Indian doctors doubtful about new global norms for diabetes

MUMBAI: A new set of guidelines on how to manage diabetes has started a controversy in the medical community. The new global norms for diabetes aim to replace the ones that have been in place for over three decades.

Practitioners in the Indian medical community feel that the guidelines which propose relaxing blood sugar levels, will not only lead to complications, but will also be a factor that creates confusion. The doctors have advised that these rules be ignored for India.

According to International Diabetes Federation, India recorded over 72 million cases of diabetes in 2017. The new guidelines speak about relaxing the long-term blood sugar target, hemoglobin A1C (HbA1c), which gives an estimate of a person’s blood sugar level over the past few months, with the help of a test.

Usually, an HbA1c of 6.5 per cent implies diabetes. According to American College of Physicians, clinicals should aim to achieve an HbA1c level between 7 per cent and 8 per cent in the cases of type 2 diabetes. This is against the traditional guidelines that state an HbA1c of 6.5 per cent is fine.

The new recommendation is the cause of conflict in the views between physicians and doctors, with a few organizations opposing it entirely.

Indian doctors say that the new global norms for diabetes should not be abided. Diabetes in India is more aggressive compared to other parts of the world, and the guidelines have been laid out by three bodies — ICMR (Indian Council of Medical Research), RSDDI (Research Society for the Study of Diabetes in India) and API (Association of Physicians of India).

Anoop Misra chairman of Delhi-based Fortis-C-DOC (Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology) stated, “In reality, Indian physicians continue to follow US-based guidelines, hence ACP guidelines may have substantial impact in India. If blood sugar control is loosened (as advised by ACP), more patients in India will suffer from complications, the burden of which is already high. We should ignore these, and stick to previous time-tested glycosylated hemoglobin limit of control of 7%.”