Globally 400 million people have diabetes, prevalence of diabetes in India is 2-3 times of reported prevalence in Western world (Bragg et al., 2016) (Goyal & Yusuf, 2006). According to WHO 2000 and Global burden of disease study, Indians would be the most affected for cardiovascular disease (CVD) as well highest for coronary artery disease (CAD) burden in the world (Nag & Ghosh, 2013) (Mohan, Venkatraman, & Pradeepa, 2010). In India, diabetes is becoming pandemic and CAD are becoming epidemic (Gupta, Mohan, & Narula, 2016) (Mohan et al., 2010) .CAD is one of the principal cause of death and disability in diabetes patients as well leads to premature deaths, affects quality of life, leads to individual /economic burdens, decreases work productivity and increases the medical care costs (Low Wang, Hess, Hiatt, & Goldfine, 2016). So, CAD is one of the leading causes of Disability –Adjusted Life Years (DALY) as a result of premature death/disability and also leads to economic burdens (Moradi et al., 2017).
By 2025, diabetes is expected to triple in India and developing nations would contribute to more than 75% of global diabetes burden (Mohan et al., 2010) (Goyal & Yusuf, 2006). In low and middle- income countries, over 80% of deaths and 85% of disability is a result of CVD and Indian subcontinent has the highest burden of cardiovascular disease (CVD) in the world. It’s also noted that CAD manifests 10 years earlier in Indian subcontinent as compared to the rest of the world (Goyal & Yusuf, 2006).Diabetes and CAD share several risk factors in common, so increase in prevalence of diabetes is indirectly escalating the risk of CAD. It’s noted that diabetes is associated with two- fold increase in risk of CAD and CAD is seen 2-3 decades earlier in diabetic patient as compared to non-diabetics(Bragg et al., 2016)(Mohan et al., 2010). It’s also noted that life expectancy with diabetes is nearly reduced by 8 years and CAD is associated with 80% of all deaths and 75% of hospitalization in diabetes patients (Goyal & Yusuf, 2006). In India ,52% of CAD deaths occur under 70 years of age as compared to 23% in the western world (Goyal & Yusuf, 2006)(Nag & Ghosh, 2013). So India suffers tremendous loss of productive working years due to CAD deaths alone. It is estimated about 9.2 million productive years of life lost in 2000 and it is expected to rise to 17.9 million years by 2030 which is ten times the projected loss of productive life in United States by CAD alone (Goyal & Yusuf, 2006).
Diabetes with CAD is more likely to develop complications leading to poor health related quality of life (HRQL). So management of diabetes with CAD should be both objective and subjective so as to improve HRQL (Harvey V. Thommasen, 2006). It is seen that mortality due to CAD is declining in developed world as compared to developing world, so it calls for appropriate action (Gupta et al., 2016). Consequences associated have affect on quality of life, has effect on the economy of the individual (Shah & Deshpande, 2014). In India CAD is projected to have considerable economic loss and there is increase of productive years of life lost to be twofold more by 2030 as compared to 2004 (Shah & Deshpande, 2014).In recent years advances in treatment have improved morbidity and mortality associated with CAD. Despite optimal management, outcomes for patients with both remain very poor. So, it’s important to evaluate the DALY & QALY for patients with type 2diabetes with newly diagnosed CAD with different treatment modalities, as in India entire cost of treatment and burden is borne by the individual.
Method and design:
A cohort study will be conducted at KMC hospital, for a period of 4 years. Participants will be those with type 2 diabetes with newly diagnosed CAD and followed for a period of 1-2 years. Participants who had at least one of the procedures as a treatment for CAD will be excluded. Study will be conducted using a proforma; basic investigations will be done at admission. Data would be managed on Microsoft excel and would use SPSS version 15 to analyze the data. Health and quality of life related indices (DALY & QALY) will be measured.
This study will act as a benchmark for caregivers, administrators, providers and policymakers to decide on the optimal treatment plan in administering the routine treatment plan. It also optimizes health resources to provide quality healthcare to a large population with the available resources.