Prevalence, diagnostic coverage, medication treatment, and glycaemic control of diabetes and associated factors in Cambodia: A cross-sectional study based on the 2023 World Health Survey Plus

Objectives
This study aimed to estimate the national prevalence of type 2 diabetes (T2D), construct a cascade of care for T2D (CoC), and determine the factors associated with prevalence, not previously diagnosed (undiagnosed), and not undergoing medication treatment (untreated).

Study design
This study analysed cross-sectional data from the 2023 World Health Survey Plus in Cambodia, a nationally representative cross-sectional study of 5271 individuals aged ≥18 years.

Methods
The survey used a GIS-based multistage sampling for all 24 Cambodian provinces and the capital city. T2D was measured by haemoglobin A1c or was self-reported. Logistic regression was used to examine the association between outcomes of interest and socio-demographic, behavioural, and metabolic factors.

Results
The weighted prevalence of T2D was 16.0% (95% CI: 14.2-17.9%), with 58.2% (95% CI: 51.9-64.3%) undiagnosed. Of diagnosed individuals, 32.9% (95% CI: 24.2-42.9%) were untreated with medication, and among treated individuals, 61.5% (95% CI: 47.4-74.5%) had poor glycaemic control. T2D prevalence was higher among older age, urban residency, high socioeconomic status, obesity, and hypertension. The prevalence of undiagnosed T2D was higher among younger individuals, less physically active, and those with no history of hypertension. Higher untreated prevalence was associated with rural residency, young individuals, and lower socioeconomic status.

Conclusions
The high prevalence of T2D, of previously undiagnosed and poorly managed T2D, emphasises the need for national policies that strengthen prevention, screening, and equitable access to care through primary healthcare and community-based services in Cambodia.