Managing diabetes in India: paradigms in care--outcomes and analysis in a comprehensive, clinical practice survey of Indian physicians.

Diabetes continues to be a pandemic despite huge strides in the awareness and management of the condition. The incidence of diabetes has been projected to rise by almost 170% in most of the developing countries including India. Currently, about 50 million people suffer from diabetes in India with the figures expected to reach 87 million by the year 2030. To assess the management trends in India, a cross-section of doctors across all the major zones of the country were requested to answer a set of questions based on a case profile. Approximately 1000 doctors from all corners of India provided their feedback on various issues of diabetes management. The patient profile was that of an overweight 46-year-old Indian female with hypertension, diabetes and dyslipidaemia with a history of recurrent urinary tract infection (UTI). Almost 84.5% of doctors concurred with the diagnosis of metabolic syndrome for this patient. The awareness about diabetes being a comorbidity as well as a cause for recurrent UTI was high with 86% of doctors choosing diabetes as a cause for recurrent UTI. Around 94% of doctors chose metformin as the drug of choice for the management of this patient. A total of 74% of doctors chose the combination of metformin and sulfonylurea for the management of postprandial hyperglycaemia. Opinions were divided on the choice of drugs for the management of diabetes in a non-obese patient with 31% of doctors still choosing metformin as the drug of choice as per the American Diabetes Association 2009 guidelines and 66% of doctors choosing glimeperide as the first choice in a non-obese patient in concordance with the Association of Physicians of India/Indian College of Physicians (API/ICP) guidelines on diabetes. However, 95% of doctors unanimously chose metformin as the drug of choice in patients with abdominal obesity and diabetes. Almost 83% of doctors were aware that Indians have a genetic predisposition to diabetes due to an inherently smaller beta cell mass associated with insulin resistance. Majority of the physicians were also aware of the adverse effects of most of the antidiabetic drugs with 86% of the physicians identifying hydrochlorothiazide as the cause of worsening uric acid levels in diabetics, when used for the management of hypertension. Practice patterns in India generally conform to guidelines. The survey also demonstrated that majority of the physicians are aware of the different complexities associated with the management of diabetes.