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May 9, 2026Clinical Epidemiology and Global HealthOpen Access

The Hidden Burden of Undiagnosed Diabetic Kidney Disease in Primary Care: Lessons from a Rural Indian Health System

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Key result

Undiagnosed diabetic kidney disease affects ~23% of rural type 2 diabetes patients, all stage 3+.

  • 95% CI 15.0-30.5
  • n=110

Population

110 adults with type 2 diabetes mellitus attending primary-care services in a rural area of Kerala, India.

Design

Cross-sectional

Authors

KRK.K. Ashwin RajMoulana HospitalMSMubarack SaniMoulana HospitalABAnaan BashaMoulana Hospital

Discussion

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Implication

Nearly a quarter of adults with type 2 diabetes in a rural Indian primary care setting had undiagnosed diabetic kidney disease, highlighting missed opportunities for early diagnosis.

Key Points

  • This research aims to assess the prevalence of undiagnosed diabetic kidney disease (DKD) among individuals with type 2 diabetes in rural Indian primary care.
  • Community-based cross-sectional analytical study conducted from May to June 2024 among adults with type 2 diabetes in rural Kerala, India.
  • Data collection involved structured interviews and medical record reviews, with estimated glomerular filtration rate calculated using the Modification of Diet in Renal Disease equation.
  • Logistic regression and descriptive analyses were performed to assess associations and prevalence of undiagnosed DKD.
  • Among 110 participants, 22.7% were found to have undiagnosed DKD, all at stage 3 or beyond (95% CI: 15.0-30.5%).
  • Association identified between undiagnosed DKD and factors such as older age, hypertension, longer diabetes duration, and higher serum creatinine levels.
  • The logistic regression model exhibited good discriminatory performance (AUC 0.89, 95% CI: 0.82-0.95).

Study Design

Type

Cross-Sectional (n=110)

Structured PICO

P
Population
110 adults with type 2 diabetes mellitus attending primary-care services in a rural area of Kerala, India.
O
Outcome
Prevalence of undiagnosed diabetic kidney disease (defined as eGFR <60 mL/min/1.73m² in individuals without a prior documented diagnosis)

Nearly a quarter of adults with type 2 diabetes in a rural Indian primary care setting had undiagnosed diabetic kidney disease, highlighting missed opportunities for early diagnosis.

Cite This Study

Raj et al. (2026) conducted a cross-sectional in Type 2 diabetes mellitus (n=110). Type 2 diabetes mellitus was evaluated on Previously undiagnosed diabetic kidney disease (eGFR <60 mL/min/1.73m2 without prior documented diagnosis) (95% CI 15.0-30.5). Among adults with type 2 diabetes in rural primary care, 22.7% (95% CI: 15.0-30.5%) had previously undiagnosed diabetic kidney disease, with all cases detected at stage 3 or beyond.

synapsesocial.com/papers/69fecf16b9154b0b82876230https://doi.org/10.1016/j.cegh.2026.102377
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Also Consider

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