Diabetes care cascade in Bangladesh: Identifying gaps and social determinants

Precise and up-to-date data regarding the care gaps is essential to prioritize interventions and guide efficient resource allocation for management of diabetes in Bangladesh. The aim of the present study was to evaluate the diabetes care cascade and identify the social determinants influencing retention at each stage of care in Bangladesh.

Data was extracted from Bangladesh Demographic and Health Survey (BDHS), 2022. Type 2 diabetes mellitus (T2DM) was defined as fasting blood glucose ≥7.0 mmol/L or a diagnosis by a healthcare provider. The care cascade comprised three stages: (i) diagnosis, (ii) receiving treatment, and (iii) glycemic control. Logistic regression and Andersen's Behavioral Model were used in the study.

Among 2,403 individuals with T2DM, 33.5 % were diagnosed, 24.6 % received treatment, and 9.6 % achieved glycemic control. Losses occurred at diagnosis (66.5 %), treatment (9 %), and control (19.6 %). Women, individuals with higher education, and those in the wealthiest quintile had higher odds of diagnosis. Receiving treatment was significantly associated with wealth and body mass index.

Significant gaps were observed at all stages of diabetes care cascade, particularly diagnosis. Strengthening screening, ensuring access to affordable treatment, and improving adherence are essential to enhance glycemic control and mitigating the diabetes burden.