Prevalence, awareness, treatment, and control of diabetes in India: a nationally representative survey of adults aged 45 years and older.

BACKGROUND India is a country of 1·4 billion people that contributes to much of the global diabetes burden. Updated evidence on the state of the diabetes epidemic among middle-aged and older adults is imperative given that the risk of diabetes increases with age and that clinical and public health interventions can prevent diabetes complications. We aimed to estimate the prevalence, awareness, treatment, and control of diabetes in a nationally representative and state-representative sample of Indians aged 45 years and older. METHODS We conducted a cross-sectional, nationally representative survey of adults in India aged 45 years and older and their spouses from 2017 to 2019. Our sample included 57 810 individuals and their spouses from 36 states and union territories, reflecting a representative sample of India as a nation and of each state and union territory. Participants had available data on glycated haemoglobin (HbA1c) measurement and non-missing information on diabetes diagnosis, household economic status, and BMI. Spouses younger than 45 years were excluded from the analysis. Our primary outcomes were diabetes prevalence and health service indicators recommended by WHO. Diabetes prevalence was defined as individuals self-reporting a previous diabetes diagnosis or having HbA1c of 6·5% or higher. Available data did not allow the identification of type 1 versus type 2 diabetes. Diabetes health service indicators were based on four core metrics recommended by WHO: (1) proportion diagnosed out of all individuals with diabetes (awareness) and, out of individuals with diagnosed diabetes, (2) proportion with glycaemic control (measured HbA1c <7·0%), (3) proportion with blood pressure control (measured blood pressure <140/90 mm Hg), and (4) proportion self-reporting use of lipid-lowering medications. Outcomes were assessed in the national sample; by state and union territory; and across individual-level characteristics of age, sex, rural versus urban area of residence, education, economic status, and BMI. FINDINGS Diabetes prevalence among adults aged 45 years and older in India was 19·8% (95% CI 19·4-20·2), which amounted to 50·4 million people (49·4-51·4). Prevalence among men and women was similar (men, 19·6% [95% CI 19·0-20·2] and women, 20·1% [19·5-20·6]). Urban diabetes prevalence (30·0% [95% CI 29·1-30·8]) was approximately twice as high as rural prevalence (15·0% [14·6-15·5]). States with higher levels of economic development tended to have greater age-standardised prevalence (standardised regression coefficient for gross domestic product per capita 0·65 [95% CI 0·45-0·85]). Overall, 60·1% (59·0-61·2) of individuals were aware of their diabetes. Of individuals with diagnosed diabetes, 45·7% (44·3-47·2) achieved glycaemic control, 58·9% (57·5-60·4) achieved blood pressure control, and 6·4% (5·8-7·2) were taking a lipid-lowering medication. INTERPRETATION Our findings emphasise the urgent need to scale up policies to better prevent, detect, manage, and control diabetes among middle-aged and older adults in India. FUNDING US National Institute on Aging; Ministry of Health and Family Welfare, Government of India.