Skip to main content

Advertisement

SpringerLink
Log in

Diabetes care cascade and their predictors in young and middle-aged population in India: evidence from the National Family Health Survey (2019-21)

  • Research article
  • Published:
Journal of Diabetes & Metabolic Disorders Aims and scope Submit manuscript

Abstract

Purpose

Weak care cascade of diabetes from the time of screening, diagnosis, treatment initiation and attainment of optimal glycemic control is a public health challenge particularly in resource limited settings. We aimed to assess the diabetes care cascade in India and its determinants in the 15–49 age group.

Methods

We conducted a secondary data analysis of the National Family Health Survey (NFHS-5, 2019–2021), a nationally representative cross-sectional survey, including a total of 724,115 women and 101,839 men with mean (SD) age 30.6 (9.9) years.

Results

The prevalence of self-reported Diabetes Mellitus (DM) in the sample was 2.14% (n = 14,116, 95% CI: 2.06, 2.21) of which 55.13% (n = 6990, 95% CI: 53.37, 56.88) were currently undergoing anti-diabetes therapy. The net prevalence of DM including both old and new cases detected on screening was 2.9%. Poor glycemic control was observed in 52.43% (n = 3506, 95% CI: 50.69, 54.16) of patients with DM on anti-diabetes therapy. Patients from the richest wealth quintile (aOR = 5.17, 95% CI: 1.93, 13.84) had significantly higher odds of accessing private health facilities, while female patients with DM were less likely to be on anti-diabetes therapy.

Conclusion

The prevalence of self-reported DM in India has increased from 1.7% (NFHS-4, 2015-16) to 2.1% (NFHS-5, 2019-21) while more than half of existing patients continue to remain undiagnosed. Consequently, diabetes care cascade have major lacunae at every stage from screening to diagnosis, initiation of effective treatment, and achievement of safe blood glucose levels.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Data availability

The NFHS-5 survey data is available free of charge on request from the International Institute of Population Sciences through the DHS program portal https://dhsprogram.com/data/.

References

  1. IDF diabetes atlas- 10th Edition. International Diabetes Federation. ISBN: 978-2-930229-98-0., 2021. https://diabetesatlas.org/atlas/tenth-edition/. Accessed November 30, 2022.

  2. World population ageing 2019. United Nations: Department of Economic and Social Affairs. Population Division., 2020. https://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2019-Highlights.pdf. Accessed November 30, 2022.

  3. Khan MA, Hashim MJ, King JK, Govender RD, Mustafa H, Al Kaabi J. Epidemiology of type 2 diabetes–global burden of disease and forecasted trends. J Epidemiol global health 2020 Mar;10(1):107. https://doi.org/10.2991%2Fjegh.k.191028.001.

  4. World Health Organization. (2020, December 9). The top 10 causes of death. https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death. Accessed November 30, 2022.

  5. Deshpande AD, Harris-Hayes M, Schootman. Epidemiology of diabetes and diabetes-related complications. M Phys Ther. 2008;88:1254–64. https://doi.org/10.2522/ptj.20080020.

    Article  Google Scholar 

  6. Rao SS, Disraeli P, McGregor T. Impaired glucose tolerance and impaired fasting glucose. American family physician. 2004 Apr 15;69(8):1961–8.

  7. Fowler MJ. Microvascular and macrovascular complications of diabetes. Clinical diabetes. 2008 Apr 1;26(2):77–82. https://doi.org/10.2337/diaclin.26.2.77.

  8. Lin X, Xu Y, Pan X, Xu J, Ding Y, Sun X, Song X, Ren Y, Shan PF. Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025. Scientific reports. 2020 Sep 8;10(1):1–1. https://doi.org/10.1038/s41598-020-71908-9.

  9. Kalra S, Saboo B, Sahay R, Khandelwal D, Talwar V, Unnikrishnan AG. The rule of two-thirds in diabetes epidemiology. Indian J Endocrinol Metabol. 2017 Jan;21(1):242. https://doi.org/10.4103/2230-8210.196027.

  10. Mohan V, Shah SN, Joshi SR, Seshiah V, Sahay BK, Banerjee S, Wangnoo SK, Kumar A, Kalra S, Unnikrishnan AG, Sharma SK. Current status of management, control, complications and psychosocial aspects of patients with diabetes in India: results from the DiabCare India 2011 study. Indian J Endocrinol Metabol. 2014 May;18(3):370. https://doi.org/10.4103/2230-8210.129715.

  11. Mathur P, Leburu S, Kulothungan V. Prevalence, awareness, treatment and control of diabetes in India from the countrywide National NCD Monitoring Survey. Front Public Health 2022 Mar 14;10:205. https://doi.org/10.3389/fpubh.2022.748157.

  12. Claypool KT, Chung MK, Deonarine A, Gregg EW, Patel CJ. Characteristics of undiagnosed diabetes in men and women under the age of 50 years in the Indian subcontinent: the National Family Health Survey (NFHS-4)/Demographic Health Survey 2015–2016. BMJ Open Diabetes Research and Care. 2020 Feb 1;8(1):e000965. https://doi.org/10.1136/bmjdrc-2019-000965.

  13. Aschner P, Gagliardino JJ, Ilkova H, Lavalle F, Ramachandran A, Mbanya JC, Shestakova M, Chantelot JM, Chan JC. Persistent poor glycaemic control in individuals with type 2 diabetes in developing countries: 12 years of real-world evidence of the International Diabetes Management Practices Study (IDMPS). Diabetologia. 2020 Apr;63:711–21. https://doi.org/10.1007/s00125-019-05078-3.

  14. Kishore J, Kohli C, Gupta N, Kumar N, Sharma PK. Awareness, practices and treatment seeking behavior of type 2 diabetes mellitus patients in Delhi. Annals of medical and health sciences research. 2015 Jul 24;5(4):266 – 73. https://doi.org/10.4103/2141-9248.160184.

  15. National Programme for Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases & Stroke (NPCDCS). National Health Mission, Ministry of Health and Family Welfare, Government of India. (n.d.). https://nhm.gov.in/index1.php?lang=1&level=2&sublinkid=1048&lid=604.Accessed December 1, 2022.

  16. International Institute for Population Sciences (IIPS) and ICF. National Family Health Survey (NFHS-5), 2019-21: India: volume I. Mumbai: IIPS; 2021.

    Google Scholar 

  17. Health Performance Index, Aayog NITI, National Institution for Transforming India., Government of India. (n.d.). https://social.niti.gov.in/hlt-ranking. Accessed December 1, 2022.

  18. Nagarathna R, Bali P, Anand A, Srivastava V, Patil S, Sharma G, Manasa K, Pannu V, Singh A, Nagendra HR. Prevalence of diabetes and its determinants in the young adults indian population-call for yoga intervention. Front Endocrinol 2020 Dec 11;11:507064. https://doi.org/10.3389/fendo.2020.507064.

  19. Anjana RM, Deepa M, Pradeepa R, Mahanta J, Narain K, Das HK, Adhikari P, Rao PV, Saboo B, Kumar A, Bhansali A. Prevalence of diabetes and prediabetes in 15 states of India: results from the ICMR–INDIAB population-based cross-sectional study. The lancet Diabetes & endocrinology. 2017 Aug 1;5(8):585 – 96. https://doi.org/10.1016/S2213-8587(17)30174-2.

  20. Daniel RA, Mani K, Aggarwal P, Gupta SK. Treatment and control of diabetes in India: A systematic review and meta-analysis. Journal of Primary Care Specialties. 2022 Sep 1;3(3):69. https://doi.org/10.4103/jopcs.jopcs_10_22.

  21. Gyawali B, Hansen MR, Povlsen MB, Neupane D, Andersen PK, McLachlan CS, Sandbæk A, Vaidya A, Kallestrup P. Awareness, prevalence, treatment, and control of type 2 diabetes in a semi-urban area of Nepal: findings from a cross-sectional study conducted as a part of COBIN-D trial. PloS one. 2018 Nov 2;13(11):e0206491. https://doi.org/10.1371/journal.pone.0206491.

  22. Wang Q, Zhang X, Fang L, Guan Q, Guan L, Li Q. Prevalence, awareness, treatment and control of diabetes mellitus among middle-aged and elderly people in a rural Chinese population: A cross-sectional study. PloS one. 2018 Jun 1;13(6):e0198343. https://doi.org/10.1371/journal.pone.0198343.

  23. Khan N, Oldroyd JC, Hossain MB, Islam RM. Awareness, treatment, and control of diabetes in Bangladesh: evidence from the Bangladesh Demographic and Health Survey 2017/18. International Journal of Clinical Practice. 2021 Jul 14;2022. https://doi.org/10.1155/2022/8349160.

  24. Borgharkar SS, Das SS. Real-world evidence of glycemic control among patients with type 2 diabetes mellitus in India: the TIGHT study. BMJ Open Diabetes Research and Care. 2019 Jul 1;7(1):e000654. https://doi.org/10.1136/bmjdrc-2019-000654.

  25. Rakhis Sr SA, AlDuwayhis NM, Aleid N, AlBarrak AN, Aloraini AA. Glycemic control for type 2 diabetes mellitus patients: A systematic review. Cureus. 2022 Jun 21;14(6). https://doi.org/10.7759/cureus.26180.

  26. Ahsan KZ, Iqbal A, Jamil K, Haider MM, Khan SH, Chakraborty N, Streatfield PK. Socioeconomic disparities in diabetes prevalence and management among the adult population in Bangladesh. Plos one 2022 Dec 20;17(12):e0279228. https://doi.org/10.1371/journal.pone.0279228.

  27. Mhlanga D, Hassan A. An investigation of the factors influencing the choice of healthcare facility in South Africa. Int J Res Bus Social Sci. 2022 Jun;5(4):2147–4478. https://doi.org/10.20525/ijrbs.v11i4.1765.

  28. Ranasinghe P, Jayawardena R, Gamage N, Sivanandam N, Misra A. Prevalence and trends of the diabetes epidemic in urban and rural India: A pooled systematic review and meta-analysis of 1.7 million adults. Annals of epidemiology. 2021 Jun 1;58:128 – 48. https://doi.org/10.1016/j.annepidem.2021.02.016.

  29. Basu S, Sharma N. Under-recognised ethical dilemmas of diabetes care in resource-poor settings. Indian J Med Ethics. 2018 Oct;3(4):324–6. https://doi.org/10.20529/IJME.2018.048.

  30. Basu S, Sharma N. Diabetes self-care in primary health facilities in India-challenges and the way forward. World journal of diabetes. 2019 Jun 6;10(6):341. https://doi.org/10.4239/wjd.v10.i6.341.

  31. American Diabetes Association Professional Practice Committee, American Diabetes Association Professional Practice Committee:. 6. Glycemic targets: standards of medical care in diabetes—2022. Diabetes Care. 2022 Jan;45(Supplement_1):S83-96. https://doi.org/10.2337/dc22-S006.

  32. Tandon N, Anjana RM, Mohan V, Kaur T, Afshin A, Ong K, Mukhopadhyay S, Thomas N, Bhatia E, Krishnan A, Mathur P. The increasing burden of diabetes and variations among the states of India: the Global Burden of Disease Study 1990–2016. The Lancet Global Health. 2018 Dec 1;6(12):e1352-62. https://doi.org/10.1016/S2214-109X(18)30387-5.

  33. Thakur JS, Paika R, Singh S. Burden of noncommunicable diseases and implementation challenges of National NCD Programmes in India. medical journal armed forces india. 2020 Jul 1;76(3):261-7. https://doi.org/10.1016/j.mjafi.2020.03.002.

  34. Prenissl J, Jaacks LM, Mohan V, Manne-Goehler J, Davies JI, Awasthi A, Bischops AC, Atun R, Bärnighausen T, Vollmer S, Geldsetzer P. Variation in health system performance for managing diabetes among states in India: a cross-sectional study of individuals aged 15 to 49 years. BMC Med. 2019 Dec;17:1–2. https://doi.org/10.1186/s12916-019-1325-6.

Download references

Acknowledgements

We thank the IIPS for providing access to the datasets and permission to conduct this analysis.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Indian Institute of Public Health – Delhi, Public Health Foundation of India, Plot No 47, Institutional Area, Sector 44, Gurugram, 122002, Haryana, India

    Saurav Basu, Vansh Maheshwari & Mansi Malik

  2. Max Healthcare, Max Multi Speciality Centre, Panchsheel Park, New Delhi, India

    Paras Agarwal

Authors
  1. Saurav Basu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vansh Maheshwari
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mansi Malik
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paras Agarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Design, concepts: SB, PA.

Methodology: SB, VM, MM.

Formal analysis: VM, MM, SB.

Literature review: All authors.

Writing (First Draft): SB, VM.

Writing (Review and Editing): All authors.

Corresponding author

Correspondence to Saurav Basu.

Ethics declarations

Conflict of interest

None.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Basu, S., Maheshwari, V., Malik, M. et al. Diabetes care cascade and their predictors in young and middle-aged population in India: evidence from the National Family Health Survey (2019-21). J Diabetes Metab Disord 22, 1405–1415 (2023). https://doi.org/10.1007/s40200-023-01263-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40200-023-01263-9

Keywords

Search

Navigation