Background

There is little information on comprehensive diabetes care comprising glycaemic, lipid, and blood pressure control in India; therefore, we aimed to assess the achievement of treatment targets among adults with self-reported diabetes.

Methods

The Indian Council of Medical Research (ICMR)-India Diabetes (INDIAB) study is a cross-sectional, population-based survey of adults aged 20 years or older in all 30 states and union territories of India. We used a stratified multistage sampling design, sampling states in a phased manner, and selected villages in rural areas and census enumeration blocks in urban areas. We used a three-level stratification method on the basis of geography, population size, and socioeconomic status for each state. For the outcome assessment, good glycaemic control was defined as HbA_1c of less than 7·0% (A), blood pressure control was defined as less than 140/90 mm Hg (B), and the LDL cholesterol target was defined as less than 100 mg/dL (C). ABC control was defined as the proportion of individuals meeting glycaemic, blood pressure, and LDL cholesterol targets together. We also performed multiple logistic regression to assess the factors influencing achievement of diabetes treatment targets.

Findings

Between Oct 18, 2008, and Dec 17, 2020, 113 043 individuals (33 537 from urban areas and 79 506 from rural areas) participated in the ICMR-INDIAB study. For this analysis, 5789 adults (2633 in urban areas and 3156 in rural areas) with self-reported diabetes were included in the study population. The median age was 56·1 years (IQR 55·7–56·5). Overall, 1748 (weighted proportion 36·3%, 95% CI 34·7–37·9) of 4834 people with diabetes achieved good glycaemic control, 2819 (weighted proportion 48·8%, 47·2–50·3) of 5698 achieved blood pressure control, and 2043 (weighted proportion 41·5%, 39·9–43·1) of 4886 achieved good LDL cholesterol control. Only 419 (weighted proportion 7·7%) of 5297 individuals with self-reported diabetes achieved all three ABC targets, with significant heterogeneity between regions and states. Higher education, male sex, rural residence, and shorter duration of diabetes (<10 years) were associated with better achievement of combined ABC targets. Only 951 (weighted proportion 16·7%) of the study population and 227 (weighted proportion 36·9%) of those on insulin reported using self-monitoring of blood glucose.

Interpretation

Achievement of treatment targets and adoption of healthy behaviours remains suboptimal in India. Our results can help governments to adopt policies that prioritise improvement of diabetes care delivery and surveillance in India.

Funding

Indian Council of Medical Research and Department of Health Research, Ministry of Health and Family Welfare.

中文翻译：

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在印度自我报告的糖尿病患者中实现指南推荐的糖尿病治疗目标和健康习惯 (ICMR-INDIAB-13)：一项全国性横断面研究

背景

在印度，关于包括血糖、血脂和血压控制在内的综合糖尿病护理的信息很少；因此，我们旨在评估自我报告的糖尿病成人患者治疗目标的实现情况。

方法

印度医学研究委员会 (ICMR)-印度糖尿病 (INDIAB) 研究是一项针对印度所有 30 个州和联邦属地的 20 岁或以上成年人的横断面、基于人口的调查。我们采用分层多阶段抽样设计，分阶段抽样各州，选择农村地区的村庄和城市地区的人口普查区。我们根据每个州的地理、人口规模和社会经济地位使用了三级分层方法。对于结果评估，良好的血糖控制定义为 HbA _1c小于 7·0% (A)，血压控制定义为小于 140/90 mm Hg (B)，LDL 胆固醇目标定义为小于 100 mg/dL (C)。ABC控制被定义为同时达到血糖、血压和低密度脂蛋白胆固醇目标的个体比例。我们还进行了多元逻辑回归，以评估影响糖尿病治疗目标实现的因素。

发现

2008 年 10 月 18 日至 2020 年 12 月 17 日期间，113 043 人（33 537 人来自城市地区，79 506 人来自农村地区）参加了 ICMR-INDIAB 研究。在这项分析中，研究人群中包括了 5789 名自述患有糖尿病的成年人（城市地区 2633 人，农村地区 3156 人）。中位年龄为 56·1 岁（IQR 55·7–56·5）。总体而言，4834 名糖尿病患者中有 1748 人（加权比例 36·3%，95% CI 34·7-37·9）实现了良好的血糖控制，2819 人（加权比例 48·8%，47·2-50·3） 5698 人实现了血压控制，4886 人中有 2043 人（加权比例 41·5%，39·9-43·1）实现了良好的 LDL 胆固醇控制。在 5297 名自我报告的糖尿病患者中，只有 419 人（加权比例 7·7%）实现了所有三个 ABC 目标，地区和州之间存在显着的异质性。高等教育，男性，农村居住和较短的糖尿病病程（<10 年）与更好地实现综合 ABC 目标相关。只有 951 人（加权比例 16·7%）研究人群和 227 人（加权比例 36·9%）使用胰岛素报告使用自我监测血糖。

解释

在印度，治疗目标的实现和健康行为的采用仍然不理想。我们的研究结果可以帮助政府采取优先改善印度糖尿病护理服务和监测的政策。

资金

印度医学研究委员会和卫生研究部，卫生和家庭福利部。