Type 2 Diabetes care cascade among adults aged 18 to 69 in Tanzania: Results from the 2023 National STEPS survey

Background: The diabetes care cascade outlines the steps required to achieve effective glycaemic control at the population level: screening, diagnosis, engagement in care, treatment initiation, and glycaemic control. In low- and middle-income countries, such as Tanzania, significant attrition occurs at various stages of the cascade, particularly between prevalence and diagnosis, and between treatment initiation and glycaemic control. Determinants of these gaps include patient, provider, and health-system factors, as well as geographic and sociodemographic inequities. Objective: To analyze the diabetes care cascade in Tanzania, identify points of attrition, and provide evidence for targeted interventions to improve detection, retention, and glycaemic control. Methods: A population-based cross-sectional study was conducted among Tanzanians aged 18–69 years. Data on diabetes prevalence, diagnosis, treatment, and glycaemic control were collected and analyzed. The cascade was disaggregated by age, sex, and urban/rural residence. Confidence intervals (CI) were calculated to assess the precision of estimates. Results: The overall prevalence of diabetes in the population aged 18–69 years was 2.9% (95% CI: 1.9–3.9), of these 0.9% (95% CI: 0.4–1.4) were currently on diabetes medication. Among identified diabetes cases, 72.4% were not previously diagnosed, 17.2% were previously diagnosed and on medication, and 10.3% were previously diagnosed but not on medication. Diabetes prevalence increased with age, with the highest rates observed in the 46–69 age group (6.5%, 95% CI: 3.8–9.1). Conclusion and Recommendations: The diabetes care cascade in Tanzania reveals significant gaps in screening, diagnosis, and treatment, with the majority of cases undiagnosed and untreated. Targeted interventions, such as community-based screening, task-sharing to primary care providers, improved medicine supply chains, and integration with other health platforms, are essential to address these gaps and reduce diabetes-related morbidity and mortality.