Courses/ Training >> Fellowship in Diabetes

  • Introduction

    Diabetes Mellitus (DM) is a common endocrine disorder that inflicts a large segment of the population the world over. With changes in lifestyle inclusive of dietary changes, alteration in physical activity and other exogenous factors it has reached epidemic proportions over the last two decades. The problem in India cannot be understated, as most epidemiological studies show an exponential increase in the prevalence of the disease to 11-19% in urban areas, and 4-10% in rural areas above the age of 30years.

    Type 2 diabetes is also becoming a major problem with the negative changes in lifestyle. The management of diabetes mellitus involves proper diet control, exercise, medications and lifestyle modification. Like most chronic disorders, if the patient understands the underlying disorder, it’s associated complications and proper handling of medications- glycaemic control and prevention of associated complications are improved.

    The number of doctors available to treat the disorder is limited, in most undergraduate and postgraduate set ups in India, the focus on handling diabetes and other non-communicable disorders which are metabolically related are not adequately emphasized. Besides regular clinical work, the scope for laboratory and clinical research in the area of diabetes is also large.

    We propose the introduction of a holistic course which enables both graduates and post graduates to adequately train and equip themselves to handle diabetes mellitus.

    Basic Foundational Degree: MD general medicine.
    2 candidates per year

    Post Doctoral Fellow
    2 candidates per year

  • Course Description

    Duration: 1 year for post-MD general Medicine

  • Background, Philosophy, and Infrastructure

    The department of Endocrinology, Diabetes and Metabolism Christian Medical College Vellore has intensified it’s activities in clinical spheres, training and Research for the past 8 years and is now considered to be one of the key leaders in Training and Research in diabetes in India. There has been in service training with theoretical lectures, hands on experience with patients, device training involving glucometers, insulin pumps and continuous glucose monitoring systems.

    At present there is no formal training course with any medical council of India certificate for clinical diabetes in India. However, the department of endocrinology has been training endocrinology registrars and diabetes nurse educators for the last 7 years .

    Diabetes being as common as it is cannot be the sole management domain of endocrinologists. There are more than 45 million subjects with diabetes expected to increase to 80 million by 2025, which is more than the regular general physician can handle.

    The clinical sphere, management tools and research areas have grown to a large extent. Thus the role for a sub-specialist in diabetes to handle this large volume of patients is necessary, moreover at the central level this is being mooted as a possibility, and an MCI recognized course is in the offing. This course is meant to be intensive and cover the rudiments of diabetes and focus on the developing the clinical abilities of the trainees and research skills, and develop a perspective of handling diabetes from bench to bedside in any setting.

    In addition, the World Diabetes Foundation had given Christian Medical College Vellore the opportunity to start short courses for doctors and educators for more than 100 hospitals across India, where by the training programme has evolved and course material and a book have been developed. The Copenhagen project has given the department the opportunity to develop basic science research facilities with regards to energy expenditure and clamps studies

    The department has conducted 25 clinical trials in diabetes, which include phase 2 and phase 3 trials and has several personal qualified in good clinical practice and technical expertise in conducting trials. 

    The integrated diabetes clinic and the endocrine outpatients see around 25,000 diabetes patients per year. The back up of the clinical biochemistry laboratory, surgical departments, the diabetes nurse educators, dieticians and PMR are excellent and give support services and training expertise in handling diabetes.

    It is necessary that specialized full-time doctors to handle diabetes and the team with an academic qualification be inducted into the system thereby enhancing the integrated management of diabetes mellitus in secondary and tertiary care systems across the country.

  • Organization of the course

    Distribution of the course in weeks
    Orientation: 1 week = 45 hours
    Journal Clubs and Seminars: 6 weeks = 180 hours
    Thesis Project: 2 weeks = 90 hours
    Clinical experience: 38 weeks
    i) Outpatient and Ward 27 weeks = 1220 hours
    ii) Clinical Trials 5 weeks= 225 hours
    iii) Outreach diabetes programmes 1 week = 45hours
    iv) Advanced device training 2 weeks = 90 hours
    v) Teaching and lectures 1 week = 45 hours
    vi) Clamp studies and Basic science work 4 weeks = 180 hours
    vii) Biochemistry laboratory 4 weeks = 180 hours
    viii) Artificial limb centre 1 week = 45 hours
    ix) Biostatistics and Epidemiology 4 weeks = 180 hours
    x) Peripheral Hospital 3 weeks = 135 hours
    Total -52 weeks = 2120 hours for post-MD - 1 year
    (4240 hours for post-MBBS) - 2 years
    Number of candidates : 2 per year. 

    Course Objectives

    General

    The candidate should be able to develop a basic understanding of the philosophy, principles and methods of in diabetes management, education and research in diabetes mellitus.

    Specific Objectives

    Clinical skills - Assess and provide management of diabetes with regards to pathogenesis, diet, exercise, medications and device utilization for patients with diabetes mellitus.

    Teaching skills - To be able to teach other paramedical health personnel in the basics of clinical practice in diabetes mellitus.

    Clinical trials - To play the role of a coordinator in clinical trials efficiently.

    Outreach - To develop the capacity to conduct outreach programmes in relation to diabetes

    Hospital infrastructure development - Set up a diabetes clinic and develop basic ward and laboratory infrastructure in a peripheral hospital

    Project design - To develop skills in cost-accounting and project design

    Laboratory skills - To handle basic laboratory tests and assess quality control

    Basic science skills - To handle hyperinsulinemic euglycemic clamp studies and energy expenditure studies

    Course Theory Practical
    Diabetes Fundamentals and Education 180 hours 1220 hours
    Clinical Trials 5 hours (GPC Training) 220 hours
    Outreach Programmes   45 hours
    Advanced Device Training 10 hours 80 hours
    Peripheral Hospital   145 hours

    Hours Distribution

    195 hours - Theoretical Training
    1565 hours - Practical Training

    Course Description

    Objectives for Journal Clubs and Seminars (122 Hours)

    • Introduction to Diabetes Mellitus physiology and anatomy of Islet cell Secretion 
    • Glucose Metabolism 
    • Glucose Monitoring Devices - strategies for use and economics 
    • Definition and Classification of Diabetes Mellitus 
    • Type I Diabetes Mellitus and Type II Diabetes Mellitus 
    • Oral Hypoglycaemic Agents-
    • Diet in Diabetes Mellitus Pt-I 
    • Diet with dyslipidemia, renal failure and pancreatic disease. 
    • Physical Examination of a diabetes patient 2 hours 
    • Exercise & Diabetes Mellitus- the physiology 
    • Exercise & Diabetes Mellitus- the clinical aspects
    • Management issues & Hospitality 
    • Peripheral Neuropathy 
    • Insulins & Insulin Therapy 
    • Diabetic Ketoacidosis 
    • Hypoglycaemia 
    • Diabetic Retinopathy 
    • Footwear & foot care 
    • Diabetes Mellitus in Pregnancy 
    • Lifestyle & DM 
    • Diabetic Nephropathy 
    • Diabetes and Hypertension 
    • Diabetes of foot care & Surgery
    • Nursing Care in DM 
    • Cardiovascular Disease in DM 
    • Insulin Administering devices in diabetes 
    • Diabetic Autonomic Neuropathy 
    • Infections in Diabetes Mellitus 
    • Pancreatic Diabetes Mellitus 
    • Secondary Diabetes Mellitus 
    • Smoking and Alcohol in Diabetes 
    • Biostatistics and epidemiology 
    • Clinical Trial Methodology 
    • Insulin Pump usage
    • Continuous Glucose Monitoring Systems 
    • Diabetes in Childhood 
    • MODY 
    • Psychosocial aspects of diabetes 
    • Diabetes in the Elderly 
    • Techniques in financial management and cost-accounting 
    • Diabetes and Lipids 
    • Diabetes Mellitus- International 
    • Epidemiological perspective 
    • Biochemistry of tests in Diabetes Mellitus

    Clinical Work(5 hours/day)

    • Outpatients
    • Wards
  • Clinical Trial Involvement

    A well-rounded diabetes physician should have the ability to be actively involved in clinical trials. The trainees will be intensively coached in data management, Good Clinical Practice (GCP) skills and laboratory basics.

    They will routinely attend the weekly diabetes research group meeting.

    The will need to:-

    • Attend at least one good clinical practice course. 
    • They will be enrolled as one of the site coordinators in at least one phase 2 or phase 3  clinical trial during their course period.

    Other Academic Essentials

    • Insulin Pump and CGMS Trainee Certification
    • Three publications as co-author in indexed journals 
    • Thesis project
    • Peripheral Hospital diabetes clinic organization: during their three week stay  at a peripheral hospital (mission) they will have to develop a diabetes clinic, improve inpatient diabetes practice, train the medical and paramedical staff on  practices in diabetes, improve laboratory quality control and provide rational  and cost-effective stocking of pharmaceutical products in the pharmacy

    Thesis

    The candidate will be expected to develop a prospective clinical study on a specific area in  diabetes mellitus with adequate epidemiological backing. Basic skills in biostatistics should  mastered.

  • Evaluation

    Theoretical and Practical Assessment

    Depending on the lectures that are conducted, periodic multiple choice question tests will be  conducted depending on the schedule of seminars- appropriate tests will be conducted in 
    connection with the seminars.  The marks will be consolidated and tallied for internal assessment.  The results of the tests will be discussed immediately and a tutorial conducted thereby.

    Theory Assessment (End of course)

    Multiple choice assessment [3hours –1 paper]

    Long and short answers assessment [3 hours – 3 papers]

    • Basic Science of Diabetes
    • Clinical and Laboratory Practice in Diabetes
    • Recent Advances in Diabetes

    Clinical Assessment

    A Two full days clinical examination will be conducted at the end of the course Eminent teachers in endocrinology and the diabetes segment will be invited as external Examiners.

    • Three long cases.
    • Three monitoring problem assessments.
    • One foot problem
    • Two Retina Problems
    • Viva on clinical trial and good clinical practice basics.
    • Insulin pump/ CGMS installation / clamp and indirect caloriemetry operations
    • Open Viva
    • Thesis Presentation
    • Peripheral Hospital Project Presentation
    • Laboratory Project Presentation