Title: The Prevalence of Diabetic Retinopathy on Screening Patients with Diabetes Mellitus, admitted to a Tertiary Care Centre in Rural South India
Authors: Harishankar S, Soman Mani, Anna Mathew, John Michael Raj
DOI: https://dx.doi.org/10.18535/jmscr/v4i12.50
Abstract
Background: Diabetic retinopathy is recognized as one of the ocular diseases with public health implications in India. The number of diabetic patients are rising rapidly; most of whom are not even aware of its complications. The risk of sight-threatening retinopathies is higher in diabetics. Screening of patients with diabetic retinopathy (damage to microvascular system of the retina due to prolonged hyperglycemia) is important in early detection and prevention of blindness. The relationship between duration of diabetes and severity of retinopathy can be assessed to figure out a remedy.
Objectives:
1. To evolve a screening programme for early detection of diabetic retinopathy (DR) in patients with Diabetes Mellitus (DM) admitted to this tertiary care hospital.
2. To find out how factors such as glycemic control and duration of illness affect severity of diabetic retinopathy in these patients.
Methodology: The study covered 70 diabetic patients from a rural tertiary care hospital. Demographic data, diabetic history and investigations were recorded in the case study form. The student investigator, who has earlier been trained in the skills lab and has practiced observing the fundus under supervision of ophthalmologists will perform a fundoscopic examination on the patient. They will then classify the patients into five groups. The data were collected and analyzed using chi-square test.
Results: The prevalence of DR (35.7%) was found to be higher in males. Risk of developing it was more in uncontrolled diabetics. 24.3% among those with retinopathy had mild non-proliferative retinopathy.
Conclusion: The study revealed that the risk of developing retinopathy was higher in male patients with uncontrolled diabetes. In this screening programme we were able to diagnose retinopathy in 25 of the 70 diabetic patients enrolled (35.7%). We hope this screening programme will continue for early detection of retinopathy.
Keywords: Diabetes Mellitus, Diabetic Retinopathy, fundoscopy, glycemic control, hyperglycaemia.
References
1. Rema M, Pradeepa R. Diabetic retinopathy: An Indian perspective. Indian J Med Res 125, March 2007, p 297-310.
2. Namperumalsamy P, Nirmalan PK, Ramasamy K. Developing a Screening Program to Detect Sight-Threatening Diabetic Retinopathy in South India. Diabetes Care. 2003;26(6):1831 -35.
3. Narendran V, John R K, Raghuram A, Ravindran R D, Nirmalan P K, Thulasiraj R D. Diabetic retinopathy among self-reported diabetics in Southern India: a population based assessment. Br J Ophthalmol 2002;86:1014–1018.
4. Raman R, Rani PK, Rachepalle, Gnanamo-orthy P, Uthra S, Kumaramanickavel G, Sharma T. Prevalence of Diabetic Retinopathy in India. Ophthalmology 2009;116(2):311-318.
5. Ramavat PR, Ramavat MR, Ghugare BW, Vaishnav RG, Joshi MU. Prevalence of Diabetic Retinopathy in Western Indian Type 2 Diabetic Population: A Hospital – based Cross – Sectional Study. Journal of Clinical and Diagnostic Research. 2013 Jul, Vol-7(7): 1387-1390. DOI: 10.7860/JCDR/2013/5259.3146.
6. Parvanova A, Iliev I, Filipponi M, Dimitrov BD, Vedovato M, Tiengo A, Trevisan R, Remuzzi G, Ruggenenti P.Insulin resistance and proliferative retinopathy: a case-control study in 115 patients with type 2 diabetes. J Clin Endocrinol Metab. 2004 Sep;89(9):4371-6.
7. Garg S, Diabetic Retinopathy Screening Update. Clinical Diabetes 2009;27(4):140-45.
8. Ferris FL 3rd, Davis MD, Aiello LM. Treatment of Diabetic Retinopathy. N Engl J Med 1999; 341: 667-678.
9. Dandona L, Dandona R, Naduvilath TJ, McCarty CA, Rao GN. Population based assessment of diabetic retinopathy in an urban population in southern india. Br J Ophthalmol 1999;83:937-40.
10. Agarwal RP, Ranku M, Beniwal R, Gothwal SR, Jain GC, Kochar DK, et al. Prevalence of diabetic retinopathy in type-2 diabetes in relation to risk factors. Hospital based study. Int J diabetes Dev Ctries 2003; 23:16-9.
11. Gadkari S, MaskatiQ, Nayak BK. Prevalence of diabetic retinopathy in India. The All India Ophthalmological Society Diabetic Retinopathy Eye Screening Study 2014; Indian Journal of Ophthalmology; Vol:64.
12. Yau JW, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski JW, Bek T, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care 2012;35:556-64.
13. Hu Y, Teng W, Liu L, Chen K, Hua R, et al. Prevalence and risk factors of diabetes and diabetic retinopathy in Liaoning province, China: A population based cross-sectional study. PLoS One 2015; 10:e0121477.
14. Jonas JB, Nangia V, Khare A, Matin A, Bhojwani K, Kulkarni M, et al. Prevalence and associated factors of diabetic retinopathy in rural central India. Diabetes Care 2013; 36:e69.
15. Schellini SA, Carvalho GM, Rendeiro FS, Padovani CR, Hirai FE. Prevalence of diabetes and diabetic retinopathy in a Brazilian population. Ophthalmic epidemiol 2014;21: 33-8.
16. Raman R, Ganesan S, Pal SS, Kulothungan V, Sharma T. Prevalence and risk factors for diabetic retinopathy in rural India. Sankara nethralaya diabetic retinopathy epidemiology and molecular genetic study III report no.2 BMJ Open Diabetes Res Care 2014;2:e000005.
17. Yang JY, Kim NK, Lee YJ, Noh JH, Kim DJ, Ko KS, et al. Prevalence and factors associated with diabetic retinopathy in a Korean adult population.
18. Kyari F, Tafida A, Sivasubramaniam S, Murthy GV, Peto T, Gilbert CE; Nigeria National Blindness and Visual Impairment Study Group.
19. Katulanda P, Ranasinghe P, Jayawardena R. Prevalence of retinopathy among adults with self-reported diabetes mellitus. BMC Ophthalmol 2014;14: 100.