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 rises with age and that clinical and public health interventions can prevent diabetes complications. We estimated 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 survey of adults aged 45 years and older from 2017 to 2019. Our sample included 56,995 individuals from 35 states and union territories, reflecting a representative sample of India as a nation and of each state and union territory. Our primary outcomes were diabetes prevalence and health service indicators recommended by the World Health Organization. Diabetes prevalence was defined as individuals self-reporting a prior diabetes diagnosis or having hemoglobin A1c (HbA1c) ≥6.5%. Diabetes health service indicators were based on four core metrics recommended by the World Health Organization: (1) proportion diagnosed out of all individuals with diabetes ('awareness') and out of individuals with diagnosed diabetes, (2) proportion with glycemic control (HbA1c <7%), (3) proportion with blood pressure control (<140/90 mmHg), and (4) proportion using 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 body mass index.Findings: Diabetes prevalence among adults aged 45 years and older in India was 19.7% (95% confidence interval 19.3% to 20.1%), which amounts to 50.1 (49.1 to 51.1) million people. Prevalence among men and women was similar (19.5% [18.9% to 20.1%] and 20.0% [19.4% to 20.6%], respectively). Urban diabetes prevalence (29.9% [29.0% to 30.7%]) was approximately twice as high as rural prevalence (14.9% [14.5% to 15.4%]). States with higher levels of economic development and in southern India tended to have greater age-standardized prevalence. Overall, 60.4% (59.3% to 61.5%) of individuals were aware of their diabetes. Out of individuals with diagnosed diabetes, 46.1% (44.7% to 47.6%) achieved glycemic control, 58.9% (57.4% to 60.3%) achieved blood pressure control, and 6.5% (5.8% to 7.2%) were taking a lipid-lowering medication.Interpretation: Our findings emphasize the urgent need to scale up policies to better prevent, detect, manage, and control diabetes among middle-aged and older adults in India.Funding Information: Data collection was funded by the National Institute on Aging, National Institutes of Health (NIA/NIH), U.S.A. (R01AG042778: DB, JL, TS, PH; https://www.nia.nih.gov); the Ministry of Health and Family Welfare, Government of India (T22011/02/2015-NCD: TS, DB, JL; https://www.mohfw.gov.in/). The NIA/NIH provided funding for a nationally representative sample, drawing samples from the 15 largest states. The Government of India provided additional funding to make the study representative of each state and union territory and enable oversampling of older adults and four metropolitan cities. The preparation of this paper was funded by the NIA/NIH (R01AG030153: JL; https://www.nia.nih.gov).Declaration of Interests: We declare no competing interests.Ethics Approval Statement: LASI obtained approval from the University of Southern California Institutional Review Board (IRB) (UP-CG-14_00005), the Harvard University IRB (CR16715-10), the International Institute for Population Sciences IRB (Sr. No. 12/1054), and Health Ministry’s Screening Committee clearance from the Indian Council of Medical Research (F.No.T.21012/07/ 2012-NCD).