Diabetes Control Program

Program Overview - Sweet Stats Scope

• NPCDCS (National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke): Launched 2010.
• Scope: Integrates NCD prevention & control across primary, secondary, tertiary healthcare.
• Key Aims (Diabetes):
  • Prevent & control through lifestyle modification & awareness.
  • Early diagnosis via opportunistic screening (age >30 years or high-risk).
  • Ensure access to affordable treatment & follow-up.
  • Reduce complications & premature mortality.
• India's Burden: Estimated 77 million adults with diabetes (IDF 2021); significant undiagnosed cases.

⭐ India is often referred to as the "diabetes capital of the world".

Objectives & Targets - Aiming for Glycemic Goals

• Overall Goal: Halt rise of diabetes & obesity; reduce premature NCD mortality.
• Core Objectives & Targets:
  • Early Detection: ↑ Screen adults >30 years for diabetes & hypertension.
  • Glycemic Management:
    • Target HbA1c <7% for most.
    • Individualize (e.g., <6.5% young, <8% elderly/comorbid).
  • Co-morbidity Control:
    • BP: <140/90 mmHg (or <130/80 mmHg high-risk).
    • Lipids: LDL-C targets based on risk.
  • Complication Reduction: ↓ incidence of retinopathy, nephropathy, foot ulcers.

⭐ Key target: Reduce premature mortality from NCDs by 25% by 2025.

Strategies & Interventions - The Action Arsenal

• Screening (NPCDCS):
  • Opportunistic: Age >30 yrs or high-risk (family hx, GDM, obesity, HTN).
  • IDRS: Score >60 = high risk.
  • Diagnosis: FPG ≥126 mg/dL; 2-hr PG (75g OGTT) ≥200 mg/dL; HbA1c ≥6.5%.
• Interventions:
  • Lifestyle Modification: Diet, physical activity, weight management.
  • IEC: Awareness on prevention, self-care.
  • Medical management & regular follow-up.
• Referral Pathway:

![NPCDCS patient workflow and referral system](https://ylbwdadhbcjolwylidja.supabase.co/storage/v1/object/public/notes/L1/Community_Medicine_Non-Communicable_Diseases_Diabetes_Control_Program/10bec4ad-4032-4be8-84cd-febda09a8e8d.png)

⭐ Opportunistic screening for diabetes (individuals >30 years) is key under NPCDCS at PHC/CHC.

Levels of Prevention - Stop Sweet Trouble

Monitoring & Challenges - Tracking & Tackling

• Key Indicators: HbA1c, FBG/PPBG, complication rates (retinopathy, nephropathy), screening coverage.
• Reporting: HMIS, NCD portal, national surveys (e.g., NFHS).
• Common Challenges:
  • Funding gaps & resource constraints.
  • Manpower shortage (trained personnel).
  • Poor patient adherence (treatment, lifestyle).
  • Low awareness & limited access to care.
• Future Directions: Strengthen PHCs, mHealth, task-sharing, community engagement.

⭐ Integration with Ayushman Bharat - Health and Wellness Centres (AB-HWCs) is a key recent development for strengthening NCD care.

High‑Yield Points - ⚡ Biggest Takeaways

• NPCDCS (National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases & Stroke) is the pivotal Indian program addressing diabetes control.
• Key strategy: opportunistic screening for individuals aged >30 years at health facilities.
• Prioritizes early diagnosis, appropriate management, and timely referral of complications.
• Strongly emphasizes health promotion for healthy diets and lifestyle modification to prevent and manage diabetes.
• Includes capacity building of healthcare providers at all levels for comprehensive diabetes care.
• Aims for integration with primary healthcare services, notably through Health and Wellness Centers (HWCs) for wider reach.
• Focus on reducing morbidity and mortality due to diabetes and its complications through these interventions.