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Diabetes scenario in a backward rural district population of India and need for restructuring of health care delivery services

Suman Kanungo, Tanmay Mahapatra, Kalyan Bhowmik, Sanchita Mahapatra, Jayanta Saha, Debottam Pal, Kamalesh Sarkar

Background: 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, 18028 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 ≥126mg/dl or post-prandial/random blood sugar ≥200mg/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 (approximately sixty-three percent) of these diabetics remained undiagnosed till this study while a little less than half (about forty-seven percent) 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.