Introduction

Diabetes is one of the fastest-growing health issues globally, and India is at the forefront of this crisis. Often referred to as the “diabetes capital of the world,” India has seen an alarming rise in the number of individuals affected by this chronic condition. According to the International Diabetes Federation, approximately 74 million people in India were living with diabetes in 2021, and this number is expected to continue rising. Managing diabetes requires a multi-faceted approach involving specialized healthcare professionals. However, India’s current healthcare infrastructure, particularly in Tier 2 and Tier 3 cities, is woefully underprepared to tackle this growing epidemic. While Tier 1 cities like Mumbai, Delhi, and Bangalore have relatively better healthcare systems in place, the majority of the Indian population resides in smaller towns and cities, where access to skilled healthcare professionals is often limited.

The Diabetes Epidemic in India

India’s increasing diabetes burden can be attributed to several factors, including urbanization, sedentary lifestyles, unhealthy diets, and genetic predisposition. The rapid shift from traditional to modern lifestyles has led to higher rates of obesity, physical inactivity, and poor dietary habits, all of which are major risk factors for diabetes. Moreover, poor awareness about the disease, delayed diagnosis, and limited access to healthcare further exacerbate the problem, especially in smaller cities and rural areas.

The rise of Type 2 diabetes is not restricted to urban or wealthy populations; it’s increasingly prevalent in rural and semi-urban areas, where healthcare facilities and resources are insufficient to handle the growing number of patients.

Healthcare Workforce Challenges in Tier 2 and Tier 3 Cities

One of the major challenges in combating diabetes in Tier 2 and Tier 3 cities is the lack of specialized healthcare professionals. Cities like Kanpur, Coimbatore, Indore, and Lucknow are home to millions of people, but the availability of endocrinologists, diabetes educators, and dietitians is significantly lower compared to Tier 1 cities. These smaller cities face several challenges:

Lack of Specialized Doctors

While general physicians are available in many Tier 2 and Tier 3 cities, there is a severe shortage of specialists, particularly endocrinologists, who are trained to manage complex cases of diabetes. According to a study, India has fewer than 6,500 endocrinologists for a population exceeding 1.4 billion. Most of these professionals are concentrated in Tier 1 cities, leaving smaller cities underserved. Without specialized care, managing complications related to diabetes, such as neuropathy, nephropathy, and retinopathy, becomes difficult, leading to worsened patient outcomes.

Lack of Diabetes Educators and Counselors

Diabetes management is not solely reliant on doctors. Patient education plays a critical role in managing diabetes effectively. Diabetes educators are trained to teach patients about self-monitoring, insulin administration, dietary changes, and lifestyle modifications. Unfortunately, these educators are scarce in smaller cities, leaving patients unaware of how to properly manage their condition. As a result, poor compliance with treatment protocols is rampant, leading to higher hospital admissions and complications.

Limited Diagnostic Facilities

Effective diabetes management requires regular blood glucose monitoring, HbA1c testing, and other diagnostics. In Tier 2 and Tier 3 cities, diagnostic facilities are often not readily available or may be too expensive for the average patient. Limited access to laboratories and screening tools delays diagnosis and treatment, contributing to the progression of the disease. The healthcare system needs trained lab technicians and affordable diagnostic services to ensure early detection and continuous monitoring.

Growing Burden on General Physicians

In the absence of specialized healthcare professionals, the burden of managing diabetes falls on general physicians (GPs). While GPs can provide basic care, they often lack the advanced training required to handle complex cases of diabetes. For example, managing patients who require insulin therapy, monitoring for organ complications, and adjusting treatment plans based on blood sugar fluctuations are tasks better suited for specialists. Without the availability of endocrinologists and other specialists, GPs are often stretched thin, leading to suboptimal care for diabetes patients in Tier 2 and Tier 3 cities.

Technological Interventions: A Partial Solution

The use of telemedicine and digital health solutions is a growing trend in managing chronic diseases, including diabetes. Teleconsultations with specialists from Tier 1 cities can provide patients in Tier 2 and Tier 3 cities with access to expert care without the need to travel long distances. Platforms such as Practo, 1mg, and Apollo TeleHealth offer remote consultations, prescriptions, and follow-ups. However, while technology can bridge some gaps, it cannot replace the need for in-person care, particularly for patients with complications or those who require frequent hospital visits for diabetic wounds, dialysis, or other conditions.

The Role of Government and Policy in Expanding Healthcare Workforce

To address the shortage of healthcare professionals, particularly in Tier 2 and Tier 3 cities, the Indian government and private healthcare sectors need to implement several initiatives:

  1. Incentivizing Healthcare Professionals to Work in Smaller Cities: Offering financial incentives, loan forgiveness programs, and housing allowances to specialists and healthcare professionals willing to work in underserved areas could attract more talent to these cities.
  2. Expanding Medical Education and Training Programs: Increasing the number of medical colleges, nursing schools, and paramedical training institutes in Tier 2 and Tier 3 cities can help produce a larger healthcare workforce. Additionally, offering specialization courses in endocrinology, diabetes management, and dietetics can help create more experts in the field.
  3. Strengthening Public Health Programs: Public health initiatives focusing on diabetes awareness, prevention, and management should be expanded in smaller cities. Community health workers, nurses, and other health professionals should be trained to provide basic diabetes care and education.
  4. Building More Healthcare Infrastructure: The healthcare infrastructure in Tier 2 and Tier 3 cities must be enhanced with more hospitals, clinics, and diagnostic centers equipped with the latest technologies and staffed with well-trained professionals.

Athar Institute of Health and management studies (AIHMS), a premier healthcare organization based in New Delhi is helping  capacity building of budding medical doctors and  healthcare professionals in effectively managing diabetes by providing value added PG Diploma in Diabetology since 2008 in collaboration with national and international universities. This program equips participants with advanced knowledge in diabetes management, including the latest diagnostic techniques, therapeutic approaches, and preventive strategies. Designed for both general practitioners and specialists, the PGD program emphasizes evidence-based practices, patient-centered care, and lifestyle management, enabling healthcare providers to address the growing diabetes epidemic, especially in underserved regions. Through this specialized training, AIHMS helps bridge the gap in diabetes care by building a more skilled and knowledgeable healthcare workforce.

To summarize, India’s battle against diabetes cannot be won without addressing the healthcare professional shortage in Tier 2 and Tier 3 cities. As the diabetes epidemic continues to grow, the demand for endocrinologists, diabetes specialists,  diabetes educators, and allied healthcare professionals will only increase. A multi-faceted approach, involving continued medical education using evidence based practice  as well know-how of using  technological interventions in day to day patient care is essential to ensure that smaller cities have the healthcare resources necessary to manage diabetes effectively. Without this investment, India risks not only worsening health outcomes for millions of people but also placing an unsustainable burden on its healthcare system.