This narrative review summarizes four decades of diabetes care and research work in India, covering capacity building, task-shifting, low-cost care models, telemedicine, mobile screening units, home care, and diabetes heterogeneity research — with the aim of identifying lessons applicable to other low- and middle-income countries (LMICs).
Key strategies proven effective in India include training primary-care doctors in diabetes basics, deploying community health workers and diabetes educators (task-shifting), using mobile vans with lab equipment for rural screening, telemedicine and digital apps for remote care, home care models, and AI-assisted smartphone retinal photography for diabetic retinopathy screening. Research into diabetes heterogeneity (e.g., lean diabetes, MODY, neonatal diabetes subgroups) enabled local, scalable, low-cost precision medicine tools such as the DIANA web-based endotype classifier.
This is a single-author narrative review based largely on the author's own institution's work, introducing potential selection bias. No systematic search strategy or quality appraisal of included studies is described. Generalizability to other LMICs requires local adaptation and is not formally validated.
In resource-limited settings, task-shifting to trained community health workers and diabetes educators — combined with telemedicine and mobile screening units — can extend specialist-level diabetes care to underserved and rural populations. Clinicians in other LMICs can adapt these low-cost, scalable models with local modifications.
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