Varghese Jithin Sam, Anjana Ranjit Mohan, Geldsetzer Pascal, Sudharsanan Nikkil, Manne-Goehler Jennifer, Thirumurthy Harsha, Bhattacharyya Soura, Narayan K M Venkat, Mohan Viswanathan, Tandon Nikhil, Ali Mohammed K
Emory Global Diabetes Research Center of Woodruff Health Sciences Center and Emory University, Atlanta, Georgia.
Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia.
JAMA Intern Med. 2023 Jul 31;183(9):963-72. doi: 10.1001/jamainternmed.2023.3070.
Diabetes is widespread and treatable, but little is known about the diabetes care continuum (diagnosis, treatment, and control) in India and how it varies at the national, state, and district levels.
To estimate the adult population levels of diabetes diagnosis, treatment, and control in India at national, state, and district levels and by sociodemographic characteristics.
DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional, nationally representative survey study from 2019 to 2021, adults in India from 28 states, 8 union territories, and 707 districts were surveyed for India's Fifth National Family Health Survey (NFHS-5). The survey team collected data on blood glucose among all adults (18-98 years) who were living in the same household as eligible participants (pregnant or nonpregnant female individuals aged 15-49 years and male individuals aged 15-54 years). The overall sample consisted of 1 895 287 adults. The analytic sample was restricted to those who either self-reported having diabetes or who had a valid measurement of blood glucose.
The exposures in this survey study were district and state residence; urban vs rural residence; age (18-39 years, 40-64 years, or ≥65 years); sex; and household wealth quintile.
Diabetes was defined by self-report or high capillary blood glucose (fasting: ≥126 mg/dL [to convert to mmol/L, multiply by 0.0555]; nonfasting: ≥220 mg/dL). Among respondents who had previously been diagnosed with diabetes, the main outcome was the proportion treated based on self-reported medication use and the proportion controlled (fasting: blood glucose <126 mg/dL; nonfasting: ≤180 mg/dL). The findings were benchmarked against the World Health Organization (WHO) Global Diabetes Compact targets (80% diagnosis; 80% control among those diagnosed). The variance in indicators between and within states was partitioned using variance partition coefficients (VPCs).
Among 1 651 176 adult respondents (mean [SD] age, 41.6 [16.4] years; 867 896 [52.6%] female) with blood glucose measures, the proportion of individuals with diabetes was 6.5% (95% CI, 6.4%-6.6%). Among adults with diabetes, 74.2% (95% CI, 73.3%-75.0%) were diagnosed. Among those diagnosed, 59.4% (95% CI, 58.1%-60.6%) reported taking medication, and 65.5% (95% CI, 64.5%-66.4%) achieved control. Diagnosis and treatment were higher in urban areas, older age groups, and wealthier households. Among those diagnosed in the 707 districts surveyed, 246 (34.8%) districts met the WHO diagnosis target, while 76 (10.7%) districts met the WHO control target. Most of the variability in diabetes diagnosis (VPC, 89.1%), treatment (VPC, 85.9%), and control (VPC, 95.6%) were within states, not between states.
In this survey study, the diabetes care continuum in India is represented by considerable district-level variation, age-related disparities, and rural-urban differences. Surveillance at the district level can guide state health administrators to prioritize interventions and monitor achievement of global targets.
糖尿病广泛存在且可治疗，但对于印度的糖尿病照护连续体（诊断、治疗和控制）以及其在国家、邦和地区层面如何变化，人们知之甚少。
估计印度全国、邦和地区层面以及按社会人口学特征划分的成年人糖尿病诊断、治疗和控制水平。
设计、背景和参与者：在这项2019年至2021年的横断面全国代表性调查研究中，对印度28个邦、8个联邦属地和707个地区的成年人进行了印度第五次全国家庭健康调查（NFHS - 5）。调查团队收集了所有与符合条件的参与者（15 - 49岁的孕妇或非孕妇女性个体以及15 - 54岁的男性个体）同住一户的成年人（18 - 98岁）的血糖数据。总体样本包括1895287名成年人。分析样本仅限于那些自我报告患有糖尿病或有有效血糖测量值的人。
本调查研究中的暴露因素包括地区和邦居住情况；城乡居住情况；年龄（18 - 39岁、40 - 64岁或≥65岁）；性别；以及家庭财富五分位数。
糖尿病通过自我报告或高毛细血管血糖水平来定义（空腹：≥126 mg/dL[换算为mmol/L，乘以0.0555]；非空腹：≥220 mg/dL）。在先前被诊断患有糖尿病的受访者中，主要结局是根据自我报告的用药情况计算的治疗比例以及控制比例（空腹：血糖<126 mg/dL；非空腹：≤180 mg/dL）。研究结果以世界卫生组织（WHO）全球糖尿病契约目标（80%的诊断率；诊断患者中80%的控制率）为基准。使用方差划分系数（VPC）对邦之间和邦内部指标的差异进行划分。
在1651176名有血糖测量值的成年受访者中（平均[标准差]年龄为41.6[16.4]岁；867896名[52.6%]为女性），糖尿病患者的比例为6.5%（95%置信区间，6.4% - 6.6%）。在患有糖尿病的成年人中，74.2%（95%置信区间，73.3% - 75.0%）得到诊断。在那些被诊断出的患者中，59.4%（95%置信区间，58.1% - 60.6%）报告正在服药，65.5%（95%置信区间，64.5% - 66.4%）实现了血糖控制。城市地区、年龄较大的群体和较富裕家庭的诊断和治疗比例更高。在接受调查的707个地区中被诊断出的患者里（34.8%）的地区达到了WHO诊断目标，而76个（10.7%）地区达到了WHO控制目标。糖尿病诊断（VPC，89.
