Only 50% of Indians are aware that they are suffering from diabetes

Understanding where adults with diabetes in India are lost in the diabetes care cascade is essential for the design of targeted health interventions and to monitor progress in health system performance for managing diabetes over time

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  • Only half of Indian adults in most productive age group (15-49) are aware about their diabetes state.
  • And just one fourth those diagnosed and treated have blood sugar under control.

In a large-scale population-based study of diabetes care in India published in BMC Medicine, carried out by researchers at the Public Health Foundation of India (PHFI), Harvard T.H. Chan School of Public Health, Madras Diabetes Research Foundation, Heidelberg Institute of Global Health, University of Birmingham and University of Gottingen, findings have shown that proportion of adults with diabetes who are aware treated and achieved control is low.

Researchers have used National Health and Family Survey (NFHS-4, 2015-16) data of 7,29,829 individuals aged 15-49 years, which covered each district of 29 states and 7 union territories of India.

Purpose of the study:

  • This study aimed to determine (i) the proportion of adults with diabetes in India who have reached each step of the care cascade and (ii) the variation of these cascade indicators among states and socio-demographic groups.
  • There are no population-based large scale study from India on the steps for awareness to successful control of diabetes at which people are lost from care.

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Study findings:

  • This large population-based analysis of adults aged 15–49 years found substantial losses of patients at each step of the diabetes care cascade, with the highest proportion (47.5%) being lost to care at the awareness stage
  • This nationally representative study suggests about half of individuals (52.5%) are aware about their diabetic status
  • About 4 in 10 (40.5%) reported currently taking medication
  • About 1 in 4 (24.8%) had their diabetes under control.
  • The study also found adults living in rural areas, men, and those who were poorer and less educated, were even less likely to receive the care they need.
  • While adults with undiagnosed diabetes make up the largest proportion of the state’s population in Goa and Andhra Pradesh, efforts at improving diabetes care should not neglect large states with a low diabetes prevalence (e.g., Uttar Pradesh), which host some of the highest absolute numbers of adults who are unaware of their diabetes and untreated.
  • Only 20.8% of diabetic men and 29.6% of diabetic women aged 15-49 years have their blood sugar under control (i.e., they are taking medications and have a normal blood sugar<126 mg/dL fasting or <200 mg/dL after meal).
  • About half of Indians aged 15-49 years with diabetes are not aware of their hypertension status. Awareness, treatment and control level was lowest in Daman and Diu (5.5%,5.3% and 2.1% respectively) and highest in Meghalaya (69.6%, 60.9% and 53.7% respectively).
  • 30 major states/union territories have blood glucose control rates below 30%.

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Dr Ashish Awasthi, Assistant Professor (INSPIRE Faculty), at PHFI and one of the authors of the study, said, “Diabetes is a growing challenge in India, and a major cause of cardiovascular deaths and renal dysfunction. Considering the co-existence of diabetes and hypertension with poor level of awareness, treatment and control, it is necessary to focus on primary prevention and screening efforts, as a cost-effective strategy to reduce the impact of diabetes on population health in India.”

The study appeared online 13 May 2019 in BMC Medicine.

The study is titled ‘Variation in health system performance for managing diabetes among states in India: a cross-sectional study of individuals aged 15 to 49 years.’