1429-P: Multimorbidity among Adults with Diabetes in India

Introduction: Limited information is available on the burden of multimorbidity among diabetics in India.

Methods: We conducted a cross-sectional study among 12284 adults aged ≥ 30 years, using multistage cluster random sampling, from rural and urban areas of North and South India. Trained interviewers administered a questionnaire to collect data on socio-demographics, lifestyle characteristics and collected blood samples. We defined diabetes, hypertension, and their control as per standard definitions; dyslipidemia as per ATP IV or on treatment; CKD as those on treatment or with urine albumin-creatinine ≥30 mg/g or eGFR <60 ml/min/1.73 m²; central obesity as waist circumference ≥ 90 cm (men) and ≥ 80 cm (women); heart disease and stroke per self-reported physician diagnosis or treatment. Multivariable logistic regression was conducted to determine factors independently associated with multimorbidity.

Results: The age-adjusted prevalence of diabetes was [17.5%, 95% CI (16.9-18.2)], 56.1% (54.5-57.6) were aware and 86.8% (85.3-88.2) were taking antidiabetic treatment. The prevalence of multimorbidity was higher among diabetics [hypertension: 55.1% (53.1-57.2), central obesity: 72.9% (71.0-74.8), dyslipidemia: 74.4% (72.5-76.2), CKD: 8.8% (8.7-8.9), heart disease: 5.5% (4.6-6.5), stroke: 2.0% (1.5-2.9)] compared to nondiabetics [hypertension: 31.1% (30.1-34.7), central obesity: 53.2% (52.5-53.8), dyslipidemia: 51.2% (50.6-51.6), CKD: 5.9% (5.6-6.2), heart disease: 2.2% (2.0-2.4), stroke: 1.1% (1.0-1.2)]. Increasing age, poor education [adjusted odds ratio (aOR): 1.7 (1.1-2.6)], richest [aOR: 2.1 (1.2-3.5)] and urban residents [aOR: 1.5 (1.1-2.0)] were more likely to have at least one multimorbidity. Those taking anti-diabetic treatment were less likely to have multimorbidity [aOR: 0.7 (0.5-0.9)].

Conclusions: High levels of multimorbidity in India warrants implementation of effective health system interventions for integrated management of diabetes and multimorbidity to improve outcomes.