newer community based initiatives to detect diabetic neuropathy early

1. Newer Community BasedNewer Community Based
Initiatives to Detect DiabeticInitiatives to Detect Diabetic
Neuropathy, EarlyNeuropathy, Early
Madhav OzaMadhav Oza
Marketing ManagerMarketing Manager
Nicholas Piramal India Ltd.,Nicholas Piramal India Ltd.,
MumbaiMumbai

2. Early Detection of DiabeticEarly Detection of Diabetic
Neuropathy ???Neuropathy ???
•Prevention of progression at least can be
instituted through early detection
• Prevention of ulceration, gangrene and
amputation can be instituted
•Delayed diagnosis at a painless stage common
•Prevalence large nearly 60 to 90% as
sophistication of detection increases

3. Detecting Diabetic Neuropathy EarlyDetecting Diabetic Neuropathy Early
Factors influencing early detection:
•Awareness
• Testing method
• Man power
• Platform to attract high risk individuals
• Enthusiasm of health care providers

4. Detecting Diabetic Neuropathy EarlyDetecting Diabetic Neuropathy Early
Awareness:
•Doctors
o Increased substantially due to efforts of DFSI and NNEF
o Demonstrate…how easy is the detection process!!!
•At Risk People
o Massive task
o Use of innovative/interactive tools (foot mats)- more
effective

5. Detecting Diabetic Neuropathy EarlyDetecting Diabetic Neuropathy Early
Selection of Testing method:
•Sensitive enough to quantitate deficit and give broad
range of gradation in deficit scale
• Reproducible
• Affordable (no recurrent costs), Portable
• Widely accepted in field of diabetic polyneuropathy

6. Detecting Diabetic Neuropathy EarlyDetecting Diabetic Neuropathy Early
Selection of Testing method:
VPT
Sensitometer

7. Detecting Diabetic Neuropathy EarlyDetecting Diabetic Neuropathy Early
Man power :
• Leveraging Services of 180 Territory Managers -
Diabetes Business of Nicholas
o Erstwhile Boehringer Mannheim team
o Trained in conducting & reporting neuropathy testing
• Dedicated Task Force of 20 people

9. Detecting Diabetic Neuropathy EarlyDetecting Diabetic Neuropathy Early
Enthusiasm of health care providers:
o Guidance of Dr.Sanjeev Kelkar, Dr.Arun Bal
o Building partnerships with Local Health Care
Team

10. Detecting Diabetic Neuropathy EarlyDetecting Diabetic Neuropathy Early
Platform to screen high risk people:
•Started with screening in clinical settings
• Culminated into Community Screening Programs

14. Detecting Diabetic Neuropathy EarlyDetecting Diabetic Neuropathy Early
Community Screening Programs:
o Participation in Diabetic Exhibitions by Novo Nordisc
Education Foundation
o Community/Charitable Hospitals - Jain/Bohri Muslim hospitals
o State/Central Govt. Employees Hospitals (Railways, Police
force etc.)
o Places of worship – Temples, Mosques
o Corporates – Indian Oil, etc.
o Collaborating with NGO’s

15. Detecting Diabetic Neuropathy EarlyDetecting Diabetic Neuropathy Early
Current Level of Effort:
• 250 in-clinic/community screening programs every month
• Spread across the country involving at least 20 people with
diabetes/program
5000 Patients/Month
Our Experience:
• Average detection rate (VPT > 15 volts): 20%

16. Detecting Diabetic Neuropathy Early
Patient Screening Data : Feb-Jul’04
Camps Pts Camps Pts Camps Pts Camps Pts Camps Pts Camps Pts Camps Pts
North 60 35 875 46 874 69 1380 83 1660 95 1900 99 2079 427 8768
West 46 46 828 52 1040 60 1260 72 1368 85 1360 80 1360 395 7216
East 31 8 132 10 200 15 285 14 280 20 340 25 375 92 1612
South 68 68 1292 84 1596 95 2090 110 2200 96 1824 101 2121 554 11123
Total 205 157 2792 185 3577 227 4775 274 4932 278 5141 288 5332 1468 28719
Zone TBMs
Feb-04 Jul-04 Feb-Jul'04Mar-04 Apr-04 May-04 Jun-04
Close to 29000 Patients Screened

17. PlacePlace DateDate Pt. ScreenedPt. Screened
BangaloreBangalore Feb 2004Feb 2004 650650
TrivendrumTrivendrum 30-1stMay’0430-1stMay’04 680680
HyderabadHyderabad 24-25 July’0424-25 July’04 550550
LucknowLucknow 7-8 Aug’047-8 Aug’04 670670
TotalTotal 25502550
Detecting Diabetic Neuropathy Early
NNEF Diabetic Exhibition

18. Detecting Diabetic Neuropathy Early
Patient Screening Data : Feb-Jul’04
New Doctors’ Coverage Data
Feb-04 Mar-04 Apr-04 May-04 Jun-04 Jul-04 Total
North 60 18 22 34 45 52 42 213
West 46 23 29 32 36 35 45 200
East 31 5 4 5 10 20 18 62
South 68 32 45 50 55 62 62 306
Total 205 78 100 121 146 169 167 781
Zone TBMs
New Clinical Practitioners
Close to 800 New Doctors Participation

19. Challenges…Challenges…
•High risk population – 40 million
people with diabetes
•Early detection of diabetes
•Reaching out to people in district/semi-
district locations
• Reaching out to low socio-economic
strata of urban diabetes population

20. Challenges…Challenges…
Early Detection of Neuropathy

Early Detection of Diabetes

21. Detecting Diabetes & Neuropathy EarlyDetecting Diabetes & Neuropathy Early

22. Detecting Diabetes & Neuropathy EarlyDetecting Diabetes & Neuropathy Early
Massive Detection Drive - Diabetes & Neuropathy
15th
October onwards
• Additional Task Force of 40 people to be positioned in
metros & semi-metros
• Aim to screen 50 people/day - Blood sugar, VPT
Sensitometry testing
• Duration – 3 months

23. Thank You
Let Every One Be Aware