Diabetes diagnosis, treatment, and control in India: results from a national survey of 1.65 million adults aged 18 years and older, 2019-2021
Year: 2023
Type: preprint
Study design: Observational Study
Abstract: ABSTRACT Importance Diabetes mellitus (DM) is widespread and treatable. Little is known about the diabetes care continuum (diagnosis, treatment, and control) in India, and whether it varies by socio-demographic characteristics and vary at the national, state, and district levels. Objective To estimate the diabetes care continuum among individuals aged 18-98 years old at national, state, and district-levels, and by socio-demographic group. Design Cross-sectional, nationally representative survey Setting 28 states, 8 union territories, and 707 districts of India Participants 1,895,287 approached in the Fifth National Family Health Survey (NFHS-5), 2019-2021 Exposures District, state, urban vs rural residence, age (18-39, 40-64, ≥65 years), sex, household wealth quintile Main Outcomes and Measures Diabetes was defined by self-report or high capillary blood glucose (≥126mg/dL [fasting] or ≥220mg/dL [non-fasting]). Of those with diabetes, we estimated proportions that were diagnosed (self-reported). Among those diagnosed, we reported the proportions treated (self-reported medication use) and proportion controlled (blood glucose <126 [fasting] or ≤180 mg/dL [non-fasting; corresponding to HbA1c≤8%]). We benchmarked findings against the World Health Organization’s Global Diabetes Compact Targets (80% diagnosis, 80% control among those diagnosed). We partitioned the variance in indicators between state and district levels using variance partition coefficients (VPC). Results Among 1,651,176 adult respondents (52.6% female; mean age: 41.6 years) with blood glucose measures, the proportion with diabetes was 6.5% (95%CI: 6.4, 6.6). Among adults with diabetes, 74.2% [73.3, 75.0] were diagnosed. Among those diagnosed, 59.4% [58.1, 60.6] reported taking medication and 65.5% [64.5, 66.4] achieved control. Diagnosis and treatment were higher in urban areas, older age groups, and wealthier households. Of the 707 districts, 34.8% districts met diagnosis target, while 10.7% districts met the control target among those diagnosed. Most of the variability in diabetes diagnosis (VPC:69.9%), treatment (VPC:51.8%), and control (VPC:66.8%) were between districts in a state, and not between states. Conclusions and Relevance Nationally, the diabetes care continuum masks considerable state- and district-level variation, as well as age- and rural-urban disparities. Surveillance at the district-level can guide state health administrators to prioritize interventions and monitor achievement of global targets. KEY POINTS Question How does the diabetes care continuum (diagnosis, treatment, and control) vary by state, district, and sociodemographic groups in India? Findings Nationally, among 1.65 million respondents in the National Family Health Survey of 2019-2021, 74.2% were diagnosed. Among those diagnosed, 59.4% reported taking medication and 65.5% achieved control. Most of the variability in care continuum was within-state, between districts (% variance explained: 51.8-69.9) and not between-states. Higher diagnosis and treatment, but lower control was observed in urban compared to rural areas and older compared to younger and middle age groups. Meaning Considerable differences between states, between districts in a state, for rural adults, and by age imply the need for targeted, decentralized solutions to improve the diabetes care continuum in India.
Source: medRxiv
Institutions: Emory University, Woodruff Health Sciences Center, Madras Diabetes Research Foundation, Dr. Mohan's Diabetes Specialities Centre, Chan Zuckerberg Biohub San Francisco, Stanford University, Heidelberg University, Heidelberg Institute of Global Health, Technical University of Munich, Brigham and Women's Hospital, Harvard University, Leonard Davis Institute of Health Economics, University of Pennsylvania, All India Institute of Medical Sciences
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4319458785