A Proposed India-Specific Algorithm for Management of Type 2 Diabetes

Several algorithms and guidelines have been proposed by countries and international professional bodies; however, no recent updated management algorithm is available for Asian Indians. Specifically, algorithms developed and validated in developed nations may not be relevant or applicable to patients in India because of several factors: early age of onset of diabetes, occurrence of diabetes in nonobese and sometimes lean people, differences in the relative contributions of insulin resistance and β-cell dysfunction, marked postprandial glycemia, frequent infections including tuberculosis, low access to healthcare and medications in people of low socioeconomic stratum, ethnic dietary practices (e.g., ingestion of high-carbohydrate diets), and inadequate education regarding hypoglycemia. All these factors should be considered to choose appropriate therapeutic option in this population. The proposed algorithm is simple, suggests less expensive drugs, and tries to provide an effective and comprehensive framework for delivery of diabetes therapy in primary care in India. The proposed guidelines agree with international recommendations in favoring individualization of therapeutic targets as well as modalities of treatment in a flexible manner suitable to the Indian population.