courstey  TOI MARCH 20
Indian docs oppose new diabetes norms
Mumbai: A new set of global guidelines on managing diabetes that aim to replace those followed for over three decades has stirred up a row within the medical community.

Doctors in India feel the norms, which recommend relaxing blood sugar targets, will not only lead to serious complications in diabetics but also confusion in treatment protocol. They advise that these should be ignored for Indians.

The controversial norm relates to relaxing the long-term blood sugar target, hemoglobin A1C (HbA1c) which, via a blood test, gives an estimate of a person’s blood sugar level average over the past few months. Generally, an HbA1c of 6.5% indicates diabetes.

‘Can’t apply Western med norms to Indians’

American College of Physicians (ACP), an organisation of internal medicine physicians, recently recommended in the medical journal, Annals of Internal Medicine, that clinicians should aim to achieve an HbA1c level between 7% and 8% in most patients with type 2 diabetes as against the traditional 6.5 to 7%. The recommendation is leading to a conflict amongst doctors, with some opposing it. Doctors here say the guideline of lowering the blood sugar target should be ignored as diabetes in India is more aggressive, and riddled with complications. They add India has its own advisory bodies—the ICMR (Indian Council of Medical Research), RSDDI (Research Society For The Study of Diabetes in India) and API (Association of Physicians of India)—which are more tuned in to Indian cases.

There were over 72 million cases of diabetes in India in 2017, according to International Diabetes Federation. Anoop Misra, chairman of Delhi-based Fortis-C-DOC (Centre of Excellence For Diabetes, Metabolic Diseases and Endocrinology), said, “Indian physicians continue to follow US-based guidelines, hence ACP guidelines may have substantial impact here. 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.”

Others concur the guidelines cannot be standardized because of differences in lifestyle, physiology and food habits. Dr Shashank Joshi, endocrinologist and diabetologist who consults at Mumbai’s Lilavati Hospital, said, “Asian Indians who develop diabetes are insulin-resistant and have different phenotype (observable physiological properties, or behavior) compared to those in the western world. None of North American or European guidance are applicable for Indians or Asian geographies.” Also, since Asians consume more carbohydrates, their response to medicines is different.

Says Dr Rajeev Chawla, president-elect of RSSDI 2018 and senior consultant diabetologist, “Pharmacotherapy using oral or injectable agents may be used in addition to lifestyle modification to achieve a target glycosylated hemoglobinof less than 7% for diabetics as far as possible to prevent complications.