Dr Sanjiv Agarwal
Founder and Managing Director of Diabetacare

Established with an underlying desire to bridge the gaps in current diabetes management strategies, Diabetacare is a first 24×7 service dedicated to put people with diabetes in regular direct touch with physicians and specialists using mobile technology, enabling an organised diabetes management platform focused on prevention, as well as treatment. Dr Sanjiv Agarwal, Founder and Managing Director of Diabetacare, shares his entrepreneurial journey, healthcare technology platforms and evolving new models in healthcare, in an exclusive interview with T Radhakrishna of Elets News Network (ENN)

Please share how and when your journey started as a medical practitioner.

I got trained as a doctor in Lucknow. In 1990s, I did my MBBS and MD in Internal Medicine from King Georges Medical College, Lucknow. Later I went to the United K i n g d o m (UK) in 1996 after doing Chief Residency for a year and did super speciality in Dermatology in the UK. I have been a consulting dermatologist for National Health Service (NHS) Hospitals, the UK for 20 years now. My association with NHS, the UK still continues.

What has prompted you to grow to be entrepreneur?

I always had interest in developing healthcare technology platforms (HTPs) and building models around it while joining as a consulting dermatologist for NHS Hospitals, the UK. My first venture was teleradiology. It became one of the largest teleradiology service providers in the UK. We won one of the largest contracts ever given out by the Department of Health, the UK in 2007 for providing 24×7 radiology reporting service to NHS Hospitals across the UK. This venture turned out to be a huge success within 6 years of establishment. I exited that business during 2011-12. Later, I developed another platform in dermatology. As part of this, I developed core dermatology services to widen NHS, the UK in partnership with Hertfordshire Community NHS Trust. This set-up was involved services, starting from development of dermatology electronic medical record (EMR) System, staff training and accreditation programme along with setting up of clinical processes and quality initiatives. This venture is still running in NHS Hospitals, Hertfordshire, the UK.

This has marked the beginning of my journey of setting up successful technology-enabled healthcare ventures across the UK and India.

When did you develop interest in diabetes? How different is your approach?

My interest in diabetes started in 2012- 13. I saw the rising problem of diabetes prent all over the world. I saw certain gaps in diabetes and I classify these biggest gaps as Six As.

Awareness:Overall, the awareness of the disease is very bad.

Acceptability: Once people become aware, the acceptability of the disease is also delayed by a few years because people do not accept easily that they are suffering from diabetes.

Access: There is poor access to quality care everywhere. Nowadays people have access to doctors everywhere, who spend 5 minutes each time. However, for a chronic disease like diabetes, which patients are going to have for lifetime, 5 minutes of a doctors time or 25 minutes in a year is not good enough.

Adoption: The adoption rate is low even for people who have seen a doctor.

Adherence: The adherence required to a given advice is not available. This behaviour due to frequent change of lifestyle is very common among people all over the world and this is not unique for India.

Affordability: Last and most important for India is affordability.

These are the six pillars on which the model was devised.

The second step, which I thought through, was putting the processes in place. This exercise is always painful when you are developing the process because it takes a lot of time. However, if you have got processes in place and try to follow it up continuously, then you always emerge as a leader in the end because the chances of faltering and chances of error get reduced.

Personally, I always like to work on the processes. That is the beauty I have learnt in my practice for 20 years at NHS Hospitals, the UK. We looked at current patient care pathway in the country and developed our own patient care pathway. Now, we thought that how can we make both uniform. Making uniform technology is the biggest boon nowadays. You have to adopt technology for uniformity and scalability. These are the two things, which are very important in business.

From uniformity perspective, we have developed Diabetacare technology tools that include a Diabetes EMR System, which is actually a Chronic Disease EMR System, currently catering to diabetes, hypertension, obesity, cardiovascular diseases and whole of cardiometabolic syndrome diseases with clinical decision-making algorithms. We connected a lot of clinic-based devices into it. We have also connected certain home devices into it, such as a glucometer and blood pressure machine, which can send data directly to the EMR.

The innovation that we did in that was that we had partnered with Vodafone to develop an end-to-end connected glucometer. As a result, the glucometer has got a customised Global System for Mobile Communications (GSM) SIM card, which conducts data transmission in a very secured manner, which is important for healthcare. As soon as the patient does reading at home, it sends the data directly to the server. We have also connected certain outputs into the system. Outpoint is being transmitted into a monitoring dashboard so that we can monitor the incoming data, which is being checked by a 24×7 contact centre set-up manned by diabetes experts. Additionally, output is happening at patients app and also on physicians app. We took 2 years to create a suitable technology ecosystem. The technology ecosystem has got critical decision-making algorithms built into it.

That is how I started Diabetacare, a 24×7 diabetes care in 2013. Our approach towards diabetes is very unique.

What is your aim or mission at Diabetacare?

Our aim is to prevent or delay diabetes- related complications to improve quality of life of patients with diabetes. I cannot cure diabetes. I can manage diabetes to delay complications. Some of the leading complications caused by diabetes are blindness, amputation, early cardic arrest and dialysis. If we can prevent anyone going on dialysis machine for 2 years, I am saving him or her Rs 5 lakh per annum and saving his or her family from the hassle of going and coming for dialysis check-ups and saving nation quite a bit. I am passionate about developing the entire disease model. I want to ensure that when a patient walks through our clinic they get accessed by diabetes specialist nurses who are trained through our partner programme from the UK. We have got a permanent trainer from the UK, who is training these people in upscaling their skills from normal nurses or normal educators to diabetes specialist nurses or diabetes specialist educators. We have a robust programme adopted from the UK.

What is your approach for business growth?

Our approach for business growth is partnering with physicians and hospitals. We partner with physicians and hospitals and provide them with components of our service. Today, we have 60+ partners and the number is growing.

For a company just 3 years old, Diabetacare has established quite a strong reputation. You are recognised for both your innovative business model and excellent service delivery. To whom will you give the credit?

I give credit to people, peoples training, processes and technology.

People: Our highly trained staff helps investigate, treat and educate patients. Youll work with diabetes specialist nurses (DSNs), diabetes educators and foot care specialists.

Process: At Diabetacare, our staff screens patients for diabetes-induced or related complications, facilitate necessary intervention and activate 24×7 monitoring of their condition via our Diabetes Management Centre (DMC).

Technology: Patients will have access to our cutting-edge technology platforms, including:

DxNET^TM “ Patient appointment booking and partner clinic management tool

dCare Smart^TM “ Connected smart blood glucose and blood pressure monitoring devices

InTouch^TM Physician App “ Mobile application that lets you manage and monitor patients requiring extra care and attention

Our expert team of doctors, healthcare specialists and scientists are united in our passion to improve diabetes treatment around the world.

Diabetacare is a medtech start- up that helps people manage their diabetes through the use of technology and big data. It provides a diabetes monitoring and care service that has both connected devices, as well as a cloud-based solution which both doctors and patients can access. What is the success model?

As explained above, our people, training, processes and technology are unique. We had our own teething trouble initially. We keep improving our model. We have streamlined our model much more in the last 1 year. I feel our business model is right. Awareness needs to be increased. The main issue in India is the paying mechanism or reimbursements for out patient care. Due to out-of-pocket expenses, people tend to delay treatment. This is too early to say that any model is a successful model because models are evolving now in the last 2 to 3 years. Altogether there are four to five major players whose business models are doing good. Diabetacare is one among them. We were recognised at TechEmerge Health Innovation Summit, which was held in New Delhi on June 15, 2016. Diabetacare was shortlisted out of 350 companies. We are among top 10 to go on stage. It is a big recognition for Diabetacare.

Does diabetes come under health insurance cover?

In India, diabetes does not come under health insurance, but it is available in other countries. It should also be done in India. The Government of India is talking a lot about diabetes in the last 2 years. However, what the Government needs to do is to create a regulation around it under special programmes and make sure that people avail the services.

What according to you is the game changer in diabetes?

As such, clinic-based models exists even in the UK. We have doyens of diabetes as in India (Dr Mohan, Dr Vishwanathan, etc). Their set-ups are really good and in fact, they are better than us compared to what we have got at NHS Hospitals, the UK. Similarly, we tried to do this here in India. But the game changer is not this. Just getting a physical centre in this age where you are asking people to come and travel so frequently you see that fallout will happen. Traffic is increasing so much every day. For a 10-minute appointment, patients have to travel 1 hour or more each time. The model has to be evolved. I feel remote patient monitoring model is a new way forward, which was started in the US.

How technology is helping you in diabetes service management?

Technology is playing a significant role in any given healthcare problem now. With chronic disease, technologys role is much more to play. Today, technology plays 50 per cent of role in treatment while remaining 50 per cent is done by medical practitioners.

How is Britains exit from the European Union going to impact Diabetcares business as a lot of benefits of operating in the European market will be now taken away?

My opinion is that the development should not impact a company like Diabetacare. Overall, the market is volatile. When market is volatile, people will start spending less and government will start spending less. It is very unknown future for next 2 to 3 years. In such a situation, risks are involved and similarly opportunities are available. Our plans for the UK are intact.

What are your future plans?

Today, Diabetacare is operating in India with four company-owned and company-operated experience centres in Bengaluru, Cochin, Hyderabad and Delhi and have many physician and hospital partners across India providing Clinico-Technology Diabetes service. We shall commence our operations within 3 to 6 months in the UK and Middle East.

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