• NNEF launched Impact India: 1000 day challenge on 13 November 2018, on the eve of World Diabetes Day to spread awareness on efficient diabetes management
• Programmme objective: to reduce the national average  HbA1c by 1% over three years and work with Government, doctors, diabetes care practitioners, associations and other stakeholders to improve diabetes care  
• It is a unique programme as such a concerted effort has not been attempted before. Despite the best efforts by all stakeholders, diabetes continues to be uncontrolled
• The most important challenge in diabetes care in contemporary times before the nation is appropriate monitoring and optimal control
• Thousands of people living with diabetes reached by qualified clinicians across 153 cities in the country
• Visakhapatnam (South), Kolkata (East), Varanasi (North) and Pune (West) have shown a dip in HbA1c level in the past year

In the run-up to World Diabetes Day, the Novo Nordisk Education Foundation today unveiled the first-year report of their ‘Impact India: 1000-Day Challenge’ programme. The program was launched a year ago, to address the issue of suboptimally controlled diabetes in India. The Year One report was launched in the presence of Mr. Melvin D’Souza, Managing Trustee, Novo Nordisk Education Foundation, Mr. H.E. Freddy Svane, Ambassador of Denmark to India, Prof. Dr. Nikhil Tandon, Professor and Head, Department of Endocrinology and Metabolism, AIIMS, New Delhi and Prof. Dr. A.K. Das, Professor and Head, Department of Endocrinology and Metabolism, Pondicherry Institute of Medical Sciences, Puducherry and Patron of the Impact India programme. The ambition of the programme is to reduce the national average  HbA1c by 1%, which can help reduce the risk of diabetes-related complications significantly in India.

iDCI® (Indian Diabetes Care Index) was introduced in 2018 as part of the programme to improve diabetes care in the country. Based on big data analytics, iDCI® has been providing a real-time view of the average HbA1c in India, a key indicator of the state of diabetes control across select cities.  Under the Impact India programme, digital platforms are being leveraged to partner with practitioners (doctors and paramedics) to evolve and implement an approach to diabetes care appropriate to India. iDCI® is a dynamic tool that not only tracks the status of diabetes care but also helps to increase awareness, motivate and sensitise healthcare professionals (HCPs) and society.

Certain cities have shown a dip in the HbA1c levels. Visakhapatnam in South India, Kolkata in the Eastern region, Varanasi in the North zone and Pune in the Western region are the top cities which have shown a decrease in HbA1c levels.

• Southern regions are doing well in terms of diabetes control. As observed in iDCI®, a reduction in HbA1c over the last year is seen in Visakhapatnam, Ernakulam, Bengaluru and Chennai.
  • Key statistics over 1 year period from Oct 2018 to Sep 2019 –  Visakhapatnam – 9.16 to 8.91 (down by 0.25); Ernakulam – 8.38 to 8.17 (down by 0.21); Bengaluru – 8.45 to 8.39 (down by 0.06); Chennai – 8.33 to 8.25 (down by 0.08)
• Barring Varanasi where the HbA1c levels dipped from 8.50 to 8.45 (down by 0.05) in the 12 month period , majority of the northern Indian cities like Delhi, Lucknow, Chandigarh etc. have seen an increase in HbA1c levels
  • Key statistics over 1 year period from Oct 2018 to Sep 2019- Chandigarh – 7.87 to 7.88 (increase by 0.01), Lucknow 8.25 to 8.45 (increase by 0.02), Delhi – 8.58 to 8.76 (up by 0.18)
• In the Eastern region, Kolkata has shown a dip in the HbA1c levels from 8.26 to 8.02 (down by 0.24) in the 12 month period , while Guwahati has seen an increase from 8.62 to 8.80  in the same period
• Pune in Western India has noted a dip from 8.15 to 8.13 (down by 0.02) in the 12 month period and Mumbai has seen an increase from 8.10 to 8.25 (up by 0.15) in the same period.

*Please refer to Annexure I for methodology and Annexure II for more details on city wise statistics

The annual iDCI® booklet carrying details of the progress made across 19 key cities in the past 12 months, was unveiled by the dignitaries present at the event.

Speaking about the scientific approach, Dr. A.K. Das, Professor and Head, Department of Endocrinology and Metabolism, Pondicherry Institute of Medical Sciences and Patron of the Impact India programme, shared, “Impact India is working towards creating awareness on the ‘Indian Reality’ of diabetes management and is focused on evolving a treatment approach more suitable to India. In Year one, we organised four advisory boards with 60 advisors (IMPACT Leaders) to develop and validate the scientific framework. Once validated, it was shared with 500 doctors (IMPACT Ambassadors) as a part of our train-the-trainer approach and is now being further cascaded. Overall 3311 doctors have been reached through 180 Impact Workshops across 153 cities and towns in India during phase one. We are confident that our efforts will reap encouraging results over the coming years ”.

Details from latest iDCI® data (July to September 2019)

Mr Melvin D’souza, Managing Trustee, Novo Nordisk Education Foundation, said, “At Novo Nordisk, we have been working towards changing diabetes for nearly 100 years. With this new initiative, we have set an ambitious target and hope to see India emerge as a role model in diabetes management. The “Impact India: 1000-Day Challenge” Programme was introduced to address the growing concern of uncontrolled diabetes in India and so far we have been able to reach over 30,000 clinicians and medical practitioners. Cities like Visakhapatnam,  Kolkata, Varanasi and Pune have shown a noticeable dip in HbA1c level in the past year. However, we are confident that in the coming years we will see a similar downward trend across multiple regions.”

Dr Nikhil Tandon, Head of Department of Endocrinology, AIIMS, and Padma Shri Awardee shared, “India has the 2^nd highest population of people living with diabetes in the world with 73 million cases, which are expected to nearly double by 2045. Diabetes control is less than satisfactory with an average HbA1c of 8.9%. Novo Nordisk’s initiative will give diabetes care a major impetus and provide medical practitioners with real-time data that can help  understand and evaluate the areas of improvement and work accordingly in a systematic manner. The goal of 1% reduction in HbA1c  as observed from landmark trials in type 2 diabetes is estimated to reduce the risk of stroke by 12%,  heart attack by 14%, diabetic eye disease by 31%, diabetic kidney disease by 33% and diabetic limb disease by 43% in people affected by diabetes. This will not only improve India’s healthcare status but also mitigate costly complications like heart attacks, kidney failure, blindness, etc.”

H.E. Freddy Svane, Ambassador of Denmark to India, mentioned, “While there are numerous health issues that the world is battling with, diabetes is one of the most concerning ones as it is progressive in nature. Novo Nordisk Education Foundation has done praiseworthy work in the field of diabetes awareness since its entry into India. The Impact India 1000 day challenge is one such unique initiative to improve the status of diabetes care in a systematic way.  I congratulate all partners who have contributed towards effective initiation of this programme across India and wish the team a great success for the coming years.”

The IMPACT India programme will continue its three-pronged approach over the next two years, by evolving interactions with healthcare practitioners (HCPs), societal/patient focus and monitoring. The journey of HCPs participating in the IMPACT India programme will expand into experience sharing forums. Moreover, partnering with governments through the public-private partnership model will help in creating the right interaction platforms with HCPs.

To maximise reach in a diverse country like India, the NNEF is exploring the possibility of customised/regional forums and will continue to leverage occasions such as World Diabetes Day, Insulin appreciation Day, etc. Government and influencer endorsement are the pivot points of the programme and are  being actively pursued.

On the monitoring front, Novo Nordisk Education Foundation expects the macro and micro- monitoring tools to generate relevant insights that will be communicated and used to improve the situation. These learnings will help the medical fraternity to improve control and enhance the quality of life for people living with diabetes.