Diabetes surveillance in low- and middle-income countries: Key challenges and future directions

Diabetes is a growing global public health concern that places a substantial burden on health care systems, particularly in low- and middle-income countries (LMICs). Rapid lifestyle and nutritional transitions, combined with limited resources, contribute to the rising prevalence and poor management of this disease in these settings. Globally, an estimated 589 million adults aged 20–79 years are living with diabetes, with LMICs carrying most of this burden. In India, the progression from impaired glucose tolerance or impaired fasting glucose to diabetes occurs more rapidly than in many other populations, highlighting the need for timely detection and effective surveillance. Diabetes surveillance is essential to guide prevention, early diagnosis, and management. Approaches include passive, active, and sentinel surveillance. Passive surveillance relies on routinely collected data to track disease patterns. However, it often underestimates the actual burden. Active surveillance involves systematically seeking cases in the community and generating more accurate estimates but requires greater resources. Sentinel surveillance, using selected health care facilities or defined populations, offers a practical middle ground by monitoring trends, assessing risk factors, and evaluating interventions in a representative manner. This strategy is particularly valuable in LMICs with fragmented health care systems and limited resources. Despite the importance of surveillance, LMICs face barriers such as limited public awareness, stigma, workforce shortages, and inadequate laboratory and treatment facilities. Strengthening surveillance through improved health information systems, integration of sentinel sites, and use of digital health care tools can provide reliable data to inform public health action and reduce the growing burden of diabetes.