Only one in three diabetes patients in India have sugar levels under control, reveals new study

Just over one in three people in India who know they have diabetes have their sugar levels under control, revealed an Indian Council of Medical Research (ICMR)-funded study, ‘INDIAB’, published in The Lancet (Diabetes and Endocrinology) on Thursday.
The decade-long study found that only 36.3% of known diabetics have their A1c levels (average blood glucose level over the last three months) under control, 48.8% have their blood pressure under control, and 41.5% have their bad cholesterol under control.
Only 7.7% of known diabetics in India have all three parameters under control.
“We call this the ABC – A1c, blood pressure, and cholesterol — control. And, we found that only 7.7% of the people who have already been diagnosed with diabetes have all three parameters under control. We have shown repeatedly through earlier studies that unless you get all three parameters under control, the risk of developing eye, kidney, heart, feet, nerve and other complications will go up. With a couple of million new diabetics each year, we will not be able to handle the numbers of transplants, dialysis, etc needed,” said Dr V Mohan, chairman of Dr Mohan’s Diabetes Specialities Centre and one of the authors of the paper.

“The ABC is much easier to control (through lifestyle changes such as diet, exercise, and smoking cessation). Take your medicines regularly and go to the doctor for check-ups. In spite of that only 7.7% have their ABC under control,” he added.
The findings of the study have raised concerns given that 83.3% of the participants used medications to lower blood sugar, blood pressure, and cholesterol. What this suggests, the researchers believe, is that people are either not taking their medicines regularly, taking it in sub-optimal doses, or not monitoring their levels and adjusting doses regularly.
The study involved 1.1 lakh participants across 30 states and Union Territories. The sample had both urban and rural representation.
The study further reveals that participants from no state had their mean A1c under good control, with values ranging from 7.3 in Tripura to 9.0 in Punjab (the ideal A1c level is 7). The mean blood pressure values were in ‘good to satisfactory control’ range in most states, with the highest in Nagaland where the upper limit breached 149.2 (it should be around 120, ideally). Only 10 states had people with LDL cholesterol levels in the ‘good control’ range.

The study also analysed other factors such as smoking, drinking, exercise, and diet. Smoking rates were highest in Mizoram, Tripura, and Meghalaya, whereas alcohol use was highest in Himachal Pradesh. Only Andhra Pradesh (undivided), Bihar, Chandigarh, and Tripura reported a mean intake of 3 or more portions of fruit and vegetables per day. Just over 19% consumed three or more fruits and vegetable portions a day, with only 2.9% reaching the World Health Organisation recommended five or more portions a day.
“We cannot have a diabetes free India, but we should aim to have a complication free India. Most people just look at their glucose, but beyond glucose, controlling the blood pressure and cholesterol is as important. We need to control the ABC at the primary care level, we need to train the foot soldiers of diabetes – educators, nurses, family doctors,” said Dr Shashank Joshi, chairman of the Southeast Asia chapter of International Diabetes Federation and among the authors of the paper.
Younger age (20–59 years), longer duration of diabetes (≥10 years), and use of multiple drugs was associated with a lower chance of achieving HbA1c of less than 7∙0%. However, being younger (20–59 years), consuming more than 3 portions of fruit and vegetables per day, and doing moderate or vigorous exercise were associated with a greater chance of controlling blood pressure, the study said.
“We must look towards a concerted effort towards improving quality of care. This will include screening for early diagnosis, using evidence-based guidelines to plan management, establishing thresholds and pathways for referral so that the continuum of care is established and maintained. The number of people with diabetes has become so large that not only medical/endocrine specials but all general practitioners should be suitably involved in treatment of this disease using objective treatment guidelines,” said Dr Nikhil Tandon, head of the department of endocrinology at the All India Institute of Medical Sciences, New Delhi.
Dr Mohan added, “There needs to be a Covid-19-like focus on diabetes. People need to be made aware of ABCs and the need to control it, governments must focus on access to primary care, there should be a place for exercising, and there should be less availability of junk food.”