This move aims to enhance the state’s healthcare response to the increasing prevalence of lifestyle-related illnesses, focusing on effective management and prevention strategies | Image used for representational purpose only
| Photo Credit: File Photograph
After nearly a decade, the State Health department is yet again launching a major initiative to revise the non-communicable diseases (NCD) protocol in the State, in line with the latest clinical practice recommendations, while tweaking it to suit the State’s specific context and practical requirements.
The last time Kerala did this exercise was in 2016-18, when a joint initiative for protocol-based standardised management of diabetes and hypertension was launched in the State, as part of India Hypertension Management Initiative (IHMI), a national programme which was being implemented by the Indian Council of Medical Research (ICMR) and Vital Strategies, an NGO. (IHMI is now known as IHCI or the India Hypertension Control Initiative)
A multidisciplinary push for better outcomes
“The idea then was to draw up a uniform protocol for the initiation of treatment for diabetes and hypertension in primary healthcare settings. But the NCD treatment scenario has changed dramatically since then, primarily with the introduction of newer medicines and newer versions of insulins. There is also huge variance in the manner in which diabetes and hypertension are treated now in the private sector. Our primary focus should be the prevention of long-term complications of diabetes and hypertension,” says Suma T.K., former Professor of Medicine, Government Medical College, Alappuzha, who had been part of the team which drew up the first NCD protocol.
The State’s attempt to revise its current NCD protocol also comes at a time when the International Diabetes Federation has just released the new Global Clinical Practice Recommendations for the Management of Type 2 diabetes, incorporating the latest evidence and advancements in diabetes care and clearly distinguishing between optimal and basic-care strategies. The new recommendations prioritise a person-centred approach, ensuring that care is aligned with the individual needs and circumstances.
With the National Programme for Prevention and Control of Non-Communicable Diseases 2023-2030 (NP-NCD), attaching much importance to metabolic dysfunction-associated steatotic Liver Disease (MASLD) and chronic kidney disease which are strongly linked to diabetes, the State is getting together a multidisciplinary team of experts in medicine, neurology, endocrinology, nephrology, cardiology, nephrology, oncology and public health experts to deliberate on a new NCD protocol for the State, with an accent on preventing multi-organ complications.
New drugs hit market
Bipin Gopal, State Nodal officer for NP-NCD, says that the focus will indeed be on the optimal management of diabetes and hypertension. Lifestyle modifications, including dietary changes, also needs a re-look. While a lot of new drugs have hit the market, the State would have to consider several factors, including a drug’s potential to reduce the rate of complications, its cost-effectiveness and availability, before it can be adopted as a drug of choice.
“NCD protocols should be revisited every five years because too many aspects are involved in proper NCD management, including drugs, the health system’s efficiency and people’s behaviour. The rate of adherence to medication amongst the population, how well the system follows up patients and the rate at which complications develop in patients are factors that determine the success of an NCD control programme,” points out K. Vijayakumar, former Professor of Community Medicine, Government Medical College, Thiruvananthapuram.
“It should be the health system’s responsibility to follow up a diabetes/hypertension patient and ensure that he does not end up requiring maintenance dialysis, which is expensive and which affects the quality of life of a patient and the family. We are talking about 20%-30% of the State’s population who might go into renal complications and I feel that the system has not been addressing this seriously,” Dr. Vijayakumar says. Proper dissemination and acceptance of the protocol among treating physicians is also important for it to be effective, he adds.
A 2017 study done by Achutha Menon Centre for Health Science Studies among a representative sample of 12,000 persons in Kerala had reported that even among the educated, only 13% of those diagnosed with hypertension and 16% of those with diabetes had achieved adequate BP/blood sugar controls.
The latest IHCI data, however, shows that 42% of those with hypertension in the State have managed to keep their blood pressure under control. But for diabetes, the system has not been able to evaluate the control rates, Dr. Gopal says.
Data gaps and the urgency for systemic reform
Even though the Health department has been collecting prevalence data of diabetes and hypertension in the State’s population at even ward-level, no data analysis has yet been done to ascertain what proportion of the population with diabetes/hypertension has been developing complications or the proportion of population with pre-diabetes/pre-hypertension who are going over to the other side.
Arriving at this conversion rate could help ascertain the efficacy of the current NCD protocol.
Published – April 16, 2025 07:19 pm IST