Introduction and Objective: There are more than 101 million individuals living with diabetes in India.Meeting treatment goals for HbA1c, Blood pressure and Cholesterol(ABC) can help prevent diabetes complications.We assessed diabetes awareness, management gaps and attainment of ABC goals among rural South Indian with self-reported diabetes.Methods: The Telemedicine pRoject for screENing Diabetes and its complications in rural Tamil Nadu(TREND) project[2018-2021] was a door-to-door cross-sectional study screening adults in 30 Tamil Nadu villages (n=14,117;1,462 with self-reported diabetes). Clinical/biochemical investigations were performed using standard techniques. ABC Targets were defined as HbA1c<7%, BP<140/90 mmHg and LDL-cholesterol(LDL-C)<100 mg/dl. Diabetic retinopathy(DR) was assessed using mydriatic Remidio “fundus on Phone” and classified using ETDRS criteria. Diabetic nephropathy(DN) was defined as albumin/creatinine ratio(≥30 µg/mg of creatinine). \Results: Mean age, BMI, fasting plasma glucose and duration of diabetes were 54.7±11.5 years, 25.2±4.2, 169±81 mg/dL, 5.8±5.2 years respectively. Only 1.8% of individuals performed self-monitoring of blood glucose and only 26.3% had their HbA1c tested at least yearly. Fifty three percent were unaware of their level of diabetes control and 35% were unaware that diabetes can affect other organs. Only 4.9% achieved all three ABC goals(HbA1c 27.2%, BP 63.4%, LDL-C 24.3%). Those who did not achieve treatment goals had higher frequency of DR(16.4 vs.4.5%;p<0.05) and DN(40.2 vs.22.2%; p<0.05) than achievers. Multivariable adjustment revealed male gender(OR:0.40, 95% CI 0.2-0.7, p=0.002) and shorter duration of diabetes[<10 years] (OR:0.26, 95% CI 0.5-0.9, p=0.04) to be associated with greater likelihood of achieving goals.Conclusion: There are significant treatment gaps among individuals with diabetes in rural South India, predisposing to high complication rates. Health care systems need to be strengthened to achieve higher treatment goals.
R. Guha Pradeepa: None. L. Natarajan: None. R. Hari: None. C.N. Palmer: None. R. Unnikrishnan: None. V. Mohan: None. R. Anjana: None.
This research was funded by the National Institute for Health Research (NIHR) (INSPIRED 16/136/102) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK government.
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