NEW DELHI: Nearly four out of every 10 diabetics in India are unaware they have the disease, a new study published in Lancet Global Health has claimed.The study is based on an analysis of a survey carried out among 57,810 adults aged 45 years and older from 2017 to 2019. It found that 20% of adults aged 45 years and above in the country had diabetes. “Prevalence among men and women was similar, at 20%,” the study said.It also found that prevalence of urban diabetes was approximately twice as high as in rural areas – which may reflect the differences in lifestyle and eating habits between people living in the two environments. The researchers from Mumbai-based International Institute of Population Sciences, the University of Michigan and the Harvard T H Chan School of Public Health, among others, have called for scaling up policies to better prevent, detect, manage, and control diabetes among middle-aged and older adults.India has the second highest number of adults with diabetes (20-79 yrs) in the world, and approximately 3% of the total deaths in India in 2019 were attributable to the disease. The number of people suffering from hypertension or high blood pressure is also on the rise, experts say.Easy access to medicines to manage the two conditions at early stages can help prevent serious complications. But studies suggest healthcare infrastructure in rural areas is far from ready.A team of researchers from ICMR and WHO among others, recently carried out a survey in 19 districts of seven states to find out how well-equipped the community and primary health centres were to manage diabetes and hypertension. They found only about four in 10 sub-centres (SCs) were prepared to treat hypertension and diabetes. Many of the rest didn’t even have basic medicines needed to manage the conditions. The survey found that out of 105 SCs assessed, nearly one-third had stockouts of tablet metformin (anti-diabetes medicine), and nearly half (45%) reported stockouts of tablet amlodipine, used to manage high blood pressure.