Prevalence and Socio-Behavioral Predictors of Undiagnosed Type 2 Diabetes in Middle-Aged Adults in Urban Slums

Abstract

Background: Undiagnosed type 2 diabetes is increasingly recognised as a critical driver of preventable morbidity in low-income urban settings where constrained access to screening and limited health literacy impede early detection. Middle-aged adults in informal settlements may be particularly vulnerable due to cumulative exposure to behavioural and social risk factors. Objective: To estimate the prevalence of undiagnosed type 2 diabetes among middle-aged adults living in urban slums in Pakistan and to identify key socio-behavioural predictors. Methods: A community-based cross-sectional study was conducted among adults aged 35–60 years selected through multistage sampling. Sociodemographic, behavioural, and anthropometric data were collected using a structured questionnaire, and fasting blood glucose was measured using calibrated glucometers. Undiagnosed diabetes was defined as fasting glucose ≥126 mg/dL in individuals without prior diagnosis. Logistic regression was used to identify independent predictors. Results: Of 326 participants, 14.7% had undiagnosed diabetes. Prevalence was higher in adults ≥51 years, individuals with obesity, those who were physically inactive, and those with low educational attainment. In multivariable models, age (AOR 1.08), obesity (AOR 2.91), physical inactivity (AOR 2.43), low education (AOR 2.57), and family history (AOR 2.12) were independent predictors. Conclusion: Undiagnosed diabetes is common among adults in urban informal settlements and is shaped by metabolic, behavioural, and social determinants. Community-based screening and targeted prevention strategies are essential to address detection gaps in these high-risk populations.