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03-03-2020 | Epidemiology | News

Diabetes often goes undiagnosed in India

Author: Anita Chakraverty


medwireNews: An Indian national survey suggests four out of every 10 of its citizens with diabetes may be unaware that they have it.

The results from more than three-quarters of a million Indians aged between 15 and 50 years who were surveyed in 2015–2016 also suggest that almost half of those with undiagnosed diabetes have access to healthcare.

“Given that nearly 45% of these undiagnosed individuals have healthcare access, we posit that providing healthcare access alone to individuals may not be sufficient and/or should be coupled with screening using random glucose tests,” the researchers advise.

They add that younger age groups, people with lower levels of education, and men were particularly vulnerable to having undiagnosed diabetes, as were individuals living in the south of the country.

The findings come from an analysis of women and men participating in the fourth National Family Health Survey/Demographic Health survey, which included people from all 29 states and seven union territories of India.

Nearly two-thirds of those in the cross-sectional survey lived in rural areas, 63% were middle class or higher, and 38% had access to healthcare.

Participants had random blood glucose measurements taken and those with levels of at least 200 mg/dL were provided with a referral form to a health facility for additional medical evaluation. While individuals were not instructed to fast, the survey did ask when they last ate or drank.

The crude prevalence of diabetes for men and women, both self-reported and undiagnosed, was 2.9%.

Self-reported diabetes was identified by 1.7%, while an additional 1.2% of patients answered “no” to having diabetes but when tested had a high glucose or fasting glucose level of at least 200 mg/dL or 126 mg/dL, respectively.

Women had a 28% lower prevalence of undiagnosed diabetes than men and people aged 45 to 49 years had a 26% lower prevalence of undiagnosed diabetes than 15–24-year-olds.

Furthermore, people with higher education had a 17–20% lower prevalence of undiagnosed diabetes than those with no education. Interestingly, among people in the southern states, where there is almost universal access to healthcare, the prevalence of undiagnosed diabetes was 54% higher compared with the central region.

Risk factors together with random glucose tests were able to discriminate individuals with undiagnosed diabetes from those without diabetes, with an area under the curve of 0.978.

“Our findings suggest that access to healthcare should potentially be coupled with routine and rapid low-cost, serendipitous screening of individuals for high glucose levels,” Chirag Patel (Harvard Medical School, Boston, Massachusetts, USA) and colleagues report in BMJ Open Diabetes Research & Care.

“Further refinement of these results to the district level can aid in decision support for individual healthcare providers and tertiary healthcare centers throughout India to determine how and when to screen for diabetes.”

medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature group

BMJ Open Diab Res Care 2020; 8: e000965


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