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05-05-2022 | Diabetes | News | Article

Diabetes treatment goal attainment ‘suboptimal’ in India

Author: Laura Cowen

medwireNews: Less than 10% of people with self-reported diabetes in India meet optimal treatment targets for glycated hemoglobin (HbA1c), blood pressure, and low-density lipoprotein (LDL) cholesterol control combined, show data from the ICMR-INDIAB study.

Furthermore, just “a small proportion of individuals with diabetes in India perform self-monitoring of blood glucose, and even fewer meet the global recommendations for physical activity and fruit and vegetable intake,” write Viswanathan Mohan (Indian Council of Medical Research Centre for Advanced Research on Diabetes, Chennai) and co-authors in The Lancet Diabetes & Endocrinology.

They say their findings “emphasise the need for better control of glycemic, blood pressure, and lipid targets to reduce microvascular and cardiovascular risk in the Asian Indian population.”

The population-based ICMR-INDIAB study includes data for 113,043 individuals (30% from urban areas and 70% from rural areas) aged 20 years or older from all 30 states and union territories of India.

In the current analysis, the researchers found that 1748 – or a weighted proportion of 36.3% – of 4834 people with self-reported diabetes and glycemic measurements achieved good glycemic control, defined as HbA1c below 7.0% (53 mmol/mol). Weighted proportions were used instead of standard calculations because only 16 states included data on details on glucose-, blood pressure-, and lipid-lowering drugs, the team notes.

In addition, 2819 of 5698 participants (weighted proportion, 48.8%) achieved blood pressure control, defined as less than 140/90 mmHg, and 2043 of 4886 individuals (weighted proportion, 41.5%) achieved good LDL cholesterol control, defined as less than 100 mg/dL.

Together, a weighted proportion of just 7.7% of 5297 participants met all three targets combined, and the investigators note that there was “significant heterogeneity between regions and states.” Furthermore, this proportion decreased to just 6.6% when nonsmoking was included as a fourth goal.

The majority (weighted proportion, 89.2%) of study participants were using glucose-lowering medication and a weighted 11.1% were on insulin, but Mohan et al report that just 16.7% (weighted) overall reported self-monitoring of blood glucose, with the proportion at 36.9% (weighted) among insulin users.

They comment: “Poor achievement of glycaemic targets despite widespread use of anti-diabetic drugs suggests a lack of timely escalation of treatment, which could be due to insufficient monitoring and follow-up.”

The researchers also observed that just 2.9% of participants met WHO recommendations for daily fruit and vegetable intake (≥5 portions per day) and just under a quarter (24.0%) were physically active.

In multivariable analyses, better achievement of the combined HbA1c, blood pressure, and LDL cholesterol treatment targets was associated with higher education level, male sex, rural residence, and shorter duration of diabetes (<10 years).

Mohan and colleagues conclude that “there is considerable scope for improving adoption of health habits in individuals with known diabetes.”

They say their “results could serve as a basis for Government policy decisions to strengthen diabetes care at the primary, secondary, and tertiary settings in India.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2022 Springer Healthcare Ltd, part of the Springer Nature Group

Lancet Diabetes Endocrinol 2022; doi:10.1016/S2213-8587(22)00072-9

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