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

Abstract

Objective: Prior studies examining diabetes prevalence in India have found that nearly 50% of the diabetes population remains undiagnosed; however, the specific populations at risk are unclear.

Research design and methods: First, we estimated the prevalence of undiagnosed diabetes in India for 750 924 persons between the ages of 15 years and 50 years who participated in the National Family Health Survey (NFHS-4)/Demographic Health Survey (2015-2016), a cross-sectional survey of all 29 states and 7 union territories of India. We defined 'undiagnosed diabetes' as individuals who did not know about their diabetes status but had high random (≥200 mg/dL) or fasting (≥126 mg/dL) blood glucose levels. Second, using Poisson regression, we associated 10 different factors, including the role of healthcare access, and undiagnosed diabetes. Third, we examined the association of undiagnosed diabetes with other potential comorbid conditions.

Results: The crude prevalence of diabetes for women and men aged 15-50 years was 2.9%, 95% CI 2.9% to 3.1%, with self-reported diabetes prevalence at 1.7%, 95% CI 1.6 to 1.8. The overall prevalence of undiagnosed diabetes for 15-50 year olds was at 1.2%, 95% CI 1.2% to 1.3%. Forty-two per cent, 95% CI 40.7% to 43.4% of the individuals with high glucose levels were unaware of their diabetes status. Approximately 45%, 95% CI 42.9% to 46.4% of undiagnosed diabetes population had access to healthcare. Men, younger individuals, and those with lower levels of education were most at risk of being undiagnosed. Geographically, the Southern states in India had a significantly higher prevalence of undiagnosed diabetes despite having nearly universal access to healthcare. Risk factors combined with random glucose could predict undiagnosed diabetes (area under the curve of 97.8%, 95% CI 97.7% to 97.8%), Nagelkerke R² of 66%).

Conclusion: Close to half (42%) of the people with diabetes in India are not aware of their disease status, and a large subset of these people are at risk of poor detection, despite having health insurance and/or having access to healthcare. Younger age groups and men are the most vulnerable.

Keywords: diagnosis; epidemiology; glucose; india.

Figure 1

(A) Overall methodology; (B) cohort selection from the National Family Health Survey/Demographic Health Surveys (NFHS/DHS) conducted in India in 2015–2016.

Figure 2

(A) Prevalence of healthcare access in India by state. (B) Prevalence of undiagnosed diabetes in India by state.