{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T03:35:22Z","timestamp":1793504122583,"version":"4.5.0"},"reference-count":38,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2023,9,1]]},"abstract":"<jats:sec id=\"ab-ioi230045-4\"><jats:title>Importance<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi230045-5\"><jats:title>Objective<\/jats:title><jats:p>To estimate the adult population levels of diabetes diagnosis, treatment, and control in India at national, state, and district levels and by sociodemographic characteristics.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi230045-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>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\u2019s 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\u202f895\u202f287 adults. The analytic sample was restricted to those who either self-reported having diabetes or who had a valid measurement of blood glucose.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi230045-7\"><jats:title>Exposures<\/jats:title><jats:p>The exposures in this survey study were district and state residence; urban vs rural residence; age (18-39 years, 40-64 years, or \u226565 years); sex; and household wealth quintile.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi230045-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Diabetes was defined by self-report or high capillary blood glucose (fasting: \u2265126 mg\/dL [to convert to mmol\/L, multiply by 0.0555]; nonfasting: \u2265220 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 &amp;amp;lt;126 mg\/dL; nonfasting: \u2264180 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).<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi230045-9\"><jats:title>Results<\/jats:title><jats:p>Among 1\u202f651\u202f176 adult respondents (mean [SD] age, 41.6 [16.4] years; 867\u202f896 [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.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi230045-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamainternmed.2023.3070","type":"journal-article","created":{"date-parts":[[2023,7,31]],"date-time":"2023-07-31T15:32:35Z","timestamp":1690817555000},"page":"963","source":"Crossref","is-referenced-by-count":20,"title":["National Estimates of the Adult Diabetes Care Continuum in India, 2019-2021"],"prefix":"10.1001","volume":"183","author":[{"given":"Jithin Sam","family":"Varghese","sequence":"first","affiliation":[{"name":"Emory Global Diabetes Research Center of Woodruff Health Sciences Center and Emory University, Atlanta, Georgia"},{"name":"Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ranjit Mohan","family":"Anjana","sequence":"additional","affiliation":[{"name":"Madras Diabetes Research Foundation and Dr Mohan\u2019s Diabetes Specialities Centre, Chennai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal","family":"Geldsetzer","sequence":"additional","affiliation":[{"name":"Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, California"},{"name":"Chan Zuckerberg Biohub\u2212San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikkil","family":"Sudharsanan","sequence":"additional","affiliation":[{"name":"Professorship of Behavioral Science for Disease Prevention and Health Care, Technical University of Munich, Munich, Germany"},{"name":"Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Manne-Goehler","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harsha","family":"Thirumurthy","sequence":"additional","affiliation":[{"name":"Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soura","family":"Bhattacharyya","sequence":"additional","affiliation":[{"name":"Lattice Innovations, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. 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National Program for Prevention and Control of Cancer, Diabetes, CVD and Stroke (NPCDCS). National Health Mission. Accessed October 14, 2022. https:\/\/nhm.gov.in\/index1.php?lang=1&level=2&sublinkid=1048&lid=604"},{"key":"ioi230045r8","unstructured":"World Health Organization. First-ever global coverage targets for diabetes adopted at the 75th World Health Assembly. May 28, 2022. Accessed August 28, 2022. https:\/\/www.who.int\/news-room\/feature-stories\/detail\/first-ever-global-coverage-targets-for-diabetes-adopted-at-the-75-th-world-health-assembly"},{"key":"ioi230045r15","doi-asserted-by":"crossref","unstructured":"Flood? D, Green? H, Hu? P, . Prevalence, awareness, treatment, and control of diabetes in India: a nationally representative survey of adults aged 45 years and older. SSRN. 2022. 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