1. 8_84
Apollo Sugar Clinic: Clinical Outcomes Micro vascular complication: Diabetic Nephropathy
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Healthcare outcomes delivery is what we assure
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2. What is our integrated care model?
A patient centric model to deliver condition management – brick and mortar and remote
Self- discipline achieved by Sugar education and Awareness S M A R T
Monitoring and Medication : SMBG, Acceptance and Compliance
Adherence: Diet, exercise and life style modification
Rx compliance and regular BS monitoring
Technology & Training: Constant connect, 2-way engagement, and training
We are empowering patients with VIDEOCONSULTATION FACILITY to have easy access and reach-out to Doctors and care team at their convenient time through Apollo Sugar App
Apollo Sugar holds the Proprietary right for the content presented. Data or Insights can neither be published nor reproduced without permission from Apollo Sugar

3. Our Typical Patient Pathway
Reception
Meet and greet
Registration (UHID issued)
Pre-Doc
Vitals
EMR Recording
Completion of Investigations
Doctor Consultation
All patient data and interactions on EMR throughout pathway
Contact Centre / Online
Expert Diabetes Management Call Centre – for both patient appointment booking and post sales patient engagement
Online and Offline support through Health coach Video-consultations through Sugar App
Patient Apollo Sugar
Diabetes Educator
Insulin Training
Exercise
Stress
Lifestyle
Dietician
Nutritional Assessment
Counselling
Patient Take-aways
Fully synched Mobile App
Diet Prescription
Contact Centre/Health Coach
UHID, Patient file with all test results, Rx, holistic treatment plan
Apollo Sugar holds the Proprietary right for the content presented. Data or Insights can neither be published nor reproduced without permission from Apollo Sugar

4. Sugar 360: A Full Scale Annual Program
Day 1
Day 90
Day 180
Day 360
Day 270
Glucose profile
Lipid profile
Kidney profile
Heart profile
Eye and Foot exam
BP Screening
Doctor consults*
CDE session
Doctor consults
Outcomes
Consultations
Diagnostics
Beyond the Clinic Services:
Sugar App with personalized Health coach with typically CDE-patient interactions/month
Personalized patient education materials (based on risk stratification, treatment plan)
Connected devices and apps (Video consult available)
24 annual calls w/ Diabetes CDE staffed call centre: Assess longitudinally with QoL questionnaire
Pharmacy benefits personalized SMSs personalized, algorithmically driven app notifications per year
Comprehensive, multi-disciplinary, integrated care approach
10 in person touchpoints, >100 beyond the clinic touchpoints
Silver, Gold, Platinum for differentiated services. Similar programs for GDM
Approx 18,000 patients enrolled in programs
Apollo Sugar holds the Proprietary right for the content presented. Data or Insights can neither be published nor reproduced without permission from Apollo Sugar

5. Our Population Health Outcomes
87% patients have been well managed by Sugar care teams to achieve better health outcomes and quality of life
41% are at targets of HbA1c and 36% achieved/improved as per physician set targets
15% who are deranged(>9%) initially, around 13% were improved or reached targets To
From
Deranged
Improved
At targets
(>9%)
15% 9% 4%
Improved (as per physician definition) 7%
21%
13%
(<7%) 1% 6%
24%
HbA1c deranged
(~23%)
Patients enrolled in Sugar Diabetes Management Program achieved:
Superior outcomes in terms of HbA1c reduction
All the patients enrolled in DMPs were under control and at targets for total Cholesterol per ADA guidelines
All the female patients enrolled in DMP were at control for Triglycerides and there is a meaningful reduction in triglycerides level in Male patients
Showcases the 360 degree approach provided by Sugar which is not only limited to HbA1C management
HbA1c control
Improved and at targets
(~77%)
Note: At targets: <7%; Improved: >7-<9%; Deranged: >9%
Apollo Sugar holds the Proprietary right for the content presented. Data or Insights can neither be published nor reproduced without permission from Apollo Sugar

6. Diabetes Nephropathy
Diabetic nephropathy is a chronic loss of renal function in patients with uncontrolled Diabetes mellitus.
Global burden of Diabetic nephropathy
Diabetic nephropathy is the most frequent cause chronic kidney disease and consequently End stage renal disease.
In the past 10 years, there is a 150% increase in Diabetic nephropathy cases reported.
Patients with Diabetic nephropathy have high risk of cardiovascular disease.
Diabetic patients with End stage renal disease have higher mortality rate than non-diabetic patients.
Apollo Sugar holds the Proprietary right for the content presented. Data or Insights can neither be published nor reproduced without permission from Apollo Sugar

7. Risk factor for developing Diabetic Nephropathy
Poor control of blood glucose
Long duration of diabetes
Presence of other diabetic complication
Ethnicity (Asian, Pima Indians)
Pre-existing hypertension
Family h/o diabetic nephropathy
Family h/o hypertension
Apollo Sugar holds the Proprietary right for the content presented. Data or Insights can neither be published nor reproduced without permission from Apollo Sugar

8. Microvascular and Macrovascular complications in Patients with Diabetic Nephropathy
Microvascular complications:
Retinopathy
Polyneuropathy including autonomic neuropathy
(gastro paresis, diarrhoea/constipation, detrusor paresis, painless myocardial ischemia, erectile dysfunction, supine hypertension/orthostatic hypotension)
Macrovascular complications:
Coronary heart disease
Left ventricular hypertrophy
Congestive heart failure
Cerebrovascular complications (stroke)
Mixed complications
Diabetic foot (neuropathic, vascular)
Apollo Sugar holds the Proprietary right for the content presented. Data or Insights can neither be published nor reproduced without permission from Apollo Sugar

9. Stages of Chronic kidney disease
Kidney failure
ESRD
Progression
Decreased GFR
Initiation
Proteinuria
At increased risk
Age, Diabetes, Hypertension
Apollo Sugar holds the Proprietary right for the content presented. Data or Insights can neither be published nor reproduced without permission from Apollo Sugar

10. Clinical outcomes at Apollo Sugar- from Jan 2017
eGFR
Of the total patients screened for diabetic nephropathy, 97.4% had normal eGFR, and 2.6% had decreased eGFR indicating Diabetic nephropathy.
Apollo Sugar holds the Proprietary right for the content presented. Data or Insights can neither be published nor reproduced without permission from Apollo Sugar

11. Clinical outcomes at Apollo Sugar- from Jan 2017
ACR
Of the total patients tested for urine albumin creatine ratio:
34% - Microalbuminuria
2% - Macroalbuminuria.
Apollo Sugar holds the Proprietary right for the content presented. Data or Insights can neither be published nor reproduced without permission from Apollo Sugar

12. Our Research publications on Diabetes and Diabetic nephropathy
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13. Renal Dysfunction in Type 2 Diabetes Mellitus in Community Health Care Clinics in India
Krishna Seshadri and Apollo Sugar Research Group
Objective: The purpose was to assess the prevalence of low GFR (≤60 mg/ml/1.73m2) and albuminuria in T2D patients in a community health care system.
Results:
Of 166 patient’s males and females were 65.7% and 34.3%, respectively with mean (SD) age, GFR and ACR concentration of 50.1 (12.9) years, 91.0±27.8 mg/ml/1.73m2 and 65.1±272.8 mg/g, respectively.
The prevalence of GFR ≤60 (14.5%), micro (20.5%) and macro albuminuria (5.4%) were higher compared to western population.
Patients with GFR ≤60 (25% and 16%) had a greater proportion of patients with ACR ( and >300 mg/g) compared to GFR >60 (19.7% and 3.5%).
However, the correlation between GFR and ACR was not significant (p >0.05).
Microalbuminuria In patients with Low GFR
Conclusion:
To our knowledge in India, the current study is the first to attempt to stratify the CKD risk based on KDIGO guidelines.
The high incidence of low GFR and albuminuria indicate multiple implications in the diabetes care including screening, choice and dose of anti-diabetics and control of hypertension.
Apollo Sugar holds the Proprietary right for the content presented. Data or Insights can neither be published nor reproduced without permission from Apollo Sugar

14. Prevalence of Diabetes Eye Disease and its Correlation with Renal Function in a Chain of Community Clinics in India
Kalpana Dash, Krishna G Seshadri, Apollo Sugar Research Group
Objective: To determine the prevalence of DED and its association with glomerular filtration rate (GFR) in a community clinic population across sugar clinics in India
Results:
A total of 1547 T2D patients were analysed, among these patients diabetes associated eye diseases were observed in 204 (13.1%) patients, their mean (SD) age was 56.7 (10.0) years.
Though not significant DED prevalence was higher among male (122 [59.8%]) patients compared to females (82 [40.2%]) patients.
Further, out of total 1547 T2D patients, GFR was calculated for 443 patients with mean GFR value of 91.2 (30.2) mg/ml/1.73 m2. Of these patients 388 (87.5%) had GFR ≥60 and 55 (12.5%) patients had GFR ≤60
Among 443 patients with GFR calculated, DED was observed in 79 (17.8%) patients, mean (SD) age 55.5 (13.8) years; among them 49 (62%) males and 30 (38%) females.
GFR was significantly lower in patients with DED compared to patients without DED (79.4 vs mg/ml/1.73m2; p=0.000).
Prevalence of DED in patients with GFR ≤60 was higher compared to patients with GFR ≥60 (38% vs. 15%; p=0.000).
Although there was high preponderance of male diabetes patients, there was no specific gender variation with DED prevalence in both GFR ≥60 and ≤60 group patients.
Prevalence of DED in low GFR T2D patients
Conclusion:
The current study is one among the few studies that reported the association of eye disease with low GFR may suggest the presence of DKD in a community, thus, reiterating the significance of early screening for eye complications in community based diabetes practices.
Therefore, implementing these real time clinical observations into clinical decision pathways may improve the quality of health care delivery.
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15. Thank you. Reach us on
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For Queries/ Concerns/Research initiatives, contact: Dr. Vamsi Krishna Kolukula Head- Clinical Excellence, Apollo Sugar Clinics Mail: Contact no:
Apollo Sugar holds the Proprietary right for the content presented. Data or Insights can neither be published nor reproduced without permission from Apollo Sugar
This mail is proprietary of Apollo Sugar Clinics Limited (ASCL) and is solely intended for the use of the addressee(s) only. It may contain privileged or confidential information and should not be circulated or used for any purpose other than for what it is intended. If you have received this message in error, please notify the originator immediately. If you are not the intended recipient, you are notified that; you are strictly prohibited from using, copying, altering, or disclosing the contents of this message. ASCL accepts no responsibility for loss or damage arising from the use of the information; transmitted by this including damage from virus. For any clarifications please