Prevalence of retinopathy in non insulin dependent diabetes mellitus at a diabetes centre in southern India

Association of Vascular Endothelial Growth Factor (VEGF) and Mouse Model Minute 2 (MDM2) Polymorphisms With Diabetic Retinopathy in a Northwest Indian Population: A Case-Control Study

INTRODUCTION

Diabetic retinopathy (DR), a microvascular complication of type 2 diabetes (T2D), results from complex interactions of genetic and environmental factors. Vascular endothelial growth factor (VEGF) and mouse model minute 2 (MDM2)are upregulated in the retina due to diabetes, which increases the risk of DR. VEGFA and MDM2 genetic variations can influence DR risk. The present case-control study was conducted to evaluate the association of VEGFA and MDM2 promoter variants with DR in a population from Punjab, Northwest India.

METHODS

A total of 414 DR patients, 425 T2D patients without DR, and 402 healthy controls were screened for VEGFA -2578C/A (rs699947), VEGFA -2549I/D (rs35569394), VEGFA -7C/T (rs25648), and MDM2 rs3730485 polymorphisms using polymerase chain reaction (PCR)-based methods.

RESULTS

VEGFA -2549 I allele (OR = 1.35 (1.00-1.81), p = 0.043) and II genotype (OR = 1.78 (1.00-3.15), p = 0.047) were significantly associated with increased risk of DR. VEGFA -7 CT genotype conferred reduced risk of DR (OR = 0.28 (0.20-0.38); p = <0.001). VEGFA -2578 and MDM2 rs3730485 showed no significant association with DR. A-I-T (OR = 0.30 (0.20-0.44); p = <0.001) and C-D-T (OR = 0.33 (0.16-0.65); p = 0.002) haplotypes of rs699947-rs35569394-rs25648 polymorphisms showed decreased risk of DR.

CONCLUSIONS

I allele and II genotype of VEGFA -2549, CT genotype of VEGFA -7, and C-I-C and A-D-C haplotypes of rs699947-rs35569394-rs25648 polymorphisms were significantly associated with DR risk in a Northwest Indian population. This is the first study worldwide to report DR risk with VEGFA promoter variants together.

[Medico-surgical management of intravitreal hemorrhage in diabetic patients]

Vitreous hemorrhage (VH) is the main complication of proliferative diabetic retinopathy and remains the primary indication for vitrectomy in diabetic patients. The objective of our study is to compare our medical and surgical management of VH with data from the literature and to report the functional results of our series. We studied a series of 284 cases collected over 2 years in two tertiary care centers. In our series, 90.1% of patients had type 2 diabetes, and 70% had glycosylated hemoglobin greater than 7.5%. On fundus examination, 35.2% presented with stage 1 VH, 42.6% with stage 2, 3.6% with stage 3 and 5.2% with stage 4. Ocular ultrasound performed when fundus exam was difficult diagnosed an associated tractional retinal detachment in 8.8% of patients. Medical treatment was sufficient in 77.8% of patients, while 22.2% of our patients underwent vitrectomy, argon laser endophotocoagulation and postoperative anti-VEGF injection. Peeling of tractional fibrovascular membranes and or associated epiretinal membranes was performed in 69.8% of cases. Iatrogenic tears were noted in 11.8% of patients. In this study, 31.5% of patients underwent intraocular gas tamponade, while 23.8% of cases underwent silicone oil tamponade. Postoperative visual acuity improved by at least 2 lines in 60% of our patients, and the VH recurred in 24.2% of cases after surgery.

Determinants and Stratification of Microvascular Complications of Type 2 Diabetes Mellitus

Background Diabetes mellitus (DM) is a prevalent metabolic disorder characterized by high blood sugar levels. It is classified into type 1 (T1DM) and type 2 (T2DM), which have different mechanisms and complications. The global prevalence of diabetes, particularly T2DM, has increased significantly in recent decades, leading to a need for standardized data collection of macrovascular and microvascular complications to track disease progression and guide treatment options. This study aims to assess and correlate the prevalence and severity of microvascular complications in patients with T2DM. Methodology This observational, cross-sectional study was conducted at Poonam Multispeciality Hospital in Ahmedabad, India. A total of 4,123 diabetic patients admitted to the hospital were included. Information on sociodemographics and medical history was collected using standardized forms. Fundus photography and fluorescein angiography were performed to assess diabetic retinopathy, and estimated glomerular filtration rate and albumin-to-creatinine ratio were measured to evaluate renal function. Neurological examinations were conducted to score diabetic neuropathy. Chi-square tests were used to determine associations between medical history with diabetic retinopathy and nephropathy, and t-tests were used to compare diabetic neuropathy scores. Kendall's Tau correlation was used to determine correlations between diabetic retinopathy and nephropathy. P-values <0.05 were considered statistically significant. Results The overall prevalence of diabetic retinopathy, nephropathy, and neuropathy was 37.5%. Of the patients included, 47.9% had diabetic nephropathy and 28.9% had diabetic neuropathy. A significant association was observed between the severity of diabetic retinopathy and age, body mass index, duration of diabetes, and hemoglobin A1c (HbA1C) levels. Similarly, significant associations were found between these factors and the severity of diabetic nephropathy. Unpaired t-tests revealed significant differences in diabetic neuropathy examination scores based on the duration of diabetes and Hba1C levels. Moreover, correlation analysis indicated a low, positive correlation between diabetic retinopathy and diabetic nephropathy. Conclusions This study provides insights into the prevalence, severity, and associations of microvascular complications in patients with T2DM, contributing to the understanding and management of these conditions. Additionally, the research revealed a direct association between diabetic retinopathy and different stages of chronic kidney disease determined by the Kidney Disease Improving Global Outcome guidelines.

Classification of diabetic retinopathy: Past, present and future

Diabetic retinopathy (DR) is a leading cause of visual impairment and blindness worldwide. Since DR was first recognized as an important complication of diabetes, there have been many attempts to accurately classify the severity and stages of disease. These historical classification systems evolved as understanding of disease pathophysiology improved, methods of imaging and assessing DR changed, and effective treatments were developed. Current DR classification systems are effective, and have been the basis of major research trials and clinical management guidelines for decades. However, with further new developments such as recognition of diabetic retinal neurodegeneration, new imaging platforms such as optical coherence tomography and ultra wide-field retinal imaging, artificial intelligence and new treatments, our current classification systems have significant limitations that need to be addressed. In this paper, we provide a historical review of different classification systems for DR, and discuss the limitations of our current classification systems in the context of new developments. We also review the implications of new developments in the field, to see how they might feature in a future, updated classification.

The All India Ophthalmological Society - Academic and Research Committee pan-India diabetic retinopathy project "Fixing the missing link": Prevalence data from West Bengal

Purpose:

The aim of this study was to determine the prevalence of diabetic retinopathy (DR) and its risk factors among diabetic patients in rural and urban West Bengal (WB).

Methods:

Patients were screened in the physician's clinic by a team of ophthalmologist, optometrist and counsellor. Demographic details, diabetic control, compliance to eye checkup, awareness regarding diabetic blindness, and visual acuity were recorded using a questionnaire. DR was graded both by indirect ophthalmoscopy and fundus photo taken with a portable fundus camera.

Results:

A total of 1553 subjects were screened over 39 camps across 14 districts of WB over 17 months. The prevalence of DR was 21.51%, with a significant difference between rural (26.55%) and urban (13.89%) areas (P < 0.01). No significant difference with gender was seen (P = 0.99). Presence and grade of DR were related to age, loss of vision, diabetic age, diabetic control, awareness of diabetic blindness and last eye checkup.

Conclusion:

This study provides the first major prevalence data from WB, and gives valuable insight regarding modifiable risk factors for DR. It is also the first DR study in India to be conducted in the physician's clinic. The study results emphasise the need to “fix the missing link” between ophthalmologists and treating physicians to win the battle against DR.

Prevalence of diabetes related vascular complications in subjects with normal glucose tolerance, prediabetes, newly detected diabetes and known diabetes

AIMS

Varying prevalence of individual diabetes related vascular complications in prediabetes has been reported. However, very few studies have looked at both macrovascular and microvascular complications in prediabetes.

METHODS

Study subjects without any history of diabetes underwent oral glucose tolerance test (OGTT) and were classified as either normal glucose tolerance (NGT), prediabetes (PD), newly detected diabetes mellitus (NDDM) on the basis of American Diabetes Association (ADA) criteria. Age and sex matched known diabetes mellitus (KDM) patients were also recruited. All the participants were subsequently screened for both macrovascular (CAD, CVA,PVD) and microvascular (retinopathy, nephropathy and neuropathy)complications of diabetes.

RESULTS

Prevalence of vascular complications among prediabetes subjects was 11.1% as compared to 1.4% among NGT subjects, 13.9% among NDDM subjects and 23.8% among KDM subjects. There was no significant between complication rates in prediabetes and NDDM group (p = 0.060). The prevalence of macrovascular and microvascular complications among prediabetes subjects was 4.2% and 6.9% while the same in NDDM was 4.2% and 9.7%.

CONCLUSIONS

The proportion of subjects with prediabetes and vascular complications was about half of those with known diabetes and almost similar to those with newly detected diabetes mellitus.

The poor quality of diabetes care in a cluster randomized community survey from Delhi (DEDICOM-II): A crisis, an opportunity

AIMS

To evaluate the quality of care in known diabetes patients of Delhi.

METHODS

A cross-sectional survey was conducted using a two-stage cluster design. In all, 30 of 150 wards were chosen in Stage 1 (using a random computer-generated seed value and then selecting wards at a predefined sampling interval; Probability Proportionate to Size-Systematic) and one colony from each ward was selected randomly in Stage 2. The selected areas were surveyed house-to-house in one-of-four random directions to recruit a minimum of 25 subjects (known diabetes ≥1 year; 35-65 years of age) per area. Data were collected by interview, blood sampling and from medical records by specifically trained research staff.

RESULTS

A total of 843 subjects (of 1315 eligible) were enrolled from 11,490 houses. For the intermediate outcome measures, an estimated 33.5% (95% CI 27.3-40.2) had an HbA_1c value >10%, 67.2% (95% CI 62.8-71.4) had an LDL cholesterol level >100 mg/dl and 57.3% (95% CI 50.4-63.9) had BP levels >140/90 mmHg. For the processes of care in the last 1 year, 25.6% (95% CI 19.7-32.6) of the patients had an HbA_1c (A1c) estimation and 2.4% (95% CI 1.1-4.9) had a dilated eye examination and 4.1% (95% CI 2.6-6.2) had foot examination. Diabetes self-management education was provided to only 11.3% (95% CI 8.6-14.7) while nutrition counselling was provided to 56.0% (95% CI 51.7-60.2).

CONCLUSIONS

The glycaemic control, lipid control and BP management of known diabetes patients in Delhi are unacceptably poor and a wide gap exists between practice recommendations and delivery of diabetes care in Delhi.

Proportion of diabetic retinopathy among diabetics presenting for the first time to a tertiary eye institute in South India

PURPOSE

To detect the proportion of diabetic retinopathy (DR) among diabetics visiting a tertiary eye care institute and correlate presenting symptoms to clinical diagnosis.

METHODS

The study recruited 1000 eyes of 1000 diabetics visiting a tertiary eye care institute in South India for the first time. Along with basic demographic data and systemic history, details of presenting complaints and clinical diagnosis were noted.

RESULTS

Data from 956 cases were analyzed. There were 29 (3%) newly diagnosed diabetics and 927 (97%) known diabetics. The commonest reason for the hospital visit was diminution of vision (66%) followed by "visiting for a routine checkup" (22.3%). Diabetic retinopathy was seen in 492 (51.5%), cataract in 161(17%) and refractive error in 240 patients (79.2%). Vision-threatening DR was present in 216 cases (22.59%) and clinically significant macular edema in 73 cases (7.63%) at first presentation itself.

CONCLUSION

The cohort from a tertiary eye care institute has higher proportion of diabetic retinopathy, with vision-threatening DR at presentation. These data emphasize the need for more robust screening for DR, along with population awareness programs.

Achievement of guideline targets of glycemic and non-glycemic parameters in North Indian type 2 diabetes mellitus patients: A retrospective analysis

BACKGROUND AND AIMS

Though, the prevalence of diabetes is increasing in the worldwide, achievement of glycemic and non-glycemic targets remain suboptimal. We conducted this retrospective cross-sectional study at two endocrine clinics of Aligarh (Uttar Pradesh) in north India.

MATERIALS AND METHODS

After screening the records of 13800 patients, 12140 patients of type 2 diabetes mellitus who were attending the clinic regularly every three to four months, were included in the final analysis. The data regarding patient's height, weight, body mass index, blood pressure, blood glucose, HbA1c, lipid profile and complications were obtained.

RESULTS

Mean age was 49.7 ± 11.3 years; males and females were almost equal in number. 2891 (23.8%) subjects were of age less than 40 years. 9614 (80%) patients had diabetes duration of less than 5 years. 3311 (27.3%) subjects were having an HbA1c of <7%, HbA1c 7-8% in 3711 (30.5%), HbA1c 8-9% in 2653 (21.9%) whereas HbA1c of >9% in 2465 (20.3%) subjects. The microvascular complications; diabetic nephropathy, diabetic neuropathy and diabetic retinopathy were present in 7.5%, 14.9% and 16.2% respectively. Hypertension was present in 25.8% and coronary artery disease was present in 15.5% of patients. Overall 27.3%, 41.7%, 44.1%, 45.3% and 67.7% of patients achieved their HbA1c, triglyceride, HDL, LDL and hypertension targets respectively, as per American Diabetes Association 2020 guidelines.

CONCLUSION

Despite availability of multiple drugs and guidelines, the attainment rates of glycemic and non-glycemic targets remain suboptimal. A more aggressive approach in the treatment of type 2 diabetes is required.

Spectrum of eye disorders in diabetes (SPEED) in India. Report # 2. Diabetic retinopathy and risk factors for sight threatening diabetic retinopathy in people with type 2 diabetes in India

Purpose:

To assess the proportion of people with type 2 diabetes mellitus (T2DM) with diabetic retinopathy (DR) and sight-threatening DR (STDR) and associated risk factors in select eye-care facilities across India.

Methods:

In this observational study, data of people with T2DM presenting for the first time at the retina clinic of eye-care facilities across India was recorded. Data collected in 2016 over 6 months included information on systemic, clinical, and ocular parameters. International Clinical Diabetic Retinopathy (ICDR) classification scale was used to grade DR. STDR was defined as presence of severe nonproliferative (NPDR), proliferative diabetic retinopathy (PDR), and/or diabetic macular edema (DME).

Results:

The analysis included 11,182 people with T2DM from 14 eye-care facilities (mean age 58.2 ± 10.6 years; mean duration of diabetes 9.1 ± 7.6 years; 59.2% male). The age-standardized proportion of DR was 32.3% (95%Confidence Interval, CI: 31.4-33.2) and STDR was 19.1% (95%CI: 18.4-19.8). DME was diagnosed in 9.1% (95%CI: 8.5-9.6) and 10.7% (95%CI: 10.1-11.3) people had PDR. Statistically significant factors associated with increased risk of DR (by multivariate logistic regression analysis) were: male gender (Odds ratio[OR] 1.57, 95%CI: 1.16-2.15); poor glycemic control–glycated hemoglobin (HbA1c >10%)(OR 2.39, 95% CI: 1.1-5.22); requirement of insulin (OR 2.55, 95%CI: 1.8-3.6);history of hypertension (OR 1.42, 95%CI: 1.06-1.88) and duration of diabetes >15 years (OR 5.25, 95%CI: 3.01-9.15).

Conclusion:

Diabetic retinopathy was prevalent in 1/3^rd and sight-threatening DR in 1/5^th of people with T2DM presenting at eye-care facilities in this pan-India facility-based study. The duration of diabetes was the strongest predictor for retinopathy.

Periodontitis is an inflammatory disease of oxidative stress: We should treat it that way

Periodontitis is a highly prevalent disease. As it progresses, it causes serious morbidity in the form of periodontal abscesses and tooth loss and, in the latter stages, pain. It is also now known that periodontitis is strongly associated with several nonoral diseases. Thus, patients with periodontitis are at greater risk for the development and/or exacerbation of diabetes, chronic obstructive pulmonary disease, and cardiovascular diseases, among other conditions. Although it is without question that specific groups of oral bacteria which populate dental plaque play a causative role in the development of periodontitis, it is now thought that once this disease has been triggered, other factors play an equal, and possibly more important, role in its progression, particularly in severe cases or in cases that prove difficult to treat. In this regard, we allude to the host response, specifically the notion that the host, once infected with oral periodontal pathogenic bacteria, will mount a defense response mediated largely through the innate immune system. The most abundant cell type of the innate immune system - polymorphonuclear neutrophils - can, when protecting the host from microbial invasion, mount a response that includes upregulation of proinflammatory cytokines, matrix metalloproteinases, and reactive oxygen species, all of which then contribute to the tissue damage and loss of teeth commonly associated with periodontitis. Of the mechanisms referred to here, we suggest that upregulation of reactive oxygen species might play one of the most important roles in the establishment and progression of periodontitis (as well as in other diseases of inflammation) through the development of oxidative stress. In this overview, we discuss both innate and epigenetic factors (eg, diabetes, smoking) that lead to the development of oxidative stress. This oxidative stress then provides an environment conducive to the destructive processes observed in periodontitis. Therefore, we shall describe some of the fundamental characteristics of oxidative stress and its effects on the periodontium, discuss the diseases and other factors that cause oxidative stress, and, finally, review potentially novel therapeutic approaches for the management (and possibly even the reversal) of periodontitis, which rely on the use of therapies, such as resveratrol and other antioxidants, that provide increased antioxidant activity in the host.

Is central obesity associated with diabetic retinopathy in Chinese individuals? An exploratory study

Objective

To our knowledge, the independent association between central obesity, defined by waist circumference (WC) or waist-to-hip ratio (WHR), and diabetic retinopathy (DR) remains unknown in Chinese individuals.

Method

The study was conducted in two stages. First, the relationship between WC or WHR and DR was estimated in a case-control set (DR vs. non-DR) for the whole population before and after propensity score matching. Subsequently, a systematic review and meta-analysis was performed on evidence from the literature to validate the relationship.

Results

Of 511 eligible patients, DR (N = 156) and non-DR (N = 156) patients with similar propensity scores were included in the propensity score matching analyses. Central obesity (defined by WC) was associated with risk of DR (odds ratio [OR] 1.07, 95% confidence interval [95% CI] (1.03–1.10). The meta-analysis showed that central obesity significantly increased the risk of DR by 12% (OR 1.12, 95% CI 1.02–1.22). Analysis of data from 18 studies showed a significant association between continuous body mass index and risk of proliferative DR (OR 0.95, 95% CI 0.93–0.98; I² = 50%).

Conclusion

Central obesity, particularly as defined by WC, is associated with the risk of DR in the Chinese population.

Diabetes Care in India

BACKGROUND

Diabetes has become a major health care problem in India with an estimated 66.8 million people suffering from the condition, representing the largest number of any country in the world.

OBJECTIVE

The rising burden of diabetes has greatly affected the health care sector and economy in India. The goal of health care experts in India is to transform India into a diabetes care capital in the world.

METHODS

An expert detailed review of the medical literature with an Asian Indian context was performed.

FINDINGS

Recent epidemiologic studies from India point to a great burden from diabetes. Diabetes control in India is far from ideal with a mean hemoglobin A1c of 9.0%-at least 2.0% higher than suggested by international bodies. Nearly half of people with diabetes remain undetected, accounting for complications at the time of diagnosis. Screening can differentiate an asymptomatic individual at high risk from one at low risk for diabetes. Despite the large number of people with diabetes in India, awareness is low and needs to be addressed. Other challenges include balancing the need for glycemic control with risk reduction due to overly tight control, especially in high-risk groups and taking into account health care professional expertise, attitudes, and perceptions. Pharmacologic care should be individualized with early consideration of combination therapy. Regular exercise, yoga, mindful eating, and stress management form a cornerstone in the management of diabetes.

CONCLUSIONS

Considering the high cost incurred at various steps of screening, diagnosis, monitoring, and management, it is important to realize the cost-effective measures of diabetes care that are necessary to implement. Result-oriented organized programs involving patient education, as well as updating the medical fraternity on various developments in the management of diabetes, are required to combat the current diabetes epidemic in India.

Microvascular complications and their associated risk factors in type 2 diabetes mellitus

AIMS

The aim of this study was to determine the prevalence of microvascular complications and to identify the various risk factors related to these complications in subjects with diabetes.

MATERIALS AND METHODS

The study was cross-sectional and conducted in Outdoor of BIRDEM, from July 2014 to December 2014. Subjects were considered at age 30 to 60 years and duration of diabetes was 2-10 years. Investigations included socio-demographic, anthropometry and blood pressure. Blood samples were collected for HbA1c, fasting plasma glucose (FBG), 2-h after breakfast (2-hBG), total cholesterol (chol), triglyceride (TG), LDL, HDL, Hb% and serum creatinine. All the complications were taken from the medical record books which was diagnosed by physician.

RESULTS

A total of 400 type 2 diabetes mellitus patients were investigated in this study. The mean and SD of age was 50.05±7.54. The male and female subjects were 41.5% and 58.5% respectively. The prevalence of diabetic retinopathy, nephropathy, neuropathy was 12.3%, 21.3% and 16.8% respectively. Logistic regression model estimated that increasing age (age>50y; OR=3.04; p=<0.001), female participants (OR=1.35; p=<0.04), rural patients (OR=3.75; p=<0.001), housewife (OR=1.89; p=<0.01) and retired patients (2.50; p=<0.03), lack of physical exercise, increasing HbA1c (p=<0.001), FBG (p=<0.001), 2-hBG (<0.001) and blood pressure (p=0.000) had independent significant risk factors for any of three microvascular complications.

CONCLUSION

This study observed that about all the microvascular complications were developed from first three years after registration at BIRDEM. Increasing age, HbA1c, FBG, 2-hBG and blood pressure had significant risk factors for any type of microvascular complications.

The Status of Maculopathy in Diabetes and Prediabetes Patients in a Population-Based Study Detected by Optical Coherence Tomography: The 2011 Health Examination Survey in Beijing

Objective

The aim of the study was to investigate the prevalence and the risk factors of maculopathy detected by optical coherence tomography (OCT) in a Chinese population with diabetes or prediabetes. Methods. 8,155 people were randomly selected to participate in the 2011 annual Health Examination Survey in Beijing. A 75 g oral glucose tolerance test (OGTT) was tested in 3760 subjects with fasting plasma glucose (FPG) ≥ 5.6 mmol/L. Of 3,760 subjects, 583 were also randomly selected to take OCT.

Results

In this study population, 21 (3.95%) patients had maculopathy. Eight patients had diabetes macular edema (DME) and the prevalence was 6.72% in diabetes patients and 1.51% in all subjects. Eleven patients had age-related macular degeneration (AMD) and the prevalence was 3.36% in diabetes patients and 2.07% in all subjects. Logistic regression model confirmed that elevated HbA1c (p < 0.001) and systolic pressure (p < 0.05) made significant contributions to DME. Stepwise regression analysis revealed that HbA1c and blood creatinine were significantly independent influence factors for central subfield thickness (CST) (p = 0.01, p < 0.001).

Conclusions

High prevalence of maculopathy was found in patients with diabetes in a Chinese population. Maculopathy poses a significant public health problem in China with rapid rising trend of diabetes.

Body mass index and risk of diabetic retinopathy: A meta-analysis and systematic review

Diabetic retinopathy (DR) is a frequent cause of acquired blindness worldwide. Various studies have reported the effects of body mass index (BMI) on the risk of DR, but the results remain controversial. Therefore, a meta-analysis was performed to evaluate the relationship between BMI and the risk of DR.A systematic search was performed using the Cochrane Library, PubMed, and Embase databases to obtain articles published through December 2016. Articles regarding the association between BMI and the risk of DR were retrieved. The adjusted odds ratios (ORs) and their 95% confidence intervals (CIs) were included and then pooled with a random effects model.A total of 27 articles were included in this meta-analysis. When BMI was analyzed as a categorical variable, neither being overweight (OR = 0.89, 95% CI 0.75-1.07; P = .21; I = 65%) nor obesity (OR = 0.97, 95% CI 0.73-1.30; P = .86) were associated with an increased risk of DR when compared with normal weight. When BMI was analyzed as a continuous variable, a higher BMI was not associated with an increased risk of DR (OR = 0.99, 95% CI 0.97-1.01; P = .25; I2 = 79%). The pooled results did not significantly change after the sensitivity analysis.Based on the current publications, neither being overweight nor obesity is associated with an increased risk of DR. Further studies should confirm these findings.

Prevalence of type 2 diabetes and its complications in India and economic costs to the nation

Diabetes, a major lifestyle disorder, has become a global burden, and the prevalence rates are rising steeply in developing economies. Rapid socioeconomic transition with urbanization and industrialization are the main causes for the global diabetes epidemic. Among developing economies, the highest increase in number of people with diabetes is in China followed by India. In India, the epidemic of diabetes continue to increase and is experiencing a shift in diabetes prevalence from urban to rural areas, the affluent to the less privileged and from older to younger people. Diabetes is a progressive disorder leading to complications, which are broadly divided into small vessel or microvascular disease and large vessel or macrovascular disease. Microvascular complications affect the inner part of the eye-the retina known as diabetic retinopathy, the kidney termed as diabetic nephropathy and the peripheral nerves termed as diabetic neuropathy. The macrovascular complications affect the heart, the brain and the peripheral arteries termed as cardiovascular disease, cerebrovascular disease and peripheral vascular disease, respectively. Given the lifelong expenditure associated with diabetes and its complications, individuals, families and the society are unable to cope with the economic, emotional and social disease burden due to diabetes. The economic burden of diabetes can be reduced by providing universal healthcare coverage, access to affordable medicines and early detection and treatment of the disorder. This emphasizes the need for a multi-prolonged strategy to minimize the burden of diabetes and its complications.

Diabetic retinopathy and the associated risk factors in diabetes type 2 patients in Abha, Saudi Arabia

Objectives:

To assess the proportion and grades of retinopathy and its risk factors in diabetes type 2 patients.

Materials and Methods:

This was a cross-sectional study of 401 type 2 diabetic patients. A questionnaire and checklist were used to collect the data. Retinopathy was diagnosed and graded by fundus photographs and slit lamp examination. The duration of diabetes, age of patients, age at onset of diabetes, body mass index, hemoglobin A1c level, blood pressure, and complications were noted.

Results:

The mean age of male and female patients was 54.93 and 54.25 years; 57.6% were males. The mean age of onset and mean duration of diabetes were 43.91 and 13.4 years, respectively. The proportion of retinopathy was 36.4%. Grades of retinopathy were: Mild 57.5%, moderate 19.9%, severe nonproliferative 11%, and proliferative retinopathy 11.6%; 7.2% of patients had maculopathy. Retinopathy was significantly associated with older age, younger age at onset, longer duration of disease, poorly controlled blood sugar, hypertension, insulin use; the presence of neuropathy and nephropathy appeared as a significant risk. Younger age at onset, longer duration, and insulin use appeared as the strongest predictors for diabetic retinopathy.

Conclusions:

More than a third (36.4%) of the diabetic patients attending a diabetic center had retinopathy. The control of the risk factors may reduce both prevalence and consequences of retinopathy.

Quality of diabetes care in low- and middle-income Asian and Middle Eastern countries (1993-2012): 20-year systematic review

OBJECTIVE

To assess the extent to which people with diabetes in low- and middle-income countries (LMIC) of Asia and the Middle East met evidence-based care recommendations through a systematic review of published literature.

METHODS

Electronic searches of Medline and Embase were carried out for studies assessing quality of care among people with diabetes in Asia and the Middle East between 1993 and 2012. Benchmarking against American Diabetes Association guidelines, we reported level and proportions meeting recommended risk factor control (glycated hemoglobin [HbA1c], blood pressure, and low density lipoprotein-cholesterol [LDL]) and preventive care processes across different settings.

RESULTS

One hundred and fifteen publications met eligibility for inclusion (91 reported risk factor control, 7 reported preventive processes, and 17 reported both). Only China, Thailand, Malaysia and Philippines had nationally representative data. Mean HbA1c (6.5-11% or 48-97 mmol/mol), SBP (120-152 mm Hg), and LDL (2.4-3.8 mmol/l) varied greatly. Despite variation in availability of data, studies consistently showed that recommended care goals were not being achieved.

CONCLUSIONS

The practice of auditing and benchmarking against evidence-based guidelines appears to be uncommon in Asia and the Middle East and there was heterogeneity of reporting across studies, populations, and methods used. The available data showed inadequate care.

Chronic complications in newly diagnosed patients with Type 2 diabetes mellitus in India

BACKGROUND

Prevalence of diabetes is on an increase in India, currently there is limited nation-wide data regarding the prevalence of chronic complications in diabetic patients at diagnosis. This information will help health-care professionals approach management more aggressively to prevent complications.

OBJECTIVE

To determine the prevalence of chronic complications in newly-diagnosed Type 2 diabetic (T2D) patients in India.

DESIGN AND METHODS

This was a cross-sectional survey of T2D patients, diagnosed within 3 months of their first visit to the centers doing the survey. Each patient was screened for diabetic complications, hypertension, dyslipidemia, and body mass index. Family history was recorded. Standard protocols were used to make the diagnosis of retinopathy, neuropathy and nephropathy. Data analysis was carried out using the standard statistical techniques.

RESULTS

Of the total 4,600 (males 67%, females 33%) newly diagnosed patients with T2D, majority were from the age group 41-50 years (40%). 13.15% of newly detected India T2D had neuropathy 6.1% had retinopathy and 1.06% had nephropathy. Risk factors of macro vascular complication such as hypertension, obesity, and dyslipidemia were observed in 23.3%, 26%, and 27% of patients respectively. Ischemic heart disease was noticed in 6%.

CONCLUSION

High prevalence of micro vascular complications was present at diagnosis along with association of CV cardiovascular risk factors among Indian T2D. In view of this, screening must be instituted for all diabetics for complications at the time of diagnosis itself.

Epidemiology and treatment outcomes of diabetic retinopathy in a diabetic population from Cameroon

BACKGROUND

Diabetic retinopathy (DR) is the most common microvascular complication of diabetes. It can lead to significant visual loss. The aim of this study was to determine the frequency and clinical profile of diabetic retinopathy, and assess the outcomes of laser photocoagulation therapy in a diabetic population in Cameroon.

METHODS

We carried out a prospective cohort study during 24 months in the Department of Ophthalmology of the Douala General Hospital, Cameroon. We included all diabetic patients who were referred from diabetes clinics for ophthalmologic evaluation. Data included type and duration of diabetes, visual acuity, intra-ocular pressure, results of fundoscopy and fluorescein angiography, and outcomes two months after treatment with laser photocoagulation.

RESULTS

We included 407 patients; 88% had type 2 diabetes. Their mean duration of diabetes was 6.4 years (SD=6.6). Forty point three percent (164/407) of patients were found to have DR on fundoscopy. Of the 164 patients with DR, 63.4% (104/164) had non-proliferative and 36.6% (60/164) had proliferative DR. Diabetic maculopathy was found in 14.5% (59/407) of all participants, and 36% (59/164) of patients with DR. There was a strong correlation between the duration of diabetes and retinopathy status (p < 0.001, r = 0.9541). Overall, 17.4% (71/407) of patients were eligible for laser photocoagulation. Of these, 66.2% (47/71) were treated, and 78.7% (37/47) of treated patients came back for control two months later. Among these treated patients an improvement of the retinopathy was noted in 73% (27/37), no change in 16.2% (6/37) and a worsening in 10.8% (4/37). Severe proliferative DR was significantly associated with treatment failure (p < 0.001).

CONCLUSIONS

The frequency of DR may be high among diabetic patients in Cameroon. There was a good uptake of laser photocoagulation therapy among patients affected by DR in our setting, with good treatment outcomes. Interventions to prevent diabetes and increase the precocity of diagnosis and treatment of DR should be scaled up.

Prevalence of microvascular complications in newly diagnosed patients with type 2 diabetes

Background & Objective: Microvascular complications are the major outcome of type 2 Diabetes Mellitus progression, which reduce the quality of life, incur heavy economic burdens to the health care system and increase diabetic mortality. The aims of this study were to assess the prevalence of microvascular complications among newly diagnosed type 2 diabetic patients and to analyze the association between these complications and poor glycemic control.

Methods: This cross sectional hospital based study was carried out in Diabetic Clinic of Shaikh Zayed Postgraduate Medical Institute, Lahore Pakistan. The study was conducted from November 2011 to November 2012 among newly diagnosed type 2 diabetic patients. Relevant information of all patients was recorded with the help of a proforma. They were investigated for retinopathy, nephropathy and neuropathy.

Results: We have divided the patients into two groups: Group I with good glycemic control (HbA₁c <6.5) and group II with poor glycemic control (HbA₁c >6.5). In group II microvascular complications were 89.8%. Neuropathy, nephropathy and retinopathy were present in 68.5%, 56.2% and 31.4% respectively. These similar percentages in Group I were 50%, 0% and 31% respectively and are significantly lower.

Conclusion: The study showed that even in newly diagnosed type 2 diabetic patients who had poor glycemic control, frequency of microvascular complications is much higher as compared to those who had average glycemic control. Thus tight glycemic control does count even in newly diagnosed type 2 diabetics to prevent and minimize the occurrence of complications.

Prevalence of Diabetic Retinopathy in Western Indian Type 2 Diabetic Population: A Hospital - based Cross - Sectional Study

CONTEXT

Diabetic Retinopathy (DR) can be defined as a damage which is caused to microvasculature in the retina by prolonged hyperglycaemia. Various studies have been conducted in south India, to find out prevalence of DR. It remains a less explored domain among type 2 diabetic patients in western India.

OBJECTIVES

(1) To assess prevalence of diabetic retinopathy in type 2 DM in western Indian population. and (2) To find out effect of duration of diabetes on severity of DR in this population.

STUDY DESIGN

A hospital - based, cross - sectional study.

MATERIAL AND METHODS

A total of 168 patients with type 2 DM underwent detailed opthalmoscopic examinations for DR. The ETDRS classification was followed to categorize retinopathy in different stages.

RESULTS

We observed that overall, prevalence of DR in type 2 patients of western India was 33.9%. Prevalences of non-proliferative DR and proliferative DR were 25.5% and 8.33% respectively. Statistically significant differences (p value<0.05) were observed between prevalences of DR in each group of patients which was classified, and duration of diabetes. Prevalence of CSME (clinically significant macular oedema) was 6.5%. Associated hypertension showed a statistically significant (p value<0.05%), higher prevalence of DR.

CONCLUSION

This study concluded that prevalence of DR in type 2 DM patients of western India was 33.9% and that it increased with duration of diabetes. Associated hypertension is a risk factor for development of DR. It was further noted that proliferative DR was prevalent only after having diabetes for 11 years.

Prevalence of diabetic complications in rural goa, India

OBJECTIVE

To determine the prevalence of diabetes mellitus (DM) and its associated diabetic complications in rural Goa, India.

MATERIALS AND METHODS

A community-based study was carried out in a rural setting in Goa, India. About 1,266 participants were selected by systematic random sampling. The participants were interviewed using a semi-structured questionnaire and were subjected to anthropometric, clinical evaluation and biochemical investigations. American Diabetes Association criteria were used to determine the prevalence of diabetes and standard operational definitions were used to define the diabetic complications. Data was analyzed using SPSS version 14.0 while chi-square and chi-square for trend were the tests used.

RESULTS

Among the total 1,266 study participants about 130 (10.3%) were diabetics. The prevalence of the associated diabetic complications were as follows viz. neuropathy (60%), CHD (32.3%) and cataract (20%), retinopathy (15.4%), peripheral vascular disease (11.5%) and cerebrovascular accidents (CVAs) (6.9%). A significant rising trend in the prevalence of all diabetic complications was observed with advancing duration of diabetes.

CONCLUSION

The prevalence of DM and its associated complications was higher among the diabetic individuals in the rural setting of Goa, India. All the associated diabetic complications observed need to be addressed with appropriate prevention and control strategies.

Prevalence of diabetic retinopathy in various ethnic groups: a worldwide perspective

The alarming rise in diabetes prevalence is a global public health and economic problem. Diabetic retinopathy is the most common complication of diabetes and the leading cause of blindness among working-age populations in the Western world. Screening and prompt treatment of diabetic retinopathy are not top priorities in many regions of the world, because the impacts of other causes of preventable blindness remain an issue. Ethnicity is a complex, independent risk factor for diabetic retinopathy. Observations from white populations cannot be extrapolated fully to other ethnic groups. The prevalence of diabetic retinopathy, sight-threatening diabetic retinopathy, and clinically significant macular edema are higher in people of South Asian, African, Latin American, and indigenous tribal descent compared to the white population. Although all ethnic groups are susceptible to the established risk factors of diabetic retinopathy-such as length of exposure and severity of hyperglycemia, hypertension, and hyperlipidemia-ethnic-specific risk factors also may influence these rates. Such risk factors may include differential susceptibility to conventional risk factors, insulin resistance, differences in anthropometric measurements, truncal obesity, urbanization, variations in access to healthcare systems, genetic susceptibility, and epigenetics. The rates of nonproliferative diabetic retinopathy appear to be declining in the United States, supporting the observation that better medical management of diabetes and prompt treatment of sight-threatening diabetic retinopathy substantially improve the long-term diabetic retinopathy incidence; studies from other parts of the world are limited and do not mirror this finding, however. We examine the ethnicity and region-based prevalence of diabetic retinopathy around the world and highlight the need to reinforce ethnicity-based screening and treatment thresholds in diabetic retinopathy.

Clinical profile of diabetes in the young seen between 1992 and 2009 at a specialist diabetes centre in south India

AIM

To describe the trends and clinical profile of young diabetic patients (YD) attending a tertiary diabetes centre in south India.

METHODS

We reviewed medical records of 2630 YD patients (age at onset ≤25 years) registered between 1992 and 2009. Patients were classified as type 1 diabetes (T1DM), type 2 diabetes (T2DM) gestational diabetes mellitus (GDM) and other types. Retinopathy was assessed initially by direct and indirect ophthalmoscopy and later by retinal photography, nephropathy if urine protein excretion was >500 mg/day, neuropathy if vibration perception threshold on biothesiometry was ≥20 V.

RESULTS

The percentage of YD patients rose from 0.55% in 1992 to 2.5% in 2009 (trend chi square, 15.1, p<0.001). Of the 2630 YD subjects registered, 1135 (43.2%) had T1DM, 1262 (48.0%) had T2DM, 118 (4.5%) had GDM and 115 (4.4%) other types. T1DM patients were younger, had lower body mass index, waist circumference, systolic and diastolic blood pressures, and less family history of diabetes compared to T2DM (p<0.001 for each). Retinopathy was seen in 71.9% and 77.3% nephropathy in 22.1% and 12.1% and neuropathy in 34.5% and 21.4% of T2DM and T1DM respectively in those with ≥15 years duration of diabetes.

CONCLUSIONS

The percentage of YD in south India is increasing, predominantly due to early onset T2DM.

Status of B-vitamins and homocysteine in diabetic retinopathy: association with vitamin-B12 deficiency and hyperhomocysteinemia

Diabetic retinopathy (DR) is a common cause of blindness. Although many studies have indicated an association between homocysteine and DR, the results so far have been equivocal. Amongst the many determinants of homocysteine, B-vitamin status was shown to be a major confounding factor, yet very little is known about its relationship to DR. In the present study, we, therefore, investigated the status of B-vitamins and homocysteine in DR. A cross-sectional case–control study was conducted with 100 normal control (CN) subjects and 300 subjects with type-2 diabetes (T2D). Of the 300 subjects with T2D, 200 had retinopathy (DR) and 100 did not (DNR). After a complete ophthalmic examination including fundus fluorescein angiography, the clinical profile and the blood levels of all B-vitamins and homocysteine were analyzed. While mean plasma homocysteine levels were found to be higher in T2D patients compared with CN subjects, homocysteine levels were particularly high in the DR group. There were no group differences in the blood levels of vitamins B1 and B2. Although the plasma vitamin-B6 and folic acid levels were significantly lower in the DNR and DR groups compared with the CN group, there were no significant differences between the diabetes groups. Interestingly, plasma vitamin-B12 levels were found to be significantly lower in the diabetes groups compared with the CN group; further, the levels were significantly lower in the DR group compared with the DNR group. Higher homocysteine levels were significantly associated with lower vitamin-B12 and folic acid but not with other B-vitamins. Additionally, hyperhomocysteinemia and vitamin-B12 deficiency did not seem to be related to subjects' age, body mass index, or duration of diabetes. These results thus suggest a possible association between vitamin-B12 deficiency and hyperhomocysteinemia in DR. Further, the data indicate that vitamin-B12 deficiency could be an independent risk factor for DR.

Prevalence and determinants of diabetic retinopathy in Al hasa region of saudi arabia: primary health care centre based cross-sectional survey, 2007-2009

PURPOSE

To evaluate the prevalence of diabetic retinopathy (DR) in the urban and rural areas of Al Hasa region of Saudi Arabia and to determine risk factors related to DR.

MATERIALS AND METHODS

This study was conducted on patient attending primary health care centers between July 2007 and June 2009. A retrospective chart review was conducted on subjects with diabetes mellitus greater than 18 years old. Ophthalmologists examined DR status through dilated pupils by using direct, indirect, and slit lamp bio-microscopy. Frequencies, percentage, and their 95% confidence intervals (CIs) were calculated. Odd's ratio was used to associate DR with possible risk factors. A P value less than 0.05 was considered statistically significant.

RESULTS

The prevalence of DR among 473 diabetic subjects was 30% (95% CI: 25.80-34.20). The odd ratios (ORs) of DR among diabetic residing in an urban area was significantly higher than diabetics residing in rural areas [OR = 1.94 (95% CI of OR 0.82-2.89)]. DR was associated to the duration of diabetes (adjusted OR = 1.70), uncontrolled blood sugar level (adjusted OR = 1.96), hyperlipidemia (adjusted OR = 2.04), and hypercholesterolemia (adjusted OR = 2.80).

CONCLUSIONS

DR appears to be a public health problem in the Al Hasa district of Saudi Arabia, and a planned approach is required to avoid severe visual impairment in patients with diabetes mellitus. Primary prevention and early detection could be implemented through primary health centers and non-ophthalmologists.

Current scenario of diabetes in India

India, a country experiencing rapid socioeconomic progress and urbanization, carries a considerable share of the global diabetes burden. Studies in different parts of India have demonstrated an escalating prevalence of diabetes not only in urban populations, but also in rural populations as a result of the urbanization of lifestyle parameters. The prevalence of prediabetes is also high. Recent studies have shown a rapid conversion of impaired glucose tolerance to diabetes in the southern states of India, where the prevalence of diabetes among adults has reached approximately 20% in urban populations and approximately 10% in rural populations. Because of the considerable disparity in the availability and affordability of diabetes care, as well as low awareness of the disease, the glycemic outcome in treated patients is far from ideal. Lower age at onset and a lack of good glycemic control are likely to increase the occurrence of vascular complications. The economic burden of treating diabetes and its complications is considerable. It is appropriate that the Indian Government has initiated a national program for the management and prevention of diabetes and related metabolic disorders. Lifestyle modification is an effective tool for the primary prevention of diabetes in Asian Indians. The primary prevention of diabetes is urgently needed in India to curb the rising burden of diabetes.

The prevalence and severity of diabetic retinopathy, associated risk factors and vision loss in patients registered with type 2 diabetes in Luganville, Vanuatu

AIM

To determine the prevalence and severity of diabetic retinopathy in patients with type 2 diabetes in Luganville, the second largest town in Vanuatu. Additionally, to investigate risk factors for retinopathy and the effect of retinopathy on visual acuity (VA) within this group.

METHOD

All 83 registered patients with type 2 diabetes in Luganville, a town of 13 121 people, were invited for an interview and anthropometric measurements. A questionnaire including assessment of hypertension and glycaemic control, which are known risk factors for diabetic retinopathy, was administered. This sample accounted for approximately 1.07% of Luganville's adult population. Presenting VA was measured. The retina was photographed with a non-mydriatic fundus camera and images later independently graded for the extent of retinopathy.

RESULTS

68 (82%) of the 83 patients attended. The mean (SD) age was 54 (11) years and 31 (46%) were male. Diabetic retinopathy was present in 36 (52.9%) of the sample. Sight-threatening retinopathy requiring urgent referral was present in 15 (22.1%) patients. Presenting VA was worse than 6/12 in the better eye in n = 32 (47%) and in up to half of these cases the principal cause was retinopathy. In addition, four people had uniocular blindness resulting from diabetes. The mean body mass index was lower in those patients with diabetes with retinopathy than in those without (p = 0.010), but there were no other significant differences between the two groups and, specifically, no difference in the frequency of retinopathy risk factors. 42 (61.8%) patients had hypertension (>or=135/85 mm Hg) or were taking antihypertensive therapy.

CONCLUSIONS

The prevalence of registered patients with diabetes in Luganville's adult population was 1.07%. Diabetic retinopathy was highly prevalent in the sample (in 36, 52.9%), and in 15 (22.1%) there was a significant threat to sight, with up to 25% of the sample possibly already affected by decreased VA or blindness resulting from diabetes-related eye disease. Retinopathy risk factors were also prevalent. A diabetes screening programme with baseline ophthalmic assessment and follow-up are urgently needed to enable timely intervention and treatment.

Epidemiology of diabetic retinopathy and macular oedema: a systematic review

AIMS

To systematically review the literature on the prevalence and incidence of diabetic retinopathy (DR) and macular oedema (MO).

METHODS

A search of the bibliographic databases (Medline, Embase, CINAHL) was conducted up to October 2001. Selected relevant studies were scrutinized and included in the review.

RESULTS

A total of 359 studies were included. The studies were reported in nearly 100 different journals and in over 50 countries. The majority of the studies were US-based, with large studies such as the Wisconsin Epidemiologic Study of Diabetic Retinopathy dominating the literature. The studies were quite dated and highly heterogeneous in nature in terms of patient selection with variable inclusion criteria (age range, gender, diabetes duration and type, ethnicity, comorbidity, and DR status, assessment, and classification).

CONCLUSIONS

There are inconsistencies between epidemiological studies, and differences in study methods may contribute to conflicting reports of prevalence and incidence of DR and MO in diabetic populations. As new therapies for DR and its associated complications emerge, the need to capture and monitor new epidemiological data becomes increasingly important to be able to assess the impact and effectiveness of these therapies. Robust, longitudinal capture of patient data is, therefore, essential to evaluate the impact of current practice on the epidemiology of diabetic eye complications.

Prevalence of diabetic complications in fibrocalculous pancreatic diabetic patients and type 2 diabetic patients: a cross-sectional comparative study

OBJECTIVE

To determine the prevalence of diabetes-related complications in subjects with fibrocalculous pancreatic diabetes (FCPD) and compare them with subjects with type 2 diabetes mellitus matched for age, sex, and duration of diabetes.

METHODS

The study group comprised of 277 FCPD patients and 277 age, sex, and duration of diabetes-matched type 2 diabetic patients. All the study subjects underwent a detailed clinical examination, and fasting blood samples were obtained for biochemical studies. Peripheral Doppler was used for diagnosis of peripheral vascular disease (PVD). Vibratory perception threshold (VPT) was determined using biothesiometry for diagnosis of neuropathy. Diagnosis of coronary artery disease (CAD) was based on medical history and 12-lead resting ECG. Retinal photographs were used for diagnosis of retinopathy using a modified version of Early Treatment Diabetic Retinopathy Study (ETDRS) grading system.

RESULTS

FCPD patients had lower body mass index (BMI) (P<.001), systolic blood pressure (P<.0001), diastolic blood pressure (P<.001), serum cholesterol (P<.001), serum triglyceride (P<.001), and serum creatinine (P<.01) but higher glycosylated hemoglobin (P<.001) levels compared to patients with type 2 diabetes. Prevalence of CAD was significantly higher among type 2 diabetic patients (11.9%) compared to FCPD patients (5.1%), P<.003. There was no significant difference in the prevalence of other diabetic complications between the two study groups (type 2 diabetes vs. FCPD: retinopathy-37.2% vs. 30.1%, PVD-4.3% vs. 4.7%, Neuropathy-25.3% vs. 20.9%, Nephropathy-15.0% vs. 10.1%). Multiple logistic regression analysis revealed the following risk factors for diabetes complications among type 2 diabetic subjects-retinopathy: BMI (P=.028), duration of diabetes (P<.001), and glycosylated hemoglobin (P=.026); nephropathy: diastolic blood pressure (P=.016) and glycosylated hemoglobin (P=.040); neuropathy: age (P<.001), duration of diabetes (P=.003), and glycosylated hemoglobin (P=.001). Among subjects with FCPD, systolic blood pressure (P=.013), glycosylated hemoglobin (P=.021), and duration of diabetes (P<.001) were associated with retinopathy; BMI (P=.057), glycosylated hemoglobin (P=.010), and duration of diabetes (P=.024) with nephropathy and age (P=.011) and BMI (P=.010) with neuropathy.

CONCLUSION

The prevalence of retinopathy, nephropathy, neuropathy, and PVD was similar among FCPD patients and type 2 diabetic patients, but the prevalence of CAD was lower among FCPD patients.

Diabetic retinopathy in Oman: a hospital based study

The magnitude of diabetic retinopathy, its determinants, and coverage of laser treatment for diabetic retinopathy among registered people with diabetes in Oman are presented. 2249 randomly selected subjects representing 5564 registered diabetics were examined. WHO recommended definitions of diabetes, retinopathy, and other related conditions were used. Physicians reported the profile of the diabetes while ophthalmologists reported ocular profile and the eye care provided to them. The prevalence of diabetic retinopathy was 14.39% (95% CI 13.46 to 15.31). Men had significantly higher rate of retinopathy than women. The retinopathy rate was higher in age groups 50-59 years and 60-69 years. The rates of background retinopathy, proliferative retinopathy, and diabetic maculopathy were 8.65%, 2.66%, and 5.12%, respectively. The rate was higher among subjects with longer duration of diabetes than those with a shorter duration. Those with an HbA(1c) level more than 9% had significantly higher rates of diabetic retinopathy than those with an HbA(1c) level less than 9%. The retinopathy rate was higher in cases with hypertension, nephropathy, and neuropathy. Of those with diabetic retinopathy who were advised to have treatment at the time of registration, only 20% were treated with laser therapy.

Diabetic retinopathy among self reported diabetics in southern India: a population based assessment

AIMS

To estimate the prevalence of diabetic retinopathy among self reported diabetics in a population of southern India.

METHODS

A cross sectional sample of subjects aged 50 years and older was selected using a cluster sampling technique from Palakkad district of Kerala state. Eligible subjects were identified through a door to door survey. Ocular examinations including visual acuity and anterior and posterior segment examinations were performed at preselected sites within clusters. History of diabetes was elicited, and height, weight, and blood pressure were measured for all subjects.

RESULTS

Among the 5212 examined people (92% response rate), 68 (26.2%) of 260 people with self reported history of diabetes had diabetic retinopathy. The age-sex adjusted prevalence of diabetes among people aged 50 years and older was 5.1% (95% CI 3.9, 6.3, deff 4.33) and of diabetic retinopathy among the diabetics was 26.8% (95% CI: 19.2, 34.4, deff 1.99). Non-proliferative diabetic retinopathy (94.1%) was the most common form of retinopathy seen. Two eyes were blind (presenting vision <6/60) as a result of retinopathy.

CONCLUSION

Preventive strategies have to be evolved to ensure that blindness due to diabetic retinopathy does not become a public health problem in India. Further studies are required to understand the risk factors for retinopathy and vision loss in this population.

Prevalence of retinopathy at diagnosis among type 2 diabetic patients attending a diabetic centre in South India

AIM

To assess the prevalence of retinopathy in newly diagnosed south Indian type 2 diabetic patients attending a diabetic centre.

METHODS

448 consecutive newly diagnosed type 2 diabetic patients were recruited. Four field retinal colour photography was performed and graded using a modified form of the Early Treatment Diabetic Retinopathy Study grading system.

RESULTS

Of the 438 patients with assessable photographs, 32 (7.3%, 95% confidence interval 5.0 to 10. 2) had retinopathy. None of the variables tested showed a significant association with retinopathy on univariate or multivariate logistic regression analysis.

CONCLUSION

The overall prevalence of retinopathy at diagnosis among clinic based south Indian patients with type 2 diabetes appears to be lower than that reported among Europeans.

Frequency of proteinuria in type 2 diabetes mellitus seen at a diabetes centre in southern India

The frequency of proteinuria was assessed in a cohort of 1848 diabetic patients attending a diabetes centre in south India. A total of 127 (6.9%) patients had evidence of macroproteinuria and 49 (2.5%) patients had microproteinuria. Thus overall 9.4% of patients had diabetes related proteinuria. In addition, 70 patients (3.8%) had evidence of proteinuria with no evidence of retinopathy. The frequency of both microproteinuria and macroproteinuria increased linearly with duration of diabetes. Multiple logistic regression analysis showed that duration of diabetes, serum creatinine, and glycated haemoglobin were risk factors for macroproteinuria.

Population based assessment of diabetic retinopathy in an urban population in southern India

AIM

To assess the prevalence of diabetic retinopathy and the visual impairment caused by it in an urban population in southern India in order to determine its public health significance.

METHODS

2522 subjects (85.4% of those eligible), a representative sample of the population of Hyderabad city in southern India, underwent interview and detailed dilated eye examination during 1996-7 as part of the Andhra Pradesh Eye Disease Study.

RESULTS

124 subjects, all >/=30 years old, reported that they had diabetes, an age-sex adjusted prevalence of 7.82% (95% confidence interval (CI) 5.76-9.88%) in this age group. Diabetes was diagnosed at age >/=30 years in all but two subjects. The duration since diagnosis of diabetes was <10 years in 75.6% and >/=15 years in 6.7%. Diabetic retinopathy was present in 28 subjects, 1.78% (95% CI 1.09-2.48%) of those >/=30 years old. Most of the diabetic retinopathy was of the mild (50%) or moderate (39.3%) non-proliferative type; one subject (3.6%) had proliferative retinopathy. Multiple logistic regression revealed that the odds of having diabetic retinopathy were significantly higher in those >/=50 years than in those 30-49 years old (odds ratio 7.78, 95% CI 2.92-20. 73). Three subjects had visual impairment between 6/12 and 6/38 in either eye due to diabetic retinopathy, 0.19% (95% CI 0-0.41%) of those >/=30 years old.

CONCLUSION

Visual impairment due to diabetic retinopathy was relatively uncommon in this urban Indian population in 1996-7. However, this could change in the near future with an increase in duration of diabetes because of the anticipated aging of India's population and the recent suggestion of increase in diabetes prevalence in urban India, and therefore should be monitored.