title: A survey on socioeconomic determinants of diabetes mellitus management in a lower middle income setting.
abstract: BACKGROUND
  Information on socioeconomic determinants in the management of diabetes mellitus is scarce in lower middle income countries. The aim of this study is to describe the socioeconomic determinants of management and complications of diabetes mellitus in a lower middle income setting.
  
  
  METHODS
  Cross sectional descriptive study on a stratified random sample of 1300 individuals was conducted by an interviewer administered questionnaire, clinical examinations and blood investigations. A single fasting venous blood sugar of ≥126 mg/dl was considered diagnostic of new diabetics and poor control of diabetes mellitus as HbA1C > 6.5 %.
  
  
  RESULTS
  There were 202 (14.7 %) with diabetes mellitus. Poor control was seen in 130 (90.7 %) while 71 (49.6 %) were not on regular treatment. Highest proportions of poor control and not on regular medication were observed in estate sector, poorest social status category and poorest geographical area. The annual HbA1C, microalbuminuria, retinal and neuropathy examination were performed in less than 6.0 %. Social gradient not observed in the management lapses. Most (76.6 %) had accessed private sector while those in estate (58.1 %) accessed the state system. The microvascular complications of retinopathy, neuropathy and microalbuminuria observed in 11.1 %, 79.3 % and 54.5 % respectively. Among the macrovascular diseases, angina, ischaemic heart disease and peripheral arterial disease seen in 15.5 %, 15.7 % and 5.5 % respectively. These complications do not show a social gradient.
  
  
  CONCLUSIONS
  Diabetes mellitus patients, irrespective of their socioeconomic status, are poorly managed and have high rates of complications. Most depend on the private healthcare system with overall poor access to care in the estate sector.
authors.affiliation: Department of Community Medicine, Faculty of Medicine, University of Colombo, No. 25, P.O. Box 271, Kynsey Road, Colombo 08, Sri Lanka. pubududesilva@ymail.com.
authors.forename: Ambepitiyawaduge Pubudu
authors.initials: AP
authors.lastname: De Silva
authors.affiliation: Department of Community Medicine, Faculty of Medicine, University of Colombo, No. 25, P.O. Box 271, Kynsey Road, Colombo 08, Sri Lanka.
authors.forename: Sudirikku Hennadige Padmal
authors.initials: SH
authors.lastname: De Silva
authors.affiliation: Centre for Tropical Medicine, University of Oxford, Oxford, UK.
authors.forename: Rashan
authors.initials: R
authors.lastname: Haniffa
authors.affiliation: Department of Para Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala University, Colombo, Sri Lanka.
authors.forename: Isurujith Kongala
authors.initials: IK
authors.lastname: Liyanage
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
authors.forename: Kosala Saroj Amarasiri
authors.initials: KS
authors.lastname: Jayasinghe
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
authors.forename: Prasad
authors.initials: P
authors.lastname: Katulanda
authors.affiliation: Department of Obstetrics & Gynaecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
authors.forename: Chandrika Neelakanthi
authors.initials: CN
authors.lastname: Wijeratne
authors.affiliation: Department of Obstetrics & Gynaecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
authors.forename: Sumedha
authors.initials: S
authors.lastname: Wijeratne
authors.affiliation: Department of Community Medicine, Faculty of Medicine, University of Colombo, No. 25, P.O. Box 271, Kynsey Road, Colombo 08, Sri Lanka.
authors.forename: Lalini Chandika
authors.initials: LC
authors.lastname: Rajapakse
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000209:etiology* / Q000523:psychology*; D015981:Epidemiologic Factors; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011203:Poverty / Q000523:psychology / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: Diabetes mellitus complications; Diabetes mellitus management; Socioeconomic determinants