Cascade of care for type 2 diabetes mellitus and hypertension in rural Bangladesh: sub-regional mapping of gaps in care

Introduction: Bangladesh has a high burden of type two diabetes mellitus (T2DM) and hypertension. To better target non-communicable disease (NCD) programmes, populations with unmet care needs must be identified. We describe the unmet care needs for people living with T2DM and hypertension in rural Bangladesh at a subregional level. Methods: We conducted a secondary analysis of cross-sectional surveys conducted in 2021 and 2022 in Alfadanga Upazila, Faridpur District. Surveys were conducted among random samples of non-pregnant adults aged >30 years, including questions about demographics, NCD diagnoses, care-seeking and treatment. Study staff conducted blood pressure measurements to determine hypertension and 2-hour oral glucose tolerance tests to determine T2DM status. We calculated the prevalence of T2DM and hypertension and the unmet need for care, defined as the prevalence minus the proportion screened (T2DM only), diagnosed, treated and controlled, following the cascade of care (COC). We present the COC for 12 subregional geographical clusters and sex. Results: 1982 participants (62.9% women) were analysed. The prevalence of T2DM was 19.0%, and the unmet need for care was 90.7%. The prevalence of hypertension was 37.9%, and the unmet need for care was 81.4%. For both T2DM and hypertension, women had a higher prevalence of disease, but there was a wider gap in the COC for hypertension, with 22.4% of women achieving good control compared with 10.9% of men. At the subregional level, the prevalence of T2DM ranged from 12.4% to 26.5%, and the unmet need for care from 85.0% to 95.6%. Variations in the prevalence and unmet need for care were also seen for hypertension but with different subregional distribution patterns. Conclusions: In this rural Bangladesh setting, the unmet care need was high for T2DM and hypertension, with subregional and sex differences. Understanding hyper-local factors driving NCD risks and access to care could support more effective programme delivery.