Photo by Curt Carnemark/World Bank
There are over 50 million diabetics in India alone,
making it the country with the highest burden of
diabetes worldwide. Government awareness of the
problem has increased, thanks in part to a
Fogarty-funded research training program.
By Steve Goldstein
The line stretching forever outside a local Sri Lankan health ministry office was filled with anxious mothers and sick babies. These infectious disease cases garnered attention from health officials, despite the piles of death certificates atop their desks attesting to a growing toll from noncommunicable diseases such as diabetes, cancer and heart disease.
This scene greeted Fogarty grantee Dr. Dale Williams, who visited the region as part of a WHO delegation in the 1980s to assess awareness of noncommunicable diseases. "We couldn't get any traction at the time to get people to think about NCDs," Williams recalled. "Now, the heartwarming thing about our program in India is their awareness and the aggressive way, for a developing country, they are tackling the issue."
Over the past decade, supported by an International Clinical, Operational and Health Services Research and Training Award from Fogarty, Williams, while working at the University of Alabama-Birmingham (UAB), helped lead a research training program in India to develop a cadre of researchers in clinical, operational, health services and prevention science research focused on NCDs.
Most significantly, the program has given "credibility to the study of NCDs as a career track," said Williams. "I think that is one of those immeasurable things that may be our biggest impact."
As many as 62.4 million people in India have diabetes, with about 77 million diagnosed as pre-diabetics, according to a recent national study by the Indian Council of Medical Research. That makes India the country with the highest burden of diabetes worldwide.
"This is very serious from a population impact standpoint," said Williams, "because people with diabetes have an enhanced risk of other NCDs, including cardiovascular disease. You can prevent a lot of disease and reduce the burden of disease with the right programs, whether its diet or exercise or helping people make the right lifestyle choices."
Collaborating with the Madras Diabetes Research Foundation (MDRF) in Chennai, the program has included short-term training in the United States, a national seminar involving trainees from throughout India, intensive training workshops for selected trainees and workshops, video conferences and special courses for MDRF faculty and staff. In addition to research methodology, trainees are taught data management, sample handling systems and basic science research skills. Together, they've created the Indian NCD Network as a formal entity to provide clinical research training that can support research and prevention programs to combat the diabetes epidemic.
MDRF has evolved into one of the leading diabetes and clinical care institutions in India and the entire South Asia region. The foundation produced over 200 research publications in the past five years, including 49 publications from trainees last year alone. Diverse areas of study include low-cost diagnostics, methods to increase physical activity through community empowerment, parental history of diabetes as a risk factor for adolescents and the risk factors for damaged eyesight due to the disease, among others.
A recent article in the journal Nature on the critical problem of diabetes in India cited 13 references - six of them were from collaborators at MDRF and 10 of the authors had been trainees in the UAB program.
MDRF is also researching the genetic component of diabetes. Although obesity is a risk factor for Indians and westerners, the disease appears at a lower threshold of obesity in India, and diabetic Indians are much more likely to suffer coronary artery disease at a relatively young age.
Fogarty grantee Dr. Viswanathan Mohan, the MDRF director, said "the training provided by Fogarty has helped identify promising young investigators for leadership roles."
Although the primary focus for capacity building is at MDRF, Williams noted that "we're also working with three other institutions that have had workshops and we're developing faculty that will work all over India." He estimated that more than 750 researchers have attended training sessions overall. Two of the faculty attendees were the directors general of the India Council of Medical Research, as well as their deputies.
"So part of our strategy is to make sure they understand the impact of NCDs in India and develop methods to address them," said Williams, now teaching at Florida International University. As evidence of the Indian government's more serious approach, Mohan cited an ongoing national study that focuses on diabetes prevalence and risk factors in both urban and rural areas of India. Mohan also noted a relatively new National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease and Stroke launched by the government of India.
Awareness of diabetes and NCDs in India has come a long way since the 1980s. One of the major accomplishments Williams likes to cite is the impact on community medical students - who are preoccupied by infectious diseases at home - attending the national seminars that often include prominent faculty and Indian government officials.