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Background: Representative data on knowledge and awareness about diabetes is scarce in India and is extremely important to plan public health policies aimed at preventing and controlling diabetes. How to cite this article:Deepa M, Bhansali A, Anjana R M, Pradeepa R, Joshi S R, Joshi P P, Dhandhania V K, Rao P V, Subashini R, Unnikrishnan R, Shukla D K, Madhu S V, Das A K, Mohan V, Kaur T. How to cite this URL:Deepa M, Bhansali A, Anjana R M, Pradeepa R, Joshi S R, Joshi P P, Dhandhania V K, Rao P V, Subashini R, Unnikrishnan R, Shukla D K, Madhu S V, Das A K, Mohan V, Kaur T. Ranjit Unnikrishnan,Viswanathan Mohan Transactions of The Royal Society of Tropical Medicine and Hygiene. Ranjit Unnikrishnan,Ranjit Mohan Anjana,Viswanathan Mohan Nature Reviews Endocrinology.
According to the World Health Organization, health care embraces all the goods and services designed to promote health, including "preventive, curative and palliative interventions, whether directed to individuals or to populations". Aim: The aim of the following study is to assess awareness and knowledge about diabetes in the general population, as well as in individuals with diabetes in four selected regions of India.
Awareness and knowledge of diabetes in Chennai - The Chennai Urban Rural Epidemiology Study [CURES-9].
Knowledge of diabetes and diabetic retinopathy among rural populations in India, and the influence of knowledge of diabetic retinopathy on attitude and practice. Awareness about diabetes and its complications in the general and diabetic population in a city in southern India. Awareness and attitude toward diabetes in the rural population of Arunachal Pradesh, Northeast India. The Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study: Methodological details. Increased awareness about diabetes and its complications in a whole city: Effectiveness of the "prevention, awareness, counselling and evaluation" [PACE] Diabetes Project [PACE-6].
Evaluation of awareness of diabetes mellitus and associated factors in four health center areas.
Methodology and feasibility of a structured education program for diabetes education in India: The National Diabetes Educator Program. Materials and Methods: The study subjects were drawn from a representative sample of four geographical regions of India, Chandigarh, Tamil Nadu, Jharkhand and Maharashtra representing North, South, East and West and covering a population of 213 million.
National Programme for Prevention and Control of Diabetes, Cardiovascular Disease and Stroke. Sridhar International Journal of Diabetes in Developing Countries. A total of 16,607 individuals (5112 urban and 11,495 rural) aged ≥20 years were selected from 188 urban and 175 rural areas.

Awareness of diabetes and knowledge of causative factors and complications of diabetes were assessed using an interviewer administered structured questionnaire in 14,274 individuals (response rate, 86.0%), which included 480 self-reported diabetic subjects. Yajnik International Journal of Diabetes in Developing Countries. There is also evidence to show that increasing knowledge regarding diabetes and its complications has significant benefits including increase in compliance to treatment, thereby decreasing the complications associated with diabetes. This article focuses on the level of awareness and knowledge of diabetes in the general, as well as the diabetic population in four regions of India based on the first phase of the ICMR-INDIAB study. The study plans to survey all the 28 states in India, the two union territories (UTs) of Chandigarh and Puducherry and the National Capital Territory of Delhi in a phased manner. Phase I of the ICMR-INDIAB study was conducted from November 2008 to April 2010 and included three states randomly selected to represent the South (Tamil Nadu), West (Maharashtra) and East (Jharkhand) of India and one UT representing Northern India (Chandigarh). Conclusion: Knowledge and awareness about diabetes in India, particularly in rural areas, is poor. The primary sampling units (PSUs) were villages in rural areas and census enumeration blocks in urban areas.
A three-level stratification process was carried out based on geography, population size and socio-economic status. The sample size was calculated separately for urban and rural areas, as previous studies have shown large variations in urban and rural prevalence of diabetes in India. Assuming an expected diabetes prevalence of 10% in urban areas and 4% in rural areas, using a precision of 20% (80% power) and allowing for a non-response rate of 20%, the sample size was calculated to be 4000 per state (2800 rural and 1200 urban). A total of 16,607 individuals (5112 urban and 11,495 rural) were selected from 363 PSU's (188 urban and 175 rural), of whom, 14,277 individuals consented to participate (response rate 86%) (Tamil Nadu - 3664, Maharashtra - 3920, Jharkhand - 3337 and Chandigarh - 3356 individuals).
Of the total 14,277 study subjects, data on awareness were available on 14,274 subjects, which included 480 self-reported diabetic subjects.
Approval of the Institutional Ethics Committee was obtained prior to study commencement and written informed consent was obtained in the local language.Data was collected using a structured and pre-tested questionnaire which included details on demography, behavioral aspects, physical activity, dietary patterns and medical information. Knowledge on causative factors and complications of diabetes was assessed using open ended questions. The questionnaire was translated into the local language and administered by a trained interviewer.Questions used for obtaining data regarding knowledge of diabetes were as follows:Have you heard of a condition called diabetes?
The 3221 subjects who stated that diabetes could be prevented received an open-ended follow-up question about the ways to prevent diabetes. The following are the significant findings: (1) Overall only about 50% of the population of the four regions of India studied have heard of a condition called diabetes. Imparting knowledge about diabetes to the community is the first step in prevention and early detection of the disease and prevention of its complications.

Two similar surveys conducted in Chennai in 2005 [2] and 2007 [7] reported that only 25% and 10% of the participants respectively had not heard of diabetes. The higher rates of awareness in Chennai could be due to the extensive diabetes awareness activities in Chennai carried out by multiple stakeholders.
This includes over 770 large diabetes awareness and free screening camps conducted between 2004 and 2007 at various locations of Chennai as part of the Prevention, Awareness, Counseling and Evaluation (PACE) Diabetes Project. This points to the need for replicating such models such as the PACE project in other parts of the country.Another matter of concern is that overall, only 60% of the population was aware that diabetes could be prevented.
Awareness of the major risk factors for diabetes, such as overweight, family history of diabetes, lack of physical activity and high blood pressure was poor. Unless the public knows that diabetes can be prevented and are aware of risk factors, primary prevention of diabetes is unlikely to become feasible in India. It is noteworthy that obesity was not reported as a risk factor for diabetes by majority of the participants. In a country where, until recently, under nutrition associated with poverty was a major problem, obesity is often considered a sign of prosperity and good health. However, the same trend was not seen among the self-reported diabetic subjects, where Maharashtra had the highest and Tamil Nadu had the lowest score. Such data on knowledge and awareness levels are extremely important to plan public health policies aimed at preventing and controlling diabetes at the national and state level in India.The regional differences in level of awareness of diabetes could be attributed to differences in the education levels. In the present study, subjects with no formal education were found to have high unawareness rates compared with the educated group regarding diabetes, which is in agreement with previous studies.
Education about risk factors, complications, diet control, physical activity, regular checkups and screening will go a long way in achieving better control of diabetes and thus reduce the burden due to diabetes complications. The National Program for Control of Diabetes, Cardiovascular Disease and Stroke is presently being rolled out all over the country and this program can help improve diabetes awareness levels at a national level. Mohan's Diabetes Education Academy (DMDEA) with the fundamental objective of improving the treatment outcomes for patients by providing evidence based guidance to physicians and general practitioners. The second program, NDEP, is a certification course jointly conducted by DMDEA and the Indian Association of Diabetes Educators and 1054 diabetes educators have been trained from 78 cities in 18 states in India. The study emphasizes the need for improvement in knowledge and awareness both among the general population as well as diabetic subjects in order to achieve prevention and better control of diabetes and its complications. We also thank the ICMR-INDIAB study Quality Managers, Quality Supervisors and the field team for smooth conduct of the study and the participants for their cooperation.

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