194-OR: Improved Linkage to the Health System and Better Diabetes Control Due to Community-Based m-Health–Enabled Screening and Follow-up in India

Introduction: India faces a huge burden of undiagnosed and uncontrolled diabetes, resulting in a significant challenge to the healthcare system.

Methods: To improve linkage to the primary healthcare system and blood glucose control among diabetics, we conducted a large community-based screening and follow-up study of individuals’ ≥ 30 years led by trained non-physician health workers (NPHWs) enabled with an m-health enabled screening and follow-up system on a tablet device, in rural and urban areas of North and South India. NPHWs collected data using an interviewer-administered questionnaire, measured random capillary blood glucose (RBG) during the screening and follow-up and collected data on health facility visits during subsequent follow-up visits. Diabetes was defined according to standard definitions. NPHWs also provided tailored lifestyle modification education.

Results: 147828 individuals were screened at their homes, of which 53.1% were from rural areas. The mean age of participants was 48.1 (SD ±13.8) years and prevalence of self-reported diabetes was 7.9% (95% CI: 7.8 % - 8.1%). The proportion of diabetics visiting any health facility increased significantly [visit 1: 32.1% (31.2%-32.9% %), visit 4: 52.2% (50.1%-54.3%] between the first and the fourth follow-up visits. There was an increase in proportion of those who had their blood glucose measured at the health facility between the two visits. Overall, there was a decrease in the mean RBG [visit 1: 215.4 (SD:86.6) mg/dl Vs visit 4: 191.5 (SD 63.9) mg/dl. There was a significant increase in proportion of diabetics with controlled blood glucose in the fourth follow-up visit, 59.2% (56.9%-61.5%) as compared to the first visit, 45.2% (43.4%-47.0%).

Conclusion: Our tailored screening and follow-up program indicates that non-physician health worker led m-health enabled screening significantly improved the health service utilization and blood glucose control among diabetics.