Trends and factors associated with diabetes screening, diagnosis and treatment in Peru, 2014-2024

Background: Timely access to screening, diagnosis, and treatment services is essential to prevent complications among people with diabetes. We evaluated trends and factors associated with self-reported diabetes screening, diagnosis, and treatment among Peruvian adults aged 18 years and older from 2014 to 2024. Methods: We analyzed data from the Health Questionnaire of the Demographic and Family Health Survey (ENDES). We used information on diabetes screening, diagnosis, and treatment, along with socio-demographic and clinical covariates. We fitted generalized linear models of the Poisson family with log link and robust variance, and performed Joinpoint regression to assess temporal trends. Results: The prevalence of screening increased from 24% to 31% (APC: 1%; p=0.483). Higher screening was associated with being female, having higher educational attainment, not being single, belonging to higher wealth quintiles, being insured, and having hypertension. In contrast, smoking and living in rural areas or the Highlands were associated with lower screening. The prevalence of diagnosis increased from 3% to 5% (APC: 7%; p<0.001). Higher diagnosis was associated with being female, not being single, higher wealth, being insured, and living in the Rainforest, while lower diagnosis was associated with higher education and living in rural areas or the Highlands. Among individuals with diabetes, treatment prevalence increased from 65% to 74% between 2014 and 2019 (APC: 2%; p=0.014), but decreased to 63% in 2024 (APC: -2%; p<0.001). Higher treatment was associated with being married/widowed/divorced, being insured, higher wealth, and having hypertension. Lower treatment was associated with higher education and living in the Highlands. Conclusions: Although the prevalences of diabetes screening and diagnosis have increased over the past 11 years, treatment has declined in the last five. Socio-demographic and clinical inequalities persist across all three indicators and should be considered in the planning of diabetes health services in Peru.