1608-P: Suboptimal Management of Diabetes in India: Findings from a Large Community-Based Study

Over the past few decades diabetes prevalence has rapidly increased across India. However, limited information is available on the levels of awareness, treatment and control, particularly in epidemiologically transitioning communities. We estimated the prevalence, awareness, treatment and control rates of diabetes in a large representative population sample aged ≥ 30 years, selected using a multistage cluster random sampling technique, residing in rural and urban areas of North and South India. Trained interviewers administered a questionnaire to collect data on socio-demographics, lifestyle characteristics and phlebotomists collected venous blood samples to estimate fasting plasma glucose (FPG) and HbA1C. Diabetes was defined as FPG ≥ 126 mg/dl or HbA1C ≥ 6.5% or self-report of physician diagnosis or being on treatment. Participants were considered to be aware of diabetes if they reported a diagnosis or being on treatment. Control was defined as HbA1C < 7%. In total 12243 participants (6208 in North and 6035 in South) were surveyed. The mean (±SD) age was 47.7 (±12.5) years. Women constituted 54%. The age-standardized prevalence of diabetes was 14.2 (95% CI: 13.6 - 14.9), with significant difference between urban (21.4%; 20.4-22.5) and rural (7.5%; 6.8-8.2) areas. Among those with diabetes, the awareness, treatment and control rates were 49.4% (46.6-52.2), 38.6% (35.9-41.3) and 12.6% (10.9-14.5) respectively. Compared to urban residents, rural counterparts were less likely to be aware (35% Vs. 55%), treated (26% Vs. 43%) and controlled (8% Vs. 14%). Similarly, patients in the lowest tertile of wealth index had lower awareness (33% Vs. 55%), treatment (22% Vs. 43%) and control rates (5% Vs. 15%) compared to those in the highest tertile. Despite a high burden, management of diabetes is sub-optimal in India. Health system strengthening to better manage diabetes with a focus on rural residents and the poor is imperative to stem the rising burden and improve diabetes related health outcomes.