Multifaceted approaches crucial to halt diabetes in India: ICMR study

According to a recent study released by the Indian Council of Medical Research (ICMR)—National Centre for Disease Informatics and Research, Bengaluru, multifaceted approaches that include improved awareness, adherence to treatment, better preventive and counseling services are crucial to halt diabetes in India.

Also, expanding traditional systems of medicine (Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy [AYUSH]) into diabetes prevention and control practices open solutions to manage this crisis.

The Noncommunicable Disease (NCD) Monitoring Framework targets and indicators set by the Ministry of Health and Family Welfare, Government of India adapted from the Global NCD framework (World Health Organization), calls for a need to halt the rise in diabetes and prevent premature deaths from NCDs by 25% by 2025.

Such targets can be met only with effective strategies at multisectoral levels. However, an important limitation and quandary for policymakers are that majority of the population might be unaware of their diabetes status and are not adherent to advice.

Robust empirical data on diabetes prevalence, awareness, treatment, control and adherence is needed to comprehend the impact of initiatives taken to halt the growing burden of diabetes, response of health systems and health-seeking behaviors amongst the population. Understanding where diabetics are lost in the care cascade is essential for targeted health interventions. 

 

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New edible sensor helps TB patients take their medicinesingestible

An ingestible sensor that allows doctors to remotely monitor patients’ intake of tuberculosis medicine could revolutionise treatment and cure of the deadly disease in India which has the highest TB burden in the world, a study suggests. A randomised controlled trial, published in the journal , involved the sensor connected to a paired mobile.

The trial, conducted in California, produced superior results to directly observed therapy (DOT), where a healthcare worker watches the patient swallow medication. Researchers from the University of California in the US suggest that the technology could be a game changer in high prevalence countries where treatment adherence remains a stumbling block to eliminating TB.

They noted that TB is the world’s largest infectious disease killer, despite it being preventable, treatable and curable. In 2017, 10 million people globally fell ill with TB and 1.6 million died from the disease, the researchers said.

India has the highest TB burden in the world with one in four people affected by the disease residing in the country, they said. The trial demonstrates that Wirelessly Observed Therapy (WOT) was reported as highly accurate in recording medication ingestion (99.3 per cent), the researchers said.
WOT consists of an ingestion sensor composed of minerals, a patch worn on the torso and a paired mobile device. Patients with active TB using WOT were confirmed as taking 93 per cent of their daily prescribed doses as opposed to 63 per cent using DOT, they said.

All the 77 patients using WOT completed treatment, were cured, and preferred it to DOT, according to the researchers. Researchers said the system allowed patients to manage their own medication taking, preserving patient privacy and autonomy, but also enabled highly targeted treatment support from practitioners with permission.

“We are not doing people affected by TB justice when we have robust genomic diagnostic tests and the emergence of new antibiotic drugs that can cure TB but cannot guarantee consistent, convenient and private treatment support for them,” said Sara Browne, a professor at the University of California, who led the trial. 

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New intervention aims to improve treatment adherence among teen kidney transplant recipients

Innovative trial combines digital technology and coaching to improve adherence to treatment among young kidney transplant patients.

Learning to become self-sufficient and responsible is part of life's journey through the teen and young adult years. Mistakes are often made, and lessons are learned. However, for young kidney-graft patients, any mistake or failure in keeping to their strict immunosuppressive therapy can lead to tragic results. In fact, low-adherence to medication remains a major contributor to the high level of organ rejection in this age group.

Transplant specialists and researchers from eight leading pediatric medical centers have united to help make a difference. Led by a pediatric nephrologist and scientist,  the team conducted a clinical trial named TAKE-IT aimed at testing a new intervention to improve adherence to treatment among adolescent kidney transplant recipients.

"Missing your anti-rejection medicine, even only a few times, can lead to graft failure," says corresponding author of the study, who is also a researcher and a professor of Medicine. "Given the shortage of organs available for transplant, every failure is not only a loss for the patient but also a loss for the transplant community."

Medication non-adherence is a major problem in the 15 to 30 per cent of children in North America who have a chronic illness, resulting in significant morbidity and mortality. It is also believed to be responsible for millions of dollars in potentially avoidable healthcare costs.

TAKE-IT: Multiplying tactics to help young patients follow treatment

The TAKE-IT intervention used a combination of electronic medication monitoring and meetings with a personal coach every three months to encourage and develop adherence behaviour. The researchers followed 169 adolescent and young adult kidney transplant recipients (aged 11 to 24) for a year. Participants used the electronic pillbox,  to monitor their medication-taking. The cohort of patients was divided into two groups. The first group (81 patients) could customize the monitoring system to send them digital nudges like emails or text messages if they did not take their medicine on time. They also received coaching from people who were not part of or did not interact with the clinical team. Members of the second group, known as the control group (88 patients), didn't receive electronic messaging or adherence coaching.

Results of the trial show that the young kidney transplant recipients who used the digital health medication management and adherence solution in combination with coaching had a 66 per cent higher adherence to the anti-rejection medicine. Better adherence is likely to lead to better graft survival.

Reactions to the intervention program varied. "Some people loved it and didn't want to give the pillbox back, but others hated it and stopped using it for reasons such as the pillbox being unwieldy. Based on this feedback, the device is being re-designed," the Dr. says. "Most teens, however, liked meeting with the coach."

"These results are exciting because they show that a multidisciplinary approach can really help teens and young adults stick to their treatment plan, which is so important for their continued well-being," adds study co-author. "The coaching has a big impact as it does in sports and other activities - the encouragement and personal connection is important, because it's not easy to be a teen or young adult with a chronic health condition."

The Dr. also emphasizes that remembering to take meds can be difficult when a lot of other things are happening in the lives of these young patients, and points out the benefit of text message and email reminders for a population who grew up using cellphones.

"This is one of the largest clinical trials on adherence to daily medication ever conducted in the kidney transplant population. Identifying an approach that is effective in promoting adherence in patients with chronic conditions is a major advance," says the Dr. "Better adherence will lead to healthier patients and is likely to save healthcare dollars by preventing serious complications that would need treatment or hospitalization."

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