Geroscience. 2026 Oct 29. doi: 10.1007/s11357-026-02616-x. Online ahead of print.
ABSTRACT
BACKGROUND: Poorly controlled diabetes drives cardiovascular disease and mortality in India, a burden set to grow as the population ages rapidly. Evidence on geographic variation in diabetes care has focused on state and district levels; finer community-level variation and its link to socioeconomic status (SES) remain underexplored. We partitioned geographic variation in each stage of the diabetes care cascade (awareness, treatment, and control) across state, district, and community levels, and quantified how much individual SES explains.
METHODS: Using nationally representative India's National Family Health Survey (2019-2021), we examined diabetes care among adults with diabetes aged 15 years and older (N = 78,118). Diabetes was defined as random blood glucose ≥ 200 mg/dL or current anti-diabetic medication use. We applied four-level multilevel logistic regression across awareness, treatment, and control. Variance partition coefficients (VPCs) quantified variation attributable to community, district, and state levels, with models adjusted for individual SES.
RESULTS: Among adults with diabetes, 70.0% were aware, 67.1% treated, and only 40.8% achieved glycaemic control. Community-level variation accounted for most variation at each stage of the care cascade (VPCs 50.6-59.3%), exceeding district and state levels, and was minimally explained by SES.
CONCLUSIONS: Care gaps widen sharply toward control. Community-level dominance points to contextual drivers, underscoring the need for locally targeted interventions to strengthen health-system capacity and improve glycaemic control.
PMID:42965646 | DOI:10.1007/s11357-026-02616-x