Poor healthcare infrastructure and utilization complicated Indian diabetic epidemic especially in backward areas
where many cases remain uncontrolled or even undiagnosed till complications develop. Dearth of information from
eastern India regarding the burden and correlates of such uncontrolled and undiagnosed diabetes and consequent
healthcare-seeking thus called for a detailed investigation in a poor-resource setting.
Methods
A community-based cross-sectional study was conducted in Malda, an under-developed district in eastern India.
Between October 2013 and July 2014, 18,028 consenting adults were randomly recruited, interviewed and tested for
capillary blood sugar (fasting/post-prandial/random). Diabetics were defined by previous diagnoses or having fasting
capillary blood sugar =126 mg/dl or post-prandial/random blood sugar =200 mg/dl. A previously diagnosed case was
defined as uncontrolled if his/her measured blood sugar did fall in the diabetic level. On the other hand, previously
undiagnosed persons, if found diabetic according to the test results, were termed as undiagnosed diabetic. Descriptive
and regression analyses were conducted using SAS-9.3.2.
Results
Six percent adult residents were suffering from diabetes in Malda, India. Unfortunately, more than two-third (approx.
63%) of these diabetics remained undiagnosed till this study while a little less than half (about 47%) of the diagnosed
cases were uncontrolled. Furthermore, eight percent of the diagnosed diabetics sought treatment from non-qualified
practitioners. Among diabetics, odds of remaining undiagnosed were relatively lower among older and richer diabetics
of urban area while females were more likely to remain undiagnosed. Secondary-educated subjects had higher and
divorced/separated/widowed/widowers had lower odds of having uncontrolled diabetes. Muslims and backward castes
were less and educated, hard-working and richer diabetics were more likely to visit qualified private practitioners.
Conclusions
Burden of uncontrolled and undiagnosed diabetes were high in Malda. Urgent interventions targeting young, female,
married, less-educated and poor diabetics from rural area seemed necessary to ensure early detection and appropriate
treatment.