Diabetes diagnosis, treatment, and control in India: results from a national survey of 1.65 million adults aged 18 years and older, 2019-2021

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.

Urban–Rural Differences in the Prevalence of Diabetes Among Adults in Haryana, India: The ICMR-INDIAB Study (ICMR-INDIAB-18)

“…The higher prevalence of diabetes in Haryana is a cause of concern. Meanwhile, the NFHS-5 estimates the prevalence of diabetes to be around 6.5% (95% CI 6.4-6.6) [25]. The differences in the estimates can be attributed to methodological differences.…”

“…This study was conducted in Haryana during the fourth phase of the ICMR-INDIAB study between December 2018 and July 2019. Haryana is a gateway to North India, which occupies 1.37% of the total geographical area and account for less than 2% (25,351,462) of India's population. It has 22 administrative districts, of which 14 are under the NCR.…”