Newer Community Based Newer Community Based Initiatives to Detect Initiatives to Detect

Diabetic Neuropathy, EarlyDiabetic Neuropathy, Early

Madhav OzaMadhav OzaMarketing ManagerMarketing Manager

Nicholas Piramal India Ltd.,Nicholas Piramal India Ltd.,MumbaiMumbai

Early Detection of Diabetic Early 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

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

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 Peopleo Massive task

o Use of innovative/interactive tools (foot mats)- more effective

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

Detecting Diabetic Neuropathy EarlyDetecting Diabetic Neuropathy Early

Selection of Testing method:

VPT

Sensitometer

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

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

Detecting Diabetic Neuropathy EarlyDetecting Diabetic Neuropathy Early

Platform to screen high risk people:

•Started with screening in clinical settings

• Culminated into Community Screening Programs

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

Detecting Diabetic Neuropathy EarlyDetecting Diabetic Neuropathy EarlyCurrent 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%

Detecting Diabetic Neuropathy Early

Patient Screening Data : Feb-Jul’04

Camps Pts Camps Pts Camps Pts Camps Pts Camps Pts Camps Pts Camps PtsNorth 60 35 875 46 874 69 1380 83 1660 95 1900 99 2079 427 8768West 46 46 828 52 1040 60 1260 72 1368 85 1360 80 1360 395 7216East 31 8 132 10 200 15 285 14 280 20 340 25 375 92 1612South 68 68 1292 84 1596 95 2090 110 2200 96 1824 101 2121 554 11123Total 205 157 2792 185 3577 227 4775 274 4932 278 5141 288 5332 1468 28719

Zone TBMsFeb-04 Jul-04 Feb-Jul'04Mar-04 Apr-04 May-04 Jun-04

Close to 29000 Patients Screened

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

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 TotalNorth 60 18 22 34 45 52 42 213West 46 23 29 32 36 35 45 200East 31 5 4 5 10 20 18 62South 68 32 45 50 55 62 62 306Total 205 78 100 121 146 169 167 781

Zone TBMsNew Clinical Practitioners

Close to 800 New Doctors Participation

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

Challenges…Challenges…

Early Detection of Neuropathy

Early Detection of Diabetes

Detecting Diabetes & Neuropathy EarlyDetecting Diabetes & Neuropathy Early

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

Thank YouLet Every One Be Aware