albuminia.The department has recently completed a study to
determine the level of glycated albumin (GA) among type II diabetes having
diabetes nephropathy. "Studies have reported that GA is useful for
the evaluation of short-term glycaemic control (two to four weeks) in
patients with diabetes. It is reported that albumin turnover should change
in patients with chronic renal failure having massive proteinuria, in
whom GA levels should be reduced as a result of shorter exposure of plasma
albumin. Hence we conducted the study of 198 subjects to asses the GA
levels at different stages of diabetes nephropathy. The levels of GA were
estimated using Lucia GA-L kit from Japan," says Dr Sathyavani K,
Assistant Director (Research), MV Hospital.
The department of genetics is conducting a study to find
out the association between monocytes chemoattractant protien (MCP-1)
gene polymorphism among type 2 diabetes subjects having nephropathy in
India and another study to find out ACE gene polymorphism among typ 2
diabetic subjects having renal impairment and to determine the efficacy
of intervention of ACE inhibitor among patients with positive association,
said Dr M Parthiban, Director of Laboratory Services, MV Hospital.
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Preventing Amputation
Diabetes patients are 40 times more likely to undergo lower leg amputation.
Thus a programme to prevent diabetes amputation is of utmost importance. MV
Hospital for Diabetes has started a five-year project-'Diabetes Amputation Prevention
Initiative In The Community'(DAPIC) from 2004. Taking two villages in the vicinity
of Chennai for the study, it took population of 1,400 people all aged above
40. In one village, it is creating awareness every two months and in another
the awareness was created only once.
"In a poor country like India, treating diabetes foot may account for 40
per cent of heath resources. Hence, tackling the menace by encouraging prevention
of complication at the level of primary care education and GPs is the best solution,'
says Dr Viswanathan.
Foot care for diabetes patients has been of special interest to Dr Viswanathan.
Pained by mass amputations caused by diabetes, way back he started improvising
on the footwear for diabetes. "Diabates patients had to use leprosy patient
footwear and often they would be barred from entering public places as they
were mistaken as leprosy patients," says Dr Viswanathan. So, Dr Viswanathan
tied up with Central Leather Institute to produce cheap but customised footwear
for diabetes patients. The footwear designed has no toe grip, no buckle and
no steel so that diabetes amputation patients can wear them with ease.
Yoga Studies
To find out the effect of yoga to prevent/ delay on the onset of diabetes, the
yoga department of the hospital is conducting a two-year study. Conducted from
2008, this study includes one group for control (standard care advice given)
and another for yoga therapy and group three for LSM (diet and exercise). Subjects
are motivated for diet control and physical activity, walking and yoga, during
baseline visit and follow-ups. At the end of two year, the final data collection
for anthropometric and biochemical details will be done. The outcome of the
study will be assessed by comparing baseline and one year and two year follow-up
details. Another study is planned to study the effect of yoga on newly diagnoses
diabetic subjects.
Road Ahead
Despite the hospital being a successful hub for treating diabetes, there is
no plan of replicating the hospital model in other cities. "Right now,
we are focusing on research activities and have not planned multi-location expansion
of the same scale," Dr Viswanathan explains. However, in the pipeline are
diabetes OPD units at Mylapore in Chennai and at Koramangala in Bangalore.
MV Hospital is also launching 'Diastep', a footwear made of cow leather priced
between Rs 1,200 to Rs 1,500. "The current diabetic footwears are not aesthetic
and hence we are creating a set of footwears which would are not only fanciful
but also more comfortable and safer," says Dr Viswanathan.
So, let's hope with dedicated focus on diabetes research, the increasing number
of diabetic patient is curtailed to some extent.
rita.dutta@expressindia.com
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