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Aytenew TM, Kefale D, Birhane BM, Kebede SD, Asferie WN, Hailemeskel HS, Kassaw A, Asnakew S, Kassie YT, Mekonnen GB, Kebede M, Eshetie Y, Ejigu N, Zeleke S, Agimas MC, Simegn A. Visual impairment among diabetes patients in Ethiopia: A systematic review and meta-analysis. PLoS One 2024; 19:e0303388. [PMID: 38820429 PMCID: PMC11142537 DOI: 10.1371/journal.pone.0303388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 04/24/2024] [Indexed: 06/02/2024] Open
Abstract
INTRODUCTION The increased prevalence of visual impairment among diabetes patients has become a major global public health problem. Although numerous primary studies have been conducted to determine the prevalence of visual impairment and its associated factors among diabetes patients in Ethiopia, these studies presented inconsistent findings. Therefore, this review aimed to determine the pooled prevalence of visual impairment and identify associated factors among diabetes patients. METHODS An extensive search of literature was done on PubMed, Google Scholar, and Web of Sciences databases. A manual search of the reference lists of included studies was performed. A weighted inverse-variance random-effects model was used to calculate the pooled prevalence of visual impairment. RESULTS A total of 34 eligible primary studies with a sample size of 11,884 participants were included in the final meta-analysis. The pooled prevalence of visual impairment was 21.73% (95% CI: 18.15, 25.30; I2 = 96.47%; P<0.001). Diabetes mellitus with a duration of diagnosis ≥10 years [AOR = 3.18, 95% CI: 1.85, 5.49], presence of co-morbid hypertension [AOR = 3.26, 95% CI: 1.93, 5.50], poor glycemic control [AOR = 4.30, 95% CI: 3.04, 6.06], age ≥56 years [AOR = 4.13, 95% CI: 2.27, 7.52], family history of diabetes mellitus [AOR = 4.18 (95% CI: 2.61, 6.69], obesity [AOR = 4.77, 95% CI: 3.00, 7.59], poor physical activity [AOR = 2.46, 95% CI: 1.75, 3.46], presence of visual symptoms [AOR = 4.28, 95% CI: 2.73, 6.69] and no history of eye exam [AOR = 2.30, 95% CI: 1.47, 3.57] were significantly associated with visual impairment. CONCLUSIONS The pooled prevalence of visual impairment was high in Ethiopia. Diabetes mellitus with a duration of diagnosis ≥10 years, presence of co-morbid hypertension, poor glycemic control, age ≥56 years, and family history of diabetes mellitus, obesity, poor physical activity, presence of visual symptoms, and no history of eye exam were independent predictors. Therefore, diabetic patients with these identified risks should be screened, and managed early to reduce the occurrence of visual impairment related to diabetes. Moreover, public health policy with educational programs and regular promotion of sight screening for all diabetes patients are needed.
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Affiliation(s)
- Tigabu Munye Aytenew
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Demewoz Kefale
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Binyam Minuye Birhane
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
- Department of Maternity and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Solomon Demis Kebede
- Department of Maternity and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Worku Necho Asferie
- Department of Maternity and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Habtamu Shimels Hailemeskel
- Department of Maternity and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amare Kassaw
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sintayehu Asnakew
- Department of Psychiatry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yohannes Tesfahun Kassie
- Department of Emergency and Critical Care Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gebrehiwot Berie Mekonnen
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Melese Kebede
- Department of Emergency and Critical Care Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yeshiambaw Eshetie
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Netsanet Ejigu
- Department of Midwifery, Dembya Primary Hospital, Koladiba, Gondar, Ethiopia
| | - Shegaw Zeleke
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Muluken Chanie Agimas
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Amare Simegn
- Department of Reproductive Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Samitinjay A, Vaishnavi K, Gongireddy R, Kulakarni SC, Panuganti R, Vishwanatham C, Manikanta AK, Biswas R. Understanding clinical complexity in organ and organizational systems: Challenges local and global. J Eval Clin Pract 2024; 30:316-329. [PMID: 37335625 DOI: 10.1111/jep.13886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 04/04/2023] [Accepted: 05/19/2023] [Indexed: 06/21/2023]
Abstract
INTRODUCTION Complexity in healthcare systems has been arbitrarily defined as tasks or systems ranging from complicated to intractable, with a general view of these not being 'simple'. Complexity in healthcare systems in first-world countries has been well elucidated, however, data from third-world countries is still scant. MATERIALS AND METHODS: We present four cases each from three different organ systems-chronic kidney disease, alcohol use disorder, and heart failure-in the backdrop of our healthcare organization. We present our analysis of the complexities faced clinically and, in our local healthcare system which led to these events. RESULTS Analysis of these cases showed that patients with chronic kidney disease had vertebral-spinal pathologies due to poor infection control measures during haemodialysis. All these patients were young with a long history of secondary hypertension. In patients with alcohol use disorder, a common theme of how government regulations and peer pressure promote alcohol use is analysed. In the four patients with unexplained heart failure, vascular health is viewed as a fractal dimension and the various factors affecting vascular health are elaborated. CONCLUSION Complexities exist clinically in making a diagnosis, and organizationally, in the variables and nodes dictating patient outcomes. Clinical complexities cannot be simplified but have to be navigated in an optimized way to improve clinical outcomes.
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Affiliation(s)
- Aditya Samitinjay
- Department of General Medicine, Kamineni Institute of Medical Sciences, Narketpally, India
| | - Karnati Vaishnavi
- Department of General Medicine, Government Medical College, Sangareddy, India
| | | | - Sai Charan Kulakarni
- Department of General Medicine, Kamineni Institute of Medical Sciences, Narketpally, India
| | - Raveen Panuganti
- Department of General Medicine, Kamineni Institute of Medical Sciences, Narketpally, India
| | - Chandana Vishwanatham
- Department of General Medicine, Kamineni Institute of Medical Sciences, Narketpally, India
| | | | - Rakesh Biswas
- Department of General Medicine, Kamineni Institute of Medical Sciences, Narketpally, India
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Li X, Tan TE, Wong TY, Sun X. Diabetic retinopathy in China: Epidemiology, screening and treatment trends-A review. Clin Exp Ophthalmol 2023; 51:607-626. [PMID: 37381613 DOI: 10.1111/ceo.14269] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/26/2023] [Accepted: 06/02/2023] [Indexed: 06/30/2023]
Abstract
Diabetic retinopathy (DR) is the leading cause of vision impairment in the global working-age population. In China, with one-third of the world's diabetes population estimated at 141 million, the blindness prevalence due to DR has increased significantly. The country's geographic variations in socioeconomic status have led to prominent disparities in DR prevalence, screening and management. Reported risk factors for DR in China include the classic ones, such as long diabetes duration, hyperglycaemia, hypertension and rural habitats. There is no national-level DR screening programme in China, but significant pilot efforts are underway for screening innovations. Novel agents with longer durations, noninvasive delivery or multi-target are undergoing clinical trials in China. Although optimised medical insurance policies have enhanced accessibility for expensive therapies like anti-VEGF drugs, further efforts in DR prevention and management in China are required to establish nationwide cost-effective screening programmes, including telemedicine and AI-based solutions, and to improve insurance coverage for related out-of-pocket expenses.
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Affiliation(s)
- Xiaorong Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Tien-En Tan
- Singapore Eye Research Institute, Singapore, Singapore National Eye Centre, Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore, Singapore National Eye Centre, Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
- Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Xiaodong Sun
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
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Sen S, Udaya P, Jeya Maheshwari J, Kohli P, Parida H, Kannan NB, Ramasamy K, Dharmalingam K. Comparative proteomics of proliferative diabetic retinopathy in people with Type 2 diabetes highlights the role of inflammation, visual transduction, and extracellular matrix pathways. Indian J Ophthalmol 2023; 71:3069-3079. [PMID: 37530283 PMCID: PMC10538831 DOI: 10.4103/ijo.ijo_276_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/22/2023] [Accepted: 06/09/2023] [Indexed: 08/03/2023] Open
Abstract
Purpose To explore the vitreous humor proteome from type 2 diabetes subjects with proliferative diabetic retinopathy (PDR) in the Indian population. Methods We performed mass spectrometry-based label-free quantitative analysis of vitreous proteome of PDR (n = 13) and idiopathic macular hole (IMH; control) subjects (n = 14). Nine samples of PDR and 10 samples of IMH were pooled as case and control, respectively, and compared. Four samples each of PDR and IMH were analyzed individually without pooling to validate the results of the pooled analysis. Comparative quantification was performed using Scaffold software which calculated the fold changes of differential expression. Bioinformatics analysis was performed using DAVID and STRING software. Results We identified 469 proteins in PDR and 517 proteins in IMH vitreous, with an overlap of 172 proteins. Also, 297 unique proteins were identified in PDR and 345 in IMH. In PDR vitreous, 37 proteins were upregulated (P < 0.05) and 19 proteins were downregulated compared to IMH. Protein distribution analysis clearly demonstrated a separation of protein expression in PDR and IMH. Significantly upregulated proteins included fibrinogen gamma chain, fibrinogen beta chain, and carbonic anhydrase 1 and downregulated proteins included alpha-1-antitrypsin, retinol-binding protein 3, neuroserpin, cystatin C, carboxypeptidase E and cathepsin-D. Conclusion Diabetic retinopathy pathogenesis involves proteins which belong to inflammation, visual transduction, and extracellular matrix pathways. Validation-based experiments using enzyme-linked immunosorbent assay (ELISA) or western blotting are needed to establish cause and effect relationships of these proteins to the disease state, to develop them as biomarkers or drug molecules.
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Affiliation(s)
- Sagnik Sen
- Department of Retina and Vitreous Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
- Department of Proteomics, Aravind Medical Research Foundation, Madurai, Tamil Nadu, India
| | - Prithviraj Udaya
- Department of Retina and Vitreous Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
- Department of Proteomics, Aravind Medical Research Foundation, Madurai, Tamil Nadu, India
| | | | - Piyush Kohli
- Department of Retina and Vitreous Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Haemoglobin Parida
- Department of Retina and Vitreous Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Naresh Babu Kannan
- Department of Retina and Vitreous Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Kim Ramasamy
- Department of Retina and Vitreous Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
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Reddy Mallimala P, Shah K, Mirchandani M, Sharma K. Determinants and Stratification of Microvascular Complications of Type 2 Diabetes Mellitus. Cureus 2023; 15:e44348. [PMID: 37779807 PMCID: PMC10539158 DOI: 10.7759/cureus.44348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
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.
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Affiliation(s)
| | - Kavita Shah
- Medicine, North Carolina Medical Center, Benson, USA
| | | | - Karan Sharma
- Medicine, Poonam Multispecialty Hospital, Ahmedabad, IND
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Vyas A, Raman S, Sen S, Ramasamy K, Rajalakshmi R, Mohan V, Raman R. Machine Learning-Based Diagnosis and Ranking of Risk Factors for Diabetic Retinopathy in Population-Based Studies from South India. Diagnostics (Basel) 2023; 13:2084. [PMID: 37370980 DOI: 10.3390/diagnostics13122084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/03/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
This paper discusses the importance of investigating DR using machine learning and a computational method to rank DR risk factors by importance using different machine learning models. The dataset was collected from four large population-based studies conducted in India between 2001 and 2010 on the prevalence of DR and its risk factors. We deployed different machine learning models on the dataset to rank the importance of the variables (risk factors). The study uses a t-test and Shapely additive explanations (SHAP) to rank the risk factors. Then, it uses five machine learning models (K-Nearest Neighbor, Decision Tree, Support Vector Machines, Logistic Regression, and Naive Bayes) to identify the unimportant risk factors based on the area under the curve criterion to predict DR. To determine the overall significance of risk variables, a weighted average of each classifier's importance is used. The ranking of risk variables is provided to machine learning models. To construct a model for DR prediction, the combination of risk factors with the highest AUC is chosen. The results show that the risk factors glycosylated hemoglobin and systolic blood pressure were present in the top three risk factors for DR in all five machine learning models when the t-test was used for ranking. Furthermore, the risk factors, namely, systolic blood pressure and history of hypertension, were present in the top five risk factors for DR in all the machine learning models when SHAP was used for ranking. Finally, when an ensemble of the five machine learning models was employed, independently with both the t-test and SHAP, systolic blood pressure and diabetes mellitus duration were present in the top four risk factors for diabetic retinopathy. Decision Tree and K-Nearest Neighbor resulted in the highest AUCs of 0.79 (t-test) and 0.77 (SHAP). Moreover, K-Nearest Neighbor predicted DR with 82.6% (t-test) and 78.3% (SHAP) accuracy.
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Affiliation(s)
- Abhishek Vyas
- Birla Institute of Technology & Science, Pilani 333031, India
| | | | - Sagnik Sen
- Aravind Eye Hospital, Madurai 625020, India
- Moorfields Eye Hospital, London EC1V 2PD, UK
| | | | | | | | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai 600006, India
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AbuHammad GAR, Naser AY, Hassouneh LKM. Diabetes mellitus-related hospital admissions and prescriptions of antidiabetic agents in England and Wales: an ecological study. BMC Endocr Disord 2023; 23:102. [PMID: 37149604 PMCID: PMC10163802 DOI: 10.1186/s12902-023-01352-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 04/25/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Around 6.5% of the population in the United Kingdom has been diagnosed with diabetes. It is associated with several long-term consequences and higher hospitalization rates. AIM To examine the profile of hospital admissions related to diabetes mellitus and the prescription rates of antidiabetic medications in England and Wales. METHOD This is an ecological study that was conducted for the period between April 1999 and April 2020 using publicly available hospitalisation data in England and Wales. Hospital admission data for patients of all ages was extracted from Hospital Episode Statistics in England and the Patient Episode Database for Wales. The difference between admission rates in 1999 and 2020, as well as the difference between diabetes mellitus medication prescription rates in 2004 and 2020, were assessed using the Pearson Chi-squared test. A Poisson regression model with robust variance estimation was used to examine the trend in hospital admissions. RESULTS A total of 1,757,892 diabetes mellitus hospital admissions were recorded in England and Wales during the duration of the study. The hospital admission rate for diabetes mellitus increased by 15.2%. This increase was concomitant with an increase in the antidiabetic medication prescribing rate of 105.9% between 2004 and 2020. Males and those in the age group of 15-59 years had a higher rate of hospital admission. The most common causes of admissions were type 1 diabetes mellitus related complications, which accounted for 47.1% of all admissions. CONCLUSION This research gives an in-depth overview of the hospitalization profile in England and Wales during the previous two decades. In England and Wales, people with all types of diabetes and related problems have been hospitalized at a high rate over the past 20 years. Male gender and middle age were significant determinants in influencing admission rates. Diabetes mellitus type 1 complications were the leading cause of hospitalizations. We advocate establishing preventative and educational campaigns to promote the best standards of care for individuals with diabetes in order to lower the risk of diabetes-related complications.
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Affiliation(s)
- Gayda Abdel Rahman AbuHammad
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan
| | - Abdallah Y Naser
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan.
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Setia S, Tidake P. Prevalence and Awareness of Diabetic Retinopathy in Diabetic Patients Visiting Tertiary Care Hospitals in Central India. Cureus 2023; 15:e39414. [PMID: 37362473 PMCID: PMC10287543 DOI: 10.7759/cureus.39414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
Background Diabetes presents a significant and ever-growing burden worldwide, impacting populations across the globe. However, this burden is particularly pronounced in developing economies like India. The rise of diabetes in such regions can largely be attributed to two key factors: the increasing prevalence of overweight/obesity and the adoption of unhealthy lifestyles. Aim and objectives The study's objectives encompassed identifying patients with type 2 diabetes mellitus through the oral glucose tolerance test and the diagnosis of diabetic retinopathy (DR) among them, followed by classification based on the severity of the disease. Furthermore, the study aimed to evaluate the factors associated with DR among the patients, focusing on the duration of diabetes and age group, both of which were deemed highly significant. Methods This cross-sectional study was conducted for two months in 2019 among 40 patients. The tests performed were an oral glucose tolerance test, ocular examination including slit lamp biomicroscopy, and fundus examination. The data were analyzed using the Chi-square test and Student T-test. Results About 42.5% of the patients were positive for diabetic retinopathy, of which 29.41% had mild NPDR, 41.18% had moderate non-proliferative diabetic retinopathy (NPDR), and 29.41% had diabetic maculopathy. No cases of severe NPDR and proliferative diabetic retinopathy (PDR) were found. Conclusion Longer duration of diabetes corresponded to a higher prevalence of diabetic retinopathy. The frequency of diabetic retinopathy was higher in ages above 60 years. Diabetic retinopathy is a concern for patients with a long history of diabetes, high blood sugar levels, and unilateral or bilateral low vision. Thirty percent of the total were newly diagnosed diabetics. Timely screening of patients and intervention can go a long way in reducing morbidity or vision loss.
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Affiliation(s)
- Shubhangi Setia
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pravin Tidake
- Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Meng C, Xing Y, Huo L, Ma H. Relationship Between Estimated Glucose Disposal Rate and Type 2 Diabetic Retinopathy. Diabetes Metab Syndr Obes 2023; 16:807-818. [PMID: 36959899 PMCID: PMC10028301 DOI: 10.2147/dmso.s395818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 03/08/2023] [Indexed: 03/18/2023] Open
Abstract
PURPOSE To investigate the association between diabetic retinopathy (DR), DR intensity, and estimated glucose disposal rate (eGDR) in individuals with type 2 diabetes mellitus (T2DM). PATIENTS AND METHODS This study comprised 1762 T2DM patients who were admitted between January and December, 2021. Overall, the DR was identified in 430 patients. Based on the eGDR, the participants were divided into four study groups. One-way analysis of variance was used to compare the groups. The correlations between eGDR and DR risk, eGDR, and DR severity were analyzed using regression analysis. Furthermore, these relationships were analyzed in different sex groups. RESULTS Patients with T2DM had a 19.75% (348/1762) DR detection rate, whereas those with DR had a 22.41% (78/348) proliferative DR detection rate. The DR group had substantially reduced levels of eGDR compared with the non-DR group. Multivariate logistic regression analysis demonstrated that reduced eGDR was an independent risk factor for DR, after adjusting for confounding variables. eGDR correlated significantly with proliferative DR in women but not in men. CONCLUSION In Chinese individuals with T2DM, lower eGDR was independently associated with a higher risk of DR.
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Affiliation(s)
- Cuiqiao Meng
- Health Examination Center, Hebei General Hospital, Shijiazhuang, People’s Republic of China
| | - Yuling Xing
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, People’s Republic of China
- Graduate School of Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Lijing Huo
- Department of Clinical Laboratory, Hebei General Hospital, Shijiazhuang, People’s Republic of China
| | - Huijuan Ma
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, People’s Republic of China
- Hebei Key Laboratory of Metabolic Diseases, Hebei General Hospital, Shijiazhuang, Hebei, People’s Republic of China
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
- Correspondence: Huijuan Ma, Department of Endocrinology, Hebei General Hospital, Shijiazhuang, 050051, People’s Republic of China, Tel +86 18032838686, Email
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Susarla G, Rizza AN, Li A, Han S, Khan R, Chan W, Lains I, Apivatthakakul A, Brustoski K, Khetan V, Raman R, Igo RP, Iyengar SK, Mathavan S, Sobrin L. Younger Age and Albuminuria are Associated with Proliferative Diabetic Retinopathy and Diabetic Macular Edema in the South Indian GeNetics of DiAbeTic Retinopathy (SIGNATR) Study. Curr Eye Res 2022; 47:1389-1396. [PMID: 35815717 PMCID: PMC9637383 DOI: 10.1080/02713683.2022.2091148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/06/2022] [Accepted: 06/10/2022] [Indexed: 11/03/2022]
Abstract
Purpose: The purpose of the South Indian GeNetics of DiAbeTic Retinopathy (SIGNATR) Study is to identify non-genetic and genetic risk factors associated with diabetic retinopathy (DR). This report examines the non-genetic risk factors for DR in South Indian patients.Methods: Participants with South Indian ancestry and type 2 diabetes (T2D) were included from two sources: the Sankara Nethralaya Diabetic Retinopathy and Molecular Genetics Study (SN-DREAMS) and prospective recruitment at Sankara Nethralaya affiliates. Fundus photography and optical coherence tomography (OCT) were obtained on participants. Fundus images were graded for DR severity and OCTs were graded for center-involved diabetic macular edema (ciDME). Multivariate analyses were performed using stepwise logistic regression to assess effects of the demographic and clinical factors on proliferative DR (PDR) and DME.Results: Among the 2941 participants with DR grading, participants with PDR were more likely to be younger [odds ratio (OR)=0.95], men (OR = 1.83), have a longer duration of diabetes (OR = 1.10), have a higher hemoglobin A1c (OR = 1.12), have albuminuria (OR = 5.83), have hypertension (OR = 1.69), have a higher HDL (OR = 1.02) and a lower total cholesterol (OR = 0.99) (all p < 0.05). Among the 483 participants with gradable OCT scans, participants who had ciDME were more likely to be younger (OR = 0.97), men (OR = 2.80), have a longer duration of diabetes (OR = 1.06), have lower triglycerides (OR = 0.99), and have albuminuria (OR = 3.12) (all p < 0.05).Conclusions: Younger age, male sex, longer duration of diabetes, higher HbA1c, and presence of albuminuria were identified as risk factors for PDR and DME in a South Indian population with T2D.
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Affiliation(s)
- Gayatri Susarla
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - A N Rizza
- Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Ashley Li
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Samuel Han
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Rehana Khan
- Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Weilin Chan
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Ines Lains
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Atitaya Apivatthakakul
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Kim Brustoski
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Vikas Khetan
- Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Rajiv Raman
- Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Robert P Igo
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Sudha K Iyengar
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | | | - Lucia Sobrin
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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11
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Khan R, Saha SK, Frost S, Kanagasingam Y, Raman R. The Longitudinal Assessment of Vascular Parameters of the Retina and Their Correlations with Systemic Characteristics in Type 2 Diabetes-A Pilot Study. Vision (Basel) 2022; 6:vision6030045. [PMID: 35893762 PMCID: PMC9326718 DOI: 10.3390/vision6030045] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/18/2022] [Accepted: 06/30/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of the study was to assess various retinal vessel parameters of diabetes mellitus (DM) patients and their correlations with systemic factors in type 2 DM. A retrospective exploratory study in which 21 pairs of baseline and follow-up images of patients affected by DM were randomly chosen from the Sankara Nethralaya−Diabetic Retinopathy Study (SN DREAMS) I and II datasets. Patients’ fundus was photographed, and the diagnosis was made based on Klein classification. Vessel thickness parameters were generated using a web-based retinal vascular analysis platform called VASP. The thickness changes between the baseline and follow-up images were computed and normalized with the actual thicknesses of baseline images. The majority of parameters showed 10~20% changes over time. Vessel width in zone C for the second vein was significantly reduced from baseline to follow-up, which showed positive correlations with systolic blood pressure and serum high-density lipoproteins. Fractal dimension for all vessels in zones B and C and fractal dimension for vein in zones A, B and C showed a minimal increase from baseline to follow-up, which had a linear relationship with diastolic pressure, mean arterial pressure, serum triglycerides (p < 0.05). Lacunarity for all vessels and veins in zones A, B and C showed a minimal decrease from baseline to follow-up which had a negative correlation with pulse pressure and positive correlation with serum triglycerides (p < 0.05). The vessel widths for the first and second arteries significantly increased from baseline to follow-up and had an association with high-density lipoproteins, glycated haemoglobin A1C, serum low-density lipoproteins and total serum cholesterol. The central reflex intensity ratio for the second artery was significantly decreased from baseline to follow-up, and positive correlations were noted with serum triglyceride, serum low-density lipoproteins and total serum cholesterol. The coefficients for branches in zones B and C artery and the junctional exponent deviation for the artery in zone A decreased from baseline to follow-up showed positive correlations with serum triglycerides, serum low-density lipoproteins and total serum cholesterol. Identifying early microvascular changes in diabetic patients will allow for earlier intervention, improve visual outcomes and prevent vision loss.
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Affiliation(s)
- Rehana Khan
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai 600006, Tamil Nadu, India;
| | - Sajib K Saha
- Australian e-Health Research Centre, The Commonwealth Scientific and Industrial Research Organisation (CSIRO), Kensington, WA 6151, Australia; (S.K.S.); (S.F.)
| | - Shaun Frost
- Australian e-Health Research Centre, The Commonwealth Scientific and Industrial Research Organisation (CSIRO), Kensington, WA 6151, Australia; (S.K.S.); (S.F.)
| | - Yogesan Kanagasingam
- Digital Health and Telemedicine, The University of Notre Dame, Fremantle, WA 6160, Australia;
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai 600006, Tamil Nadu, India;
- Correspondence: ; Tel.: +91-44-28271616
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12
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Srinivasan S, Sivaprasad S, Rajalakshmi R, Anjana RM, Malik RA, Kulothungan V, Natarajan V, Raman R, Bhende M. Early retinal functional alteration in relation to diabetes duration in patients with type 2 diabetes without diabetic retinopathy. Sci Rep 2022; 12:11422. [PMID: 35794201 PMCID: PMC9259684 DOI: 10.1038/s41598-022-15425-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/23/2022] [Indexed: 12/24/2022] Open
Abstract
To examine the retinal structure and function in relation to diabetes duration and glycemia in patients without diabetic retinopathy (DR). 85 adults with type 2 diabetes without DR or macular edema underwent dilated indirect ophthalmoscopy, optical coherence tomography (OCT), ultra-wide field fundus photography, multifocal electroretinography (mfERG) and HbA1C assessment. Patients were stratified as those with diabetes duration < 10 years and ≥ 10 years. Right eyes of all participants were analyzed. mfERG was analysed as ring 12, 34, 56. No significant differences were noted in OCT-derived retinal thickness measures between groups. mfERG P1 latencies were delayed, and amplitudes (nV/deg2) were reduced in all three rings in those with diabetes duration ≥ 10 years vs. < 10 years, with significant correlations to diabetes duration in all rings. Logistic regression showed that duration of diabetes ≥ 10 years was associated with greater age (odds ratio (OR) 1.081, 95% CI 1.022, 1.143) and lower P1 amplitudes in the middle ring (OR 0.924, 95% CI 0.854, 0.999). No significant correlations were observed between HbA1c and retinal measures. In the absence of DR, early retinal functional alterations are detectable on mfERG in patients with longer diabetes duration, but with no difference in OCT-derived retinal thickness.
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Affiliation(s)
| | - Sobha Sivaprasad
- grid.512112.4NIHR Moorfields Biomedical Research Centre, London, UK
| | - Ramachandran Rajalakshmi
- grid.429336.90000 0004 1794 3718Dr. Mohan’s Diabetes Specialties Centre and Madras Diabetes Research Foundation, Chennai, India
| | - Ranjit Mohan Anjana
- grid.429336.90000 0004 1794 3718Dr. Mohan’s Diabetes Specialties Centre and Madras Diabetes Research Foundation, Chennai, India
| | - Rayaz A. Malik
- grid.416973.e0000 0004 0582 4340Weill Cornell Medicine-Qatar, Education City, Doha, Qatar ,grid.498924.a0000 0004 0430 9101Central Manchester University Hospitals Foundation Trust, Manchester, UK
| | - Vaitheeswaran Kulothungan
- grid.508060.bNational Centre for Disease Informatics and Research (NCDIR) & Indian Council of Medical Research (ICMR), Bangalore, India
| | - Viswanathan Natarajan
- grid.414795.a0000 0004 1767 4984Department of Preventive Ophthalmology, Sankara Nethralaya, Chennai, India
| | - Rajiv Raman
- grid.414795.a0000 0004 1767 4984Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
| | - Muna Bhende
- grid.414795.a0000 0004 1767 4984Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
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13
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Jha A, Verma A, Alagorie AR. Association of severity of diabetic retinopathy with corneal endothelial and thickness changes in patients with diabetes mellitus. Eye (Lond) 2022; 36:1202-1208. [PMID: 34117392 PMCID: PMC9151793 DOI: 10.1038/s41433-021-01606-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 04/25/2021] [Accepted: 05/11/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To analyse the central corneal thickness, endothelial cell density and morphology in patients with diabetes mellitus (DM). METHODS We analysed corneal endothelium, i.e. central corneal thickness (CCT), endothelial cell density (ECD), coefficient of variation in cell size (CV), and hexagonality (Hex) with specular microscopy in patients with type 2 DM and compared with age-matched controls. The influence of diabetic retinopathy (DR) severity, duration of DM, and level of glycosylated haemoglobin (HbA1c) was also analysed. RESULTS The study cohort included 592 eyes of 592 diabetic patients and 596 eyes of 596 control subjects. A significant difference was found in CCT (522.1 ± 36.6 μm in DM, 514.9 ± 37.1 μm in controls; P = 0.001), ECD (2484.5 ± 299.5 cells/mm2 in DM, 2555.9 ± 258.2 cells/mm2 in controls; P = 0.017), CV (40.3 ± 6.1 in DM, 37.2 ± 6.1 in controls; P < 0.001) and Hex (39.9 ± 5.2 in DM, 44.6 ± 6.0 in controls; P < 0.001). The longer duration of DM ( > 10 years) and poor glycaemic control (HbA1c > 7.5%) were associated with similar results. A significantly reduced ECD (P < 0.001) and Hex (P = 0.001) and higher CV (P = 0.007) and CCT (P = 0.01) was noted when assessed against various stages of DR. Multivariate analysis showed that increasing age was significantly associated with lower ECD (P < 0.001), Hex (P < 0.001), and CCT (P = 0.004); and a higher CV (P < 0.001). CONCLUSIONS DM has deleterious effects on corneal endothelium and thickness. The presence of DR may further warrant a thorough corneal evaluation, especially when planning intraocular surgery.
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Affiliation(s)
- Ashok Jha
- Consultant and classified specialist, Department of Ophthalmology, Military Hospital, Gaya, Bihar India
| | - Aditya Verma
- Senior consultant, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India.
| | - Ahmed Roshdy Alagorie
- grid.412258.80000 0000 9477 7793Consultant, Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
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14
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Brar AS, Sahoo J, Behera UC, Jonas JB, Sivaprasad S, Das T. Prevalence of diabetic retinopathy in urban and rural India: A systematic review and meta-analysis. Indian J Ophthalmol 2022; 70:1945-1955. [PMID: 35647959 PMCID: PMC9359280 DOI: 10.4103/ijo.ijo_2206_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A systematic review and meta-analysis were conducted to estimate the prevalence of diabetic retinopathy (DR) in India’s urban and rural areas. Medline, Scopus, and ScienceDirect databases were searched for population-based studies published in English between January 1990 and April 2021, wherein the prevalence of DR among Indian residents with type 2 diabetes mellitus (DM) was reported. A random-effects model was used to estimate the overall, rural, and urban prevalence. Data from 10 eligible studies were aggregated for meta-analysis. The prevalence of DR was 17.44% (95% confidence interval [CI], 14.33–20.55) in urban and 14.00% (95% CI: 9.13–18.86) in rural population (P = 0.24). The overall DR prevalence was 16.10% (95% CI: 13.16–24.32), and the population prevalence was 1.63% [95% CI: 0.94–2.32]. Prevalence of DR in people with diabetes was lower in the age group of 40–49 years [13.57% (95% CI: 7.16–19.98)] than in the age group of 50–59 years [16.72% (95% CI: 12.80–20.64)] and the age group of 60 years and above [16.55% (95% CI: 12.09–21.00)]. Variability in studies was high: urban (I2 = 88.90%); rural (I2 = 92.14%). Pooled estimates indicate a narrow difference in DR prevalence among people with diabetes in rural and urban India. The fast urbanization and increasing diabetes prevalence in rural areas underscore the need for providing equitable eye care at the bottom of the health pyramid.
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Affiliation(s)
- Anand Singh Brar
- Department of Retina and Vitreous, L V Prasad Eye Institute (Mithu Tulsi Chanrai Campus), Bhubaneswar, Odisha, India
| | - Jyotiranjan Sahoo
- Department of Community Medicine, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, Odisha, India
| | - Umesh Chandra Behera
- Department of Retina and Vitreous, L V Prasad Eye Institute (Mithu Tulsi Chanrai Campus), Bhubaneswar, Odisha, India
| | - Jost B Jonas
- Department of Ophthalmology, Institute of Molecular and Clinical Ophthalmology Basel, Switzerland
| | - Sobha Sivaprasad
- Department of Ophthalmology, NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London EC1V 2PD, UK
| | - Taraprasad Das
- Srimati Kanuri Santhamma Center for Vitreoretinal Diseases, L V Prasad Eye Institute (Kallam Anji Reddy Campus), Hyderabad, Telangana, India
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15
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Khan R, Surya J, Agarwal R, Sharma T, Raman R. Revised Glycemic Index for Diagnosing and Monitoring of Diabetes Mellitus in South Indian Population. Cureus 2022; 14:e22510. [PMID: 35371723 PMCID: PMC8948497 DOI: 10.7759/cureus.22510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/06/2022] Open
Abstract
Aim: To find the optimal threshold of fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) for diagnosis of diabetes mellitus (DM) and to evaluate the association with diabetic retinopathy (DR) in the South Indian population. Settings and Design: A retrospective population-based study. Methods and Materials: A total of 909 newly detected type 2 DM patients were selected from our two previously conducted studies, which include an urban and a rural population of South India. All underwent estimation of fasting, postprandial plasma glucose (PPG), and other biochemical tests. A comprehensive and detailed ophthalmic examination was carried out. The fundi of patients were photographed using 45°, four-field stereoscopic photography. Based on receiver operating characteristic (ROC) curves, sensitivity and specificity were derived. Results: The optimal cut-off values determined by maximizing the sensitivity and specificity of FPG and HbA1c using the Youden index were ≥ 6.17 mmol/L and ≥ 6.3%, respectively. By distributing the cut-off points into deciles and comparing them to the WHO criteria, we found that our HbA1c level of 6.60% was more than the WHO threshold (6.5%), with higher sensitivity (81.6%) and lower specificity (48.3%). The FPG level of 6.80 mmol/L was lower to the WHO criteria (7 mmol/L) with increased sensitivity (77.0%) and lower specificity (45.7%). Prevalence of DR by HbA1c levels between 6.5% and 6.9% was 15.3%. The prevalence of DR was more in the FPG category between 6.4 and 6.9 mmol/L and ≥ 7.5 mmol/L. Conclusion: Our population-based data indicate that for the South Indian population HbA1c value of ≥63 % and FPG value of ≥6.17 mmol/L may be optimal for diagnosing DM with a high level of accuracy and will be useful for the identification of mild and moderate DR.
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16
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Naserrudin NA, Jeffree MS, Kaur N, Syed Abdul Rahim SS, Ibrahim MY. Diabetic retinopathy among type 2 diabetes mellitus patients in Sabah primary health clinics–Addressing the underlying factors. PLoS One 2022; 17:e0261249. [PMID: 35089931 PMCID: PMC8797256 DOI: 10.1371/journal.pone.0261249] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/28/2021] [Indexed: 11/18/2022] Open
Abstract
Every person diagnosed with diabetes mellitus (T2DM) is at risk of developing Diabetic retinopathy (DR). Thus, DR is one of the major chronic microvascular complications of T2DM. However, in Malaysia, research about DR is still scarce. This study aimed to determine the prevalence of DR among diabetic patients across 46 primary healthcare clinics in Sabah, Malaysia. Secondly, it purported to identify the factors influencing the development of DR. This cross-sectional study involved a total of 22,345 Type 2 diabetes mellitus (T2DM) patients in the Sabah Diabetic Registry from 2008 to 2015. Of the 22,345 T2DM patients, 13.5% (n = 3,029) of them were diagnosed with DR. Multiple logistic regression revealed seven major risk factors of DR, i.e. patients with diabetic foot ulcer [aOR: 95% CI 3.08 (1.96–4.85)], patients with diabetic nephropathy [aOR: 95% CI 2.47 (2.13–2.86)], hypertension [aOR: 95% CI 1.63 (1.43–1.87)], dyslipidaemia [aOR: 95% CI 1.30 (1.17–1.44)], glycated haemoglobin [(HbA1c) > 6.5 (aOR: 95% CI 1.25 (1.14–1.38)], duration of diabetes mellitus (T2DM) [aOR: 95% CI 1.06 (1.05–1.07)] and age of patient [aOR: 95% CI 1.01 (1.00–1.02)] respectively. DR is a preventable complication. The effective glycaemic control is crucial in preventing DR. In minimizing the prevalence of DR, the healthcare authorities should institute programmes to induce awareness on the management of DR’s risk factors among patient and practitioner.
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Affiliation(s)
- Nurul Athirah Naserrudin
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Cheras, Kuala Lumpur, Malaysia
- Sabah State Health Department, Malaysia Ministry of Health, Sabah, Malaysia
- * E-mail:
| | - Mohammad Saffree Jeffree
- Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Kota Kinabalu Sabah, Malaysia
| | - Nirmal Kaur
- Sabah State Health Department, Malaysia Ministry of Health, Sabah, Malaysia
| | | | - Mohd Yusof Ibrahim
- Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Kota Kinabalu Sabah, Malaysia
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17
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Shao A, Jin K, Li Y, Lou L, Zhou W, Ye J. Overview of global publications on machine learning in diabetic retinopathy from 2011 to 2021: Bibliometric analysis. Front Endocrinol (Lausanne) 2022; 13:1032144. [PMID: 36589855 PMCID: PMC9797582 DOI: 10.3389/fendo.2022.1032144] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To comprehensively analyze and discuss the publications on machine learning (ML) in diabetic retinopathy (DR) following a bibliometric approach. METHODS The global publications on ML in DR from 2011 to 2021 were retrieved from the Web of Science Core Collection (WoSCC) database. We analyzed the publication and citation trend over time and identified highly-cited articles, prolific countries, institutions, journals and the most relevant research domains. VOSviewer and Wordcloud are used to visualize the mainstream research topics and evolution of subtopics in the form of co-occurrence maps of keywords. RESULTS By analyzing a total of 1147 relevant publications, this study found a rapid increase in the number of annual publications, with an average growth rate of 42.68%. India and China were the most productive countries. IEEE Access was the most productive journal in this field. In addition, some notable common points were found in the highly-cited articles. The keywords analysis showed that "diabetic retinopathy", "classification", and "fundus images" were the most frequent keywords for the entire period, as automatic diagnosis of DR was always the mainstream topic in the relevant field. The evolution of keywords highlighted some breakthroughs, including "deep learning" and "optical coherence tomography", indicating the advance in technologies and changes in the research attention. CONCLUSIONS As new research topics have emerged and evolved, studies are becoming increasingly diverse and extensive. Multiple modalities of medical data, new ML techniques and constantly optimized algorithms are the future trends in this multidisciplinary field.
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Affiliation(s)
- An Shao
- Department of Ophthalmology, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, China
| | - Kai Jin
- Department of Ophthalmology, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, China
| | - Yunxiang Li
- College of Computer Science and Technology, Hangzhou Dianzi University, Hangzhou, China
| | - Lixia Lou
- Department of Ophthalmology, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, China
| | - Wuyuan Zhou
- Zhejiang Academy of Science and Technology Information, Hangzhou, China
- *Correspondence: Juan Ye, ; Wuyuan Zhou,
| | - Juan Ye
- Department of Ophthalmology, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, China
- *Correspondence: Juan Ye, ; Wuyuan Zhou,
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18
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Sen S, Ramasamy K, Vignesh TP, Kannan NB, Sivaprasad S, Rajalakshmi R, Raman R, Mohan V, Das T, Mani I. Identification of risk factors for targeted diabetic retinopathy screening to urgently decrease the rate of blindness in people with diabetes in India. Indian J Ophthalmol 2021; 69:3156-3164. [PMID: 34708762 PMCID: PMC8725095 DOI: 10.4103/ijo.ijo_496_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/20/2021] [Accepted: 07/21/2021] [Indexed: 11/04/2022] Open
Abstract
PURPOSE There is an exponential rise in the prevalence of diabetes mellitus (DM) in India. Ideally all people with DM should be periodically screening for diabetic retinopathy (DR) but is not practical with current infrastructure. An alternate strategy is to identify high-risk individuals with vision-threatening diabetic retinopathy (VTDR) for priority screening and treatment. METHODS We reanalyzed four population-based studies, conducted in South India between 2001 and 2010, and reclassified individuals above 40 years into known and newly diagnosed diabetes. Multiple regression analysis was done to identify risk factors in people with known and new DM. RESULTS The prevalence of DR in 44,599 subjects aged ≥40 years was 14.8% (18.4 and 4.7% in known and new DM, respectively), and the prevalence of VTDR was 5.1%. Higher risk factors of VTDR were older age >50 years, diabetes duration >5 years, and systolic blood pressure >140 mm Hg. Targeted screening of people with diabetes using high-risk criteria obtained from this study was able to detect 93.5% of all individuals with VTDR. CONCLUSION In a limited resource country like India, a high-risk group-based targeted screening of individuals with DM could be prioritized while continuing the current opportunistic screening till India adopts universal screening of all people with DM.
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Affiliation(s)
- Sagnik Sen
- Department of Retina and Vitreous Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Kim Ramasamy
- Department of Retina and Vitreous Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - TP Vignesh
- Department of Retina and Vitreous Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Naresh B Kannan
- Department of Retina and Vitreous Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Sobha Sivaprasad
- Department of Medical Retina, NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Ramachandran Rajalakshmi
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Taraprasad Das
- Srimati Kanuri Santhamma Centre for Vitreo Retinal Diseases, Kallam Anji Reddy Campus, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Iswarya Mani
- Department of Biostatistics, Aravind Medical Research Foundation, Madurai, Tamil Nadu, India
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19
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Singh HV, Das S, Deka DC, Kalita IR. Prevalence of diabetic retinopathy in self-reported diabetics among various ethnic groups and associated risk factors in North-East India: A hospital-based study. Indian J Ophthalmol 2021; 69:3132-3137. [PMID: 34708755 PMCID: PMC8725127 DOI: 10.4103/ijo.ijo_1144_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose: To describe the prevalence and severity of diabetic retinopathy (DR) among different ethnic groups of North-East India and to study the associated risk factors. Methods: In this hospital based cross sectional study 7,133 individuals among the age group of 20-79 years, attending the OPD, were screened for presence of Diabetes Mellitus (DM) (HbA1c >7% or previously diagnosed). Among them, 780 (10.94%) had diabetes; they were evaluated for presence of any retinopathy (based on fundus photograph and fluorescein angiography), its grade (based on International DR severity scale), and risk factors. DR patients were further grouped into different ethnicities (Assamese, Bengali, minor tribes, and other immigrants). Results: Of the 780 patients with diabetes, 58 patients had type 1 DM and 722 patients had type 2 DM. The overall prevalence of DR was 30.0% with vision-threatening retinopathy and maculopathy being 10.00% and 4.49%, respectively. The prevalence of retinopathy range was the highest in the immigrants’ group (50.00% among type 1 DM and 44.93% among type 2 DM) and lowest in the tribal's groups (16.67% among type 1 DM and 22.35% among type 2 DM). The risk factors showing significant association with DR were longer diabetes duration, older age, family history of diabetes, higher HbA1c level, associated hypertension, hypertriglyceridemia, and pregnancy state (P value <0.05). Conclusion: Every third patient with diabetes had some form of DR with Vision Threatening DR (VTDR) affecting every tenth patient. There was also a wide variation in the prevalence of DR among ethnic groups and this difference could not be attributed to variation in the known measurable risk factors among different ethnic groups, thus signifying the role of ethnicity in occurrence and severity of DR.
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Affiliation(s)
- Harsh V Singh
- Department of Retina-Vitreous, Aravind Eye Hospital, Pondicherry, India
| | - Shubhra Das
- Professor, Department of Ophthalmology, Regional Institue of Ophthalmology, Guwahati, Assam, India
| | - Dipali C Deka
- Professor, Department of Ophthalmology, Regional Institue of Ophthalmology, Guwahati, Assam, India
| | - Iva R Kalita
- Department of Paediatric Ophthalmology and Strabismus, Aravind Eye Hospital, Pondicherry, India
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20
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Giridhar A. Commentary: Targeted screening for effective detection of vision threatening diabetic retinopathy. Indian J Ophthalmol 2021; 69:3166. [PMID: 34708764 PMCID: PMC8725111 DOI: 10.4103/ijo.ijo_2643_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Anantharaman Giridhar
- Medical Director and Chief of Vitreo Retinal Services, Giridhar Eye Institute, Cochin, Kerala, India
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21
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Das T, Murthy GVS, Pant HB, Gilbert C, Rajalakshmi R, Behera UC. Regional variation in diabetic retinopathy and associated factors in Spectrum of Eye Disease in Diabetes (SPEED) study in India-Report 5. Indian J Ophthalmol 2021; 69:3095-3101. [PMID: 34708748 PMCID: PMC8725106 DOI: 10.4103/ijo.ijo_3620_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose: To study the zonal variations in diabetic retinopathy (DR) and associated factors in people with known type 2 diabetes mellitus (T2DM) attending large eye care facilities in different regions of India. Methods: In this cross-sectional eye-care facility-based study, India was divided into five zones; large eye care facilities with a good referral base and offering an entire range of care for patients with DR were invited. First-time T2DM attendees aged ≥18 years were recruited. All subjects received a comprehensive systemic and ophthalmic examination. DR and systemic diseases were classified as per the international/national standards. Findings were compared between the zones and with the national average. Results: Fourteen eye-care facilities (15% public) from five zones participated. In the cohort of 11,173 people, there were more males (59%); the average age was above 45 years, and in 57%, DM had been diagnosed more than 5 years earlier. Compared with the overall study population, the proportion of people with any DR, sight-threatening DR, and blind were higher in the east zone (42.5%, 95% confidence interval [CI]: 40.2–44.8; 24.3%, 95% CI 22.3–26.3, and 11.5%, respectively); diabetic macular edema was more frequent in the south zone (12.2%, 95% CI 11.2–13.2); people with moderate-to-severe visual impairment were more in the west zone (32.1%) and higher proportion of people in the south-central zone had systemic hypertension (56.8%, 95% CI 54.8–58.9). Conclusion: The zonal variation in DR and related vision loss could be related to variable health-seeking behavior, availability, and confidence in the available services.
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Affiliation(s)
- Taraprasad Das
- Srimati Kanuri Santhamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute (Kallam Anji Reddy campus), Hyderabad, Telangana, India
| | - Gudlavalleti V S Murthy
- Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, India; London School of Hygiene & Tropical Medicine, London, UK
| | - Hira B Pant
- Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, India
| | - Clare Gilbert
- London School of Hygiene & Tropical Medicine, London, UK
| | - Ramachandran Rajalakshmi
- Department of Ophthalmology, Dr. Mohan's Diabetes Specialties Centre and Madras Diabetes Research Foundation, Chennai, India
| | - Umesh C Behera
- Department of Vitreo-Retina, L V Prasad Eye Institute (Mithu Tulsi Chanrai campus), Bhubaneswar, India
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22
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Kaushik M, Nawaz S, Qureshi TS. Profile of sight-threatening diabetic retinopathy and its awareness among patients with diabetes mellitus attending a tertiary care center in Kashmir, India. Indian J Ophthalmol 2021; 69:3123-3130. [PMID: 34708753 PMCID: PMC8725088 DOI: 10.4103/ijo.ijo_831_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: To study the profile of sight-threatening diabetic retinopathy (STDR), its association with various factors affecting it, and awareness of diabetic retinopathy (DR) among patients with diabetes mellitus (DM) attending a tertiary care center in Kashmir. Methods: In this prospective cross-sectional study, 625 consecutive patients with DM were assessed for STDR. Demographic/clinical data were obtained. Early treatment diabetic retinopathy study (ETDRS) criteria were used to grade fundus photographs. Severe nonproliferative DR, proliferative DR, and/or macular edema were classified as STDR. Optical coherence tomography was used to confirm the diagnosis of macular edema. Results: The mean age of patients was 56.36 ± 9.29 years. The male-to-female ratio was 0.92:1. The majority (99.36%) of patients had type 2 DM. STDR was seen in 208 (33.28%) patients. Non-sight-threatening diabetic retinopathy (NSTDR) was seen in 173 (27.68%) patients. Eye care was sought by 313 (50.08%) patients for the first time. STDR had a significant association with difficulty in accessing the health care facilities, duration of diabetes, uncontrolled diabetes, presence of other diabetes complications, use of insulin, and hypertension (P < 0.05 for all). Awareness that diabetes can affect eyes showed a significant association with age, gender, educational status, duration of diabetes, glycemic status, DR, and STDR (P < 0.001 for all). Conclusion: STDR is a common complication in diabetes and is duration- and glycemic control-dependent. Understanding the factors associated with STDR can help in making strategies for its prevention. Spreading awareness regarding STDR at the community level in the Kashmir valley is crucial in this regard.
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Affiliation(s)
- Madhurima Kaushik
- Department of Ophthalmology, Govt. Medical College, Srinagar, Jammu and Kashmir, India
| | - Shah Nawaz
- Department of Ophthalmology, Govt. Medical College, Srinagar, Jammu and Kashmir, India
| | - Tariq Syed Qureshi
- Department of Ophthalmology, Govt. Medical College, Srinagar, Jammu and Kashmir, India
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23
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Rajalakshmi R, Prathiba V, Rani PK, Mohan V. Various models for diabetic retinopathy screening that can be applied to India. Indian J Ophthalmol 2021; 69:2951-2958. [PMID: 34708729 PMCID: PMC8725090 DOI: 10.4103/ijo.ijo_1145_21] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The increased burden of diabetes in India has resulted in an increase in the complications of diabetes including sight-threatening diabetic retinopathy (DR). Visual impairment and blindness due to DR can be prevented by early detection and management of sight-threatening DR. Life-long evaluation by repetitive retinal screening of people with diabetes is an essential strategy as DR has an asymptomatic presentation. Fundus examination by trained ophthalmologists and fundus photography are established modes of screening. Various modes of opportunistic screening have been followed in India. Hospital-based screening (diabetes care/eye care) and community-based screening are the common modes. Tele-ophthalmology programs based on retinal imaging, remote interpretation, and grading of DR by trained graders/ophthalmologists have facilitated greater coverage of DR screening and enabled timely referral of those with sight-threatening DR. DR screening programs use nonmydriatic or mydriatic fundus cameras for retinal photography. Hand-held/smartphone-based fundus cameras that are portable, less expensive, and easy to use in remote places are gaining popularity. Good retinal image quality and accurate diagnosis play an important role in reducing unnecessary referrals. Recent advances like nonmydriatic ultrawide field fundus photography can be used for DR screening, though likely to be more expensive. The advent of artificial intelligence and deep learning has raised the possibility of automated detection of DR. Efforts to increase the awareness regarding DR is essential to ensure compliance to regular follow-up. Cost-effective sustainable models will ensure systematic nation-wide DR screening in the country.
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Affiliation(s)
- Ramachandran Rajalakshmi
- Department of Ophthalmology, Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Vijayaraghavan Prathiba
- Department of Ophthalmology, Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Padmaja Kumari Rani
- Vitreo-Retina Department, Smt Kanuri Santhamma Centre for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Viswanathan Mohan
- Department of Diabetology, Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
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24
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Parameswarappa DC, Rajalakshmi R, Mohamed A, Kavya S, Munirathnam H, Manayath G, Kumar MA, Raman R, Vignesh TP, Ramasamy K, Mani S, Muralidhar A, Agarwal M, Anantharaman G, Bijlani N, Chawla G, Sen A, Kulkarni S, Behera UC, Sivaprasad S, Das T, Rani PK. Severity of diabetic retinopathy and its relationship with age at onset of diabetes mellitus in India: A multicentric study. Indian J Ophthalmol 2021; 69:3255-3261. [PMID: 34708783 PMCID: PMC8725142 DOI: 10.4103/ijo.ijo_1459_21] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: To present clinical profile and risk factors of sight-threatening diabetic retinopathy (STDR) among people with age of onset of diabetes (AOD) <25 versus ≥25 years. Methods: A retrospective chart analysis of consecutive patients with diabetic retinopathy (DR) n = 654) treated at 14 eye care centers across India between 2018 and 2019 was performed. Patients were divided into two groups, Group 1: AOD <25 years and Group 2: AOD ≥25 years. DR and diabetic macular edema (DME) were classified using the International Clinical Classification of DR severity scale. STDR included severe nonproliferative DR (NPDR), proliferative DR (PDR), and moderate to severe DME. A multilevel mixed-effects model was used for comparison between two groups: 1) Patients with DR and AOD <25 years and 2) Patients with DR and AOD ≥25 years. Bivariate and multivariate regression analyses were used to evaluate risk factors between the two groups. Results: A total of 654 patients were included, 161 (307 eyes) in AOD <25 and 493 (927 eyes) in AOD >25 group. There was a higher prevalence of PDR with high-risk characteristics in AOD <25 group (24% vs. 12%) at baseline and 12-month follow-up (25% vs. 6%); P < 0.001. Systolic hypertension and poor glycemic control were risk factors in both groups, with no difference in these modifiable risk factors between groups. Conclusion: People with youth-onset DM are likely to present with severer form of STDR despite similar modifiable risk factors. Therefore, strict control of systolic blood pressure, glycemic status, and regular screening for DR are recommended to reduce the risk of STDR irrespective of the age of onset of diabetes.
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Affiliation(s)
- Deepika C Parameswarappa
- Smt Kanuri Santhamma Center for Vitreo-aRetina Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Ramachandran Rajalakshmi
- Department of Ophthalmology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Ashik Mohamed
- Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sanagavarapu Kavya
- Smt Kanuri Santhamma Center for Vitreo-aRetina Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | | | | | | | - Rajiv Raman
- Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - T P Vignesh
- Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Kim Ramasamy
- Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Sheena Mani
- Dr. Tony Fernandez Eye Hospital, Aluva, Kerala, India
| | | | | | | | - Neha Bijlani
- Vision Care And Research Centre, Bhopal, Madhya Pradesh, India
| | - Gajendra Chawla
- Vision Care And Research Centre, Bhopal, Madhya Pradesh, India
| | - Alok Sen
- Sadguru Netra Chikitsalaya, Chitrakot, Madhya Pradesh, India
| | | | - Umesh C Behera
- Retina Vitreous Service, Mithu Tulsi Chanrai campus, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Sobha Sivaprasad
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust; Vision Sciences, UCL Institute of Ophthalmology, London, UK
| | - Taraprasad Das
- Smt Kanuri Santhamma Center for Vitreo-aRetina Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Padmaja Kumari Rani
- Smt Kanuri Santhamma Center for Vitreo-aRetina Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
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25
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Biswas P, Batra S, Majji AB, Natarajan S, Sachdev M, Verma L, Sharma N, Honavar SG, Sinha S, Porwal AC, Prasad RK, Bawankule P, Saxena R, Narayanan R, Raman R, Nag S, Ghosh P. The All India Ophthalmological Society - Academic and Research Committee pan-India diabetic retinopathy project "Fixing the missing link": Prevalence data from West Bengal. Indian J Ophthalmol 2021; 69:3103-3109. [PMID: 34708750 PMCID: PMC8725092 DOI: 10.4103/ijo.ijo_3322_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
| | - Sneha Batra
- Associate Consultant, B B Eye Foundation, Kolkata, India
| | | | | | - Mahipal Sachdev
- Chairman & Medical Director, Centre for Sight Group of Eye Hospitals, New Delhi, India
| | - Lalit Verma
- Director, Vitreoretina services, Centre for Sight, New Delhi, India
| | - Namrata Sharma
- Professor of Ophthalmology, Dr RP Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | | | | | - Amit C Porwal
- Senior Consultant Cataract & Head Glaucoma Services, Choithram Netralaya, Indore, India
| | | | | | - Rohit Saxena
- Professor, Dr RP Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Raja Narayanan
- Director, Suven Clinical Research, Hyderabad Eye Research Foundation, L V Prasad Eye Institute, Hyderabad, India
| | - Rajiv Raman
- Consultant, Sankara Nethralaya, Chennai, India
| | - Subhasish Nag
- Chief Consultant, Oculus Clinic, Kolkata, West Bengal, India
| | - Prajjwal Ghosh
- Senior Optometrist, Trenetralaya, Kolkata, West Bengal, India
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26
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Prevalent vascular complications in people with diabetes: a multicentre observational cohort study. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-021-01010-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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27
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Patewar SK, Panchavarthi CS, Gadala SR, Pillanagrovi VK, Guggilla S, Sotu RD, Kumar P, Chatla C. Utility of secondary screening in early detection of diabetic retinopathy and assessing diabetes management through rural referral mechanism. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-021-01011-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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28
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Padhy SK, Akkulugari V, Kandagori M, Padhi TR, Rathi VM, Das T. Tribal Odisha Eye Disease Study (TOES) Report # 9. Eye diseases and retinal disorders in an adult and elderly tribal community in Odisha, India - A community hospital-based study. Indian J Ophthalmol 2021; 69:1846-1849. [PMID: 34146041 PMCID: PMC8374820 DOI: 10.4103/ijo.ijo_3420_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: To measure the proportion of people with major ophthalmic and retinal disorders in the tribal and non-tribal people presenting to a community eye hospital in an Indian state with a sizeable tribal population. Methods: Hospital-based cross-sectional retrospective study of all new adult patients, examined between September 2015 and June 2020. A tribal was defined as per the Indian ethnic classification. Blindness and visual impairment were defined as per the WHO standards. Diabetes and hypertension were defined as per Indian standards. The proportion of common ophthalmic and retinal disorders between the tribal and non-tribal community were compared. Results: This cohort consisted of 76,166 people (45.8%; n = 34,869, tribal); 39.4% (n = 29,989; non-tribal 23.6% and tribal 15.8%) people had ophthalmic disorders. In the examined people 2.3% were blind (higher in tribal community 4.7% versus 0.8%; P < 0.001) and 8.4% had moderate-to-severe visual impairment (higher in tribal community 14.4% versus 4.4%; P < 0.001). Refractive error (64.4%; higher in non-tribal community, 77.3% versus 44.6%, P < 0.001) and operable cataract (23.9%; higher in tribal community, 40.9% versus 11.8%, P < 0.001) were the principal ophthalmic disorders. Retinal disorders were higher in non-tribal people (5.9% vs. 2.9%; P < 0.001), but the tribal group had higher proportion of retinitis pigmentosa (20% vs. 6.4%; P < 0.001) and lower proportion of diabetic retinopathy (8% vs. 40.7%; P < 0.001). Conclusion: The health-seeking behavior of the tribal community in India is low. A tribal person in India apparently visits the hospital when vision is grossly affected. It calls for greater advocacy, increased access to healthcare, and a larger population-based study.
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Affiliation(s)
- Srikanta Kumar Padhy
- Vitreoretinal Services, Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Vidhyadhar Akkulugari
- Srimati Kanuri Santhamma Center for Vitreoretinal Diseases, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
| | - Meenaketan Kandagori
- Naraindas Morbai, Budhrani Eye Centre and JK Centre for Tribal Eye Health, L V Prasad Eye Institute, Rayagada, Odisha, India
| | - Tapas Ranjan Padhi
- Vitreoretinal Services, Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Varsha M Rathi
- Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Taraprasad Das
- Srimati Kanuri Santhamma Center for Vitreoretinal Diseases, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
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Deep learning for diabetic retinopathy detection and classification based on fundus images: A review. Comput Biol Med 2021; 135:104599. [PMID: 34247130 DOI: 10.1016/j.compbiomed.2021.104599] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/12/2021] [Accepted: 06/18/2021] [Indexed: 02/02/2023]
Abstract
Diabetic Retinopathy is a retina disease caused by diabetes mellitus and it is the leading cause of blindness globally. Early detection and treatment are necessary in order to delay or avoid vision deterioration and vision loss. To that end, many artificial-intelligence-powered methods have been proposed by the research community for the detection and classification of diabetic retinopathy on fundus retina images. This review article provides a thorough analysis of the use of deep learning methods at the various steps of the diabetic retinopathy detection pipeline based on fundus images. We discuss several aspects of that pipeline, ranging from the datasets that are widely used by the research community, the preprocessing techniques employed and how these accelerate and improve the models' performance, to the development of such deep learning models for the diagnosis and grading of the disease as well as the localization of the disease's lesions. We also discuss certain models that have been applied in real clinical settings. Finally, we conclude with some important insights and provide future research directions.
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30
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Raman R, Ramasamy K, Rajalakshmi R, Sivaprasad S, Natarajan S. Diabetic retinopathy screening guidelines in India: All India Ophthalmological Society diabetic retinopathy task force and Vitreoretinal Society of India Consensus Statement. Indian J Ophthalmol 2021; 69:678-688. [PMID: 33269742 PMCID: PMC7942107 DOI: 10.4103/ijo.ijo_667_20] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/13/2020] [Accepted: 07/14/2020] [Indexed: 12/15/2022] Open
Abstract
Diabetic retinopathy (DR) is an emerging preventable cause of blindness in India. All India Ophthalmology Society (AIOS) and Vitreo-Retinal Society of India (VRSI) have initiated several measures to improve of DR screening in India. This article is a consensus statement of the AIOS DR task force and VRSI on practical guidelines of DR screening in India. Although there are regional variations in the prevalence of diabetes in India at present, all the States in India should screen their population for diabetes and its complications. The purpose of DR screening is to identify people with sight-threatening DR (STDR) so that they are treated promptly to prevent blindness. This statement provides strategies for the identification of people with diabetes for DR screening, recommends screening intervals in people with diabetes with and without DR, and describes screening models that are feasible in India. The logistics of DR screening emphasizes the need for dynamic referral pathways with feedback mechanisms. It provides the clinical standards required for DR screening and treatment of STDR and addresses the governance and quality assurance (QA) standards for DR screening in Indian settings. Other aspects incorporate education and training, recommendations on Information technology (IT) infrastructure, potential use of artificial intelligence for grading, data capture, and requirements for maintenance of a DR registry. Finally, the recommendations include public awareness and the need to work with diabetologists to control the risk factors so as to have a long-term impact on prevention of diabetes blindness in India.
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Affiliation(s)
- Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Chennai, Tamil Nadu, India
| | - Kim Ramasamy
- Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Ramachandran Rajalakshmi
- Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | | | - S Natarajan
- Aditya Jyot Eye Hospital Pvt. Ltd., Mumbai, Maharashtra, India
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31
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Shivakumar K, Rajalakshmi A, Jha KN, Nagarajan S, Srinivasan A, Lokesh Maran A. Serum magnesium in diabetic retinopathy: the association needs investigation. Ther Adv Ophthalmol 2021; 13:25158414211056385. [PMID: 34901747 PMCID: PMC8655827 DOI: 10.1177/25158414211056385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 10/08/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Magnesium has an essential role in glucose metabolism, and hypomagnesaemia is common in diabetes mellitus. However, the relationship between serum magnesium and diabetic retinopathy is poorly understood. AIM To determine the association between serum magnesium levels and retinopathy in type 2 diabetic patients with normal renal function and to correlate it with severity of retinopathy. METHODS This cross-sectional observational study was conducted in a semi-urban tertiary-care teaching hospital. Clinicodemographic profile and serum magnesium levels were determined in patients with type 2 diabetes mellitus (DM) with (group 1) and without (group 2) retinopathy. Serum magnesium levels were correlated with the presence and severity of retinopathy. RESULTS Of 104 type 2 DM patients, 50 had retinopathy. Younger age, longer duration of disease and poorer glycaemic control (p < 0.05) were found to be associated with retinopathy. The mean serum magnesium levels in patients with retinopathy and those without retinopathy were 1.63 ± 0.30 mg/dL and 1.76 ± 0.22 mg/dL, respectively (p = 0.029). Reduced serum magnesium was associated with elevated fasting sugars (p = 0.019) and female gender (p = 0.037). On comparative analysis of patients with sight-threatening diabetic retinopathy (STDR), non-STDR and no retinopathy by ANOVA test, patients with STDR had significantly lower serum magnesium (1.55 ± 0.33 mg/dL) (p = 0.031). CONCLUSION Serum magnesium levels were lower in patients with diabetic retinopathy. Patients with STDR had lower serum magnesium compared with those without STDR. SUMMARY Serum magnesium, studied extensively for its role in glucose metabolism, was found to be lower in patients with diabetic retinopathy compared with those without retinopathy. Sight-threatening diabetic retinopathy had significantly lower levels of serum magnesium.
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Affiliation(s)
- Koushik Shivakumar
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Pondicherry, India
| | - A.R. Rajalakshmi
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Pondicherry UT 607402, India
| | - Kirti Nath Jha
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Pondicherry, India
| | - Swathi Nagarajan
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Pondicherry, India
| | - A.R. Srinivasan
- Department of Biochemistry, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Pondicherry, India
| | - A. Lokesh Maran
- Department of Community Medicine, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Pondicherry, India
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32
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Rajalakshmi R, Behera UC, Bhattacharjee H, Das T, Gilbert C, Murthy GVS, Pant HB, Shukla R. 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. Indian J Ophthalmol 2020; 68:S21-S26. [PMID: 31937724 PMCID: PMC7001176 DOI: 10.4103/ijo.ijo_21_19] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
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 1/3rd and sight-threatening DR in 1/5th 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.
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Affiliation(s)
- Ramachandran Rajalakshmi
- Department of Ophthalmology, Dr. Mohan's Diabetes Specialties Centre and Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Umesh C Behera
- Department of Vitreo-Retina, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | | | - Taraprasad Das
- Department of Vitreo-Retina, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Clare Gilbert
- London School of Hygiene and Tropical Medicine, London, UK
| | - G V S Murthy
- Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Hira B Pant
- Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Rajan Shukla
- Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
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Chariwala RA, Shukla R, Gajiwala UR, Gilbert C, Pant H, Lewis MG, Murthy GVS. Effectiveness of health education and monetary incentive on uptake of diabetic retinopathy screening at a community health center in South Gujarat, India. Indian J Ophthalmol 2020; 68:S52-S55. [PMID: 31937730 PMCID: PMC7001183 DOI: 10.4103/ijo.ijo_2118_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose: The effectiveness of Accredited Social Health Activists (ASHAs) with and without monetary incentive in uptake of diabetic retinopathy (DR) screening at community health center (CHC) was compared in South Gujarat, India. Methods: In this non-randomized controlled trial, ASHAs were incentivized to refer people with diabetes mellitus (PwDM) from their respective villages for DR screening after people were sensitized to DM and DR. The minimum sample size was 63 people in each arm. Results: Of 162, 50.6% were females, 80.2% were literate, 56.2% were >50 years, 54.3% had increased random blood sugar (RBS), and 59.9% had diabetes for 5 years. The percentage of screening was significantly higher [relative risk (RR) = 4.37, 95% confidence interval (CI) 2.79, 6.84] in ASHA incentive group and health education (HE) group (RR = 3.67, 95% CI 2.35, 5.75) compared with baseline. Providing incentive to ASHAs was not found to be of extra advantage (RR = 1.19, 95% CI 0.89, 1.57). The likelihood of uptake of screening was higher among uncontrolled PwDM, poor literacy, and higher duration of diabetes in incentive phase (P < 0.001) compared with HE. The results show that age (P = 0.017), education (P = 0.015) and level of RBS (P = 0.001) of those referred were significantly associated with incentives to ASHAs. Conclusion: ASHAs can be used effectively to refer known PwDM for DR screening especially when DR screening program is introduced in population with low awareness and poor accessibility. When incentives are planned, additional burden on resources should be kept in mind before adapting this model of care.
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Affiliation(s)
| | - Rajan Shukla
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Uday R Gajiwala
- Divyajyoti Trust, Tejas Eye Hospital, Mandvi, District-Surat, Gujarat, India
| | - Clare Gilbert
- Department of Clinical Research, International Centre for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Hira Pant
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Melissa Glenda Lewis
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
| | - G V S Murthy
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India; Department of Clinical Research, International Centre for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Murthy GVS, Gilbert C, Shukla R, Bala V, Anirudh GG, Mukpalkar S, Yamarthi P, Pendyala S, Puppala A, Supriya E, Batchu T. Overview and project highlights of an initiative to integrate diabetic retinopathy screening and management in the public health system in India. Indian J Ophthalmol 2020; 68:S12-S15. [PMID: 31937722 PMCID: PMC7001184 DOI: 10.4103/ijo.ijo_1964_19] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Purpose: Diabetes is a public health concern in India and diabetic retinopathy (DR) is an emerging cause of visual impairment and blindness. Approximately 3.35–4.55 million people with diabetes mellitus (PwDM) are at risk of vision-threatening DR (VTDR) in India. More than 2/3 of India's population resides in rural areas where penetration of modern medicine is mostly limited to the government public health system. Despite the increasing magnitude, there is no systematic screening for the complications of diabetes, including DR in the public health system. Therefore, a pilot project was initiated with the major objectives of management of DR at all levels of the government health system, initiating a comprehensive program for the detection of eye complications among PwDM at public health noncommunicable disease (NCD) clinics, augmenting the capacity of physicians, ophthalmologists and health support personnel and empowering carers/PwDM to control the risk of DR through increased awareness and self-management. Methods: A national task force (NTF) was constituted to oversee policy formulation and provide strategic direction. 10 districts were identified for implementation across 10 states. Protocols were developed to help implement training and service delivery. Results: Overall, 66,455 PwDM were screened and DR was detected in 16.2% (10,765) while VTDR was detected in 7.5%. 10.1% of those initially screened returned for the next annual assessment. There was a 7-fold increase in the number of PwDM screened and a 7.6-fold increase in the number of PwDM treated between 2016 and 2018. Conclusion: Services for detecting and managing DR can be successfully integrated into the existing public health system.
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Affiliation(s)
- G V S Murthy
- International Centre for Eye Health, Clinical Research Department, London School for Hygiene and Tropical Medicine, London, UK; Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Clare Gilbert
- International Centre for Eye Health, Clinical Research Department, London School for Hygiene and Tropical Medicine, London, UK
| | - Rajan Shukla
- Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Vidyadhar Bala
- Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Gaurang G Anirudh
- Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Sridivya Mukpalkar
- Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Pavani Yamarthi
- Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Suneetha Pendyala
- Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Anusha Puppala
- Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Edla Supriya
- Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Tripura Batchu
- Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
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- India DR Program Implementation
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Singh S, Shukla AK, Sheikh A, Gupta G, More A. Effect of health education and screening location on compliance with diabetic retinopathy screening in a rural population in Maharashtra. Indian J Ophthalmol 2020; 68:S47-S51. [PMID: 31937729 PMCID: PMC7001165 DOI: 10.4103/ijo.ijo_1976_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: To compare the acceptance of diabetic retinopathy (DR) screening by the proximity of care and health education in rural Maharashtra. Methods: Study was done in the public health facilities in four blocks (in two blocks at community health center (CHC) level and in other two blocks at primary health center (PHC) level with the provision of transport from villages to PHCs) over 3 months. Health education was not imparted in one block in each segment. Health education consisted of imparting knowledge on diabetes mellitus (DM) and DR by trained village-level workers. The screening was done using non-mydriatic fundus camera and teleophthalmology supported remote grading of DR. Results: In the study period, 1,472 people with known diabetes were screened in four blocks and 86.6% (n = 1275) gradable images were obtained from them. 9.9% (n = 126) were detected having DR and 1.9% (n = 24) having sight-threatening DR (STDR). More people accepted screening closer to their residence at the PHC than CHC (24.4% vs 11.4%; P < 0.001). Health education improved the screening uptake significantly (14.4% vs 18.7%; P < 0.01) irrespective of the place of screening—at CHC, 9.5% without health education vs 13.1% with health education; at PHC, 20.1% without health education versus 31.6% with health education. Conclusion: Conducting DR screening closer to the place of living at PHCs with the provision of transport and health education was more effective for an increase in the uptake of DR screening by people with known diabetes in rural Maharashtra.
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Affiliation(s)
- Smita Singh
- Department of Ophthalmology, Mahatma Gandhi Institute of Medical Sciences, Sewagram Wardha, Maharashtra, India
| | - Ajay K Shukla
- Department of Ophthalmology, Mahatma Gandhi Institute of Medical Sciences, Sewagram Wardha, Maharashtra, India
| | - Azhar Sheikh
- Department of Ophthalmology, Mahatma Gandhi Institute of Medical Sciences, Sewagram Wardha, Maharashtra, India
| | - Girdharilal Gupta
- Department of Ophthalmology, Mahatma Gandhi Institute of Medical Sciences, Sewagram Wardha, Maharashtra, India
| | - Aarti More
- Department of Ophthalmology, Mahatma Gandhi Institute of Medical Sciences, Sewagram Wardha, Maharashtra, India
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Kozioł M, Nowak MS, Udziela M, Piątkiewicz P, Grabska-Liberek I, Szaflik JP. First nation-wide study of diabetic retinopathy in Poland in the years 2013-2017. Acta Diabetol 2020; 57:1255-1264. [PMID: 32500357 PMCID: PMC7495995 DOI: 10.1007/s00592-020-01540-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 04/23/2020] [Indexed: 12/18/2022]
Abstract
AIMS To assess the prevalence and time trends of diabetic retinopathy (DR) in the overall population of Poland from 2013 to 2017 and diagnose the risk factors of occurring DR among patients with diabetes mellitus (DM). METHODS Data from all levels of healthcare services at public and private institutions recorded in the National Health Fund (NHF) database were evaluated. International Classification of Diseases codes (ICD-9 and ICD-10) and unique NHF codes were used to identify DM type 1 and type 2 patients, DR and treatment procedures including laser photocoagulation, pars plana vitrectomy (PPV), anti-VEGF and steroid intravitreal injections. RESULTS The overall registered prevalence of DR in the entire population of Poland was 0.81%. The mean prevalence of DR was 20.01% in the population with type 1 DM and 9.70% in the population with type 2 DM. In the study period, women represented 56.36% of all individuals registered with DR and 55.09% of all DM patients. In Poland, only 6.34% of all DM patients with DR received specific treatment with laser photocoagulation of the retina (82.32%), PPV (11.56%), anti-VEGF or steroid injections (5.15% and 0.97%, respectively). Cox regression hazard analysis showed that the risk of DR was associated with DM treatment only by GPs, female sex, coexisting systemic diseases and urban residence in both type 1 and type 2 DM. CONCLUSIONS A 5-year retrospective analysis reveals the mean prevalence of DR in the population with type 1 and type 2 DM in Poland was rather low.
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Affiliation(s)
- Milena Kozioł
- Department of Analyses and Strategies, Ministry of Health, 15 Miodowa str., 00-952, Warsaw, Poland
- Department of Ophthalmology, Medical University of Warsaw, Public Ophthalmic Clinical Hospital (SPKSO), 13 Sierakowskiego str., 03-709, Warsaw, Poland
| | - Michał S Nowak
- Provisus Eye Clinic, 112 Redzinska str., 42-209, Czestochowa, Poland.
- Saint Family Hospital Medical Center, 19 Wigury str., 90-302, Lodz, Poland.
| | - Monika Udziela
- Department of Ophthalmology, Medical University of Warsaw, Public Ophthalmic Clinical Hospital (SPKSO), 13 Sierakowskiego str., 03-709, Warsaw, Poland
| | - Paweł Piątkiewicz
- Department of Internal Diseases, Diabetology and Endocrinology, Medical University of Warsaw, 8 Kondratowicza str., 03-242, Warsaw, Poland
| | - Iwona Grabska-Liberek
- Department of Ophthalmology, Centre of Postgraduate Medical Education, 231 Czerniakowska str., 01-416, Warsaw, Poland
| | - Jacek P Szaflik
- Department of Ophthalmology, Medical University of Warsaw, Public Ophthalmic Clinical Hospital (SPKSO), 13 Sierakowskiego str., 03-709, Warsaw, Poland
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Chen T, Jin L, Zhu W, Wang C, Zhang G, Wang X, Wang J, Yang K, Cochrane GM, Lamoureux EL, Friedman DS, Gilbert S, Lansingh VC, Resnikoff S, Zhao J, Xiao B, He M, Congdon N. Knowledge, attitudes and eye health-seeking behaviours in a population-based sample of people with diabetes in rural China. Br J Ophthalmol 2020; 105:806-811. [PMID: 32737033 DOI: 10.1136/bjophthalmol-2020-316105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/05/2020] [Accepted: 06/12/2020] [Indexed: 12/23/2022]
Abstract
AIMS To assess knowledge of diabetes and acceptance of eye care among people with diabetes in rural China, to improve service uptake. METHODS Population-based study of people in Guangdong, China, with glycosylated haemoglobin A1c≥6.5% and/or known history of diabetes. Between August and November 2014, participants answered a questionnaire (based on Delphi process/previous focus groups) on medical history, demographic characteristics, self-rated health and vision, knowledge about diabetes and diabetic retinopathy, quality of local healthcare, barriers to treatment, likely acceptance of eye exams and treatment, and interventions rated most likely to improve service uptake. Presenting visual acuity was assessed, fundus photography performed and images graded by trained graders. Potential predictors of accepting care were evaluated and confounders adjusted for using logistic regression. RESULTS A total of 562 people (9.6% (256/5825), mean age 66.2±9.84 years, 207 (36.8%) men) had diabetes, 118 (22.3%) previously diagnosed. 'Very likely' or 'likely' acceptance of laser treatment (140/530=26.4%) was lower than for eye exams (317/530=59.8%, p<0.001). Predictors of accepting both exams and laser included younger age (p<.001) and prior awareness of diabetes diagnosis (p=0.004 and p=0.035, respectively). The leading barrier to receiving diabetes treatment was unawareness of diagnosis (409/454, 97.2%), while interventions rated most likely to improve acceptance of eye exams included reimbursement of travel costs (387/562, 73.0%), video or other health education (359/562, 67.7%) and phone call reminders (346/562, 65.3%). CONCLUSIONS Improving diagnosis of diabetes, along with incentives, education and communication strategies, is most likely to enhance poor acceptance of diabetic eye care in this setting.
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Affiliation(s)
- Tingting Chen
- The Ophthalmology Department, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China.,State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, China
| | - Ling Jin
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, China
| | - Wenhui Zhu
- The Ophthalmology Department, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China.,State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, China
| | - Congyao Wang
- The Ophthalmology Department, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China.,State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, China
| | - Guoshan Zhang
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, China
| | - Xiuqin Wang
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, China
| | - Jun Wang
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, China
| | - Ke Yang
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, China
| | - Gillian M Cochrane
- Faculty of Health, School of Medicine (Optometry), Deakin University, Burwood, Australia
| | - Ecosse Luc Lamoureux
- Health Services Research Unit, Singapore Eye Research Institute, Singapore, Singapore
| | - David S Friedman
- Glaucoma Center of Excellence, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Suzanne Gilbert
- Innovation & Sight Programs, Seva Foundation, Berkeley, California, USA
| | | | | | - Jialiang Zhao
- Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Dongcheng-qu,China
| | - Baixiang Xiao
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, China
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, China.,Centre for Eye Research Australia; Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Nathan Congdon
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, China .,Centre for Public Health, Queen's University Belfast, Belfast, UK
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Chawla R, Madhu SV, Makkar BM, Ghosh S, Saboo B, Kalra S. RSSDI-ESI Clinical Practice Recommendations for the Management
of Type 2 Diabetes Mellitus 2020. Int J Diabetes Dev Ctries 2020. [PMCID: PMC7371966 DOI: 10.1007/s13410-020-00819-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Rajeev Chawla
- North Delhi Diabetes Centre Rohini, New Delhi, India
| | - S. V. Madhu
- Centre for Diabetes, Endocrinology & Metabolism, UCMS-GTB Hospital, Delhi, India
| | - B. M. Makkar
- Dr Makkar’s Diabetes & Obesity Centre Paschim Vihar, New Delhi, India
| | - Sujoy Ghosh
- Department of Endocrinology & Metabolism, Institute of Post Graduate Medical Education & Research, Kolkata, West Bengal India
| | - Banshi Saboo
- DiaCare - A Complete Diabetes Care Centre, Ahmedabad, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana India
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Garoma D, Merga H, Hiko D. Determinants of diabetic retinopathy in Southwest Ethiopia: a facility-based case-control study. BMC Public Health 2020; 20:503. [PMID: 32295571 PMCID: PMC7161237 DOI: 10.1186/s12889-020-08652-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 04/03/2020] [Indexed: 12/13/2022] Open
Abstract
Background Diabetic Retinopathy is one of the serious complications patients’ diabetic patients suffer from. Little is known about which risk factors are associated with this complication. The aim of this study was therefore to identify determinants of Diabetic Retinopathy in Jimma University Medical Center. Methods A facility-based case-control study was conducted. Cases were Diabetic patients with diabetic retinopathy and who were on follow up at the Jimma University Medical Center while controls were Diabetic patients but free of diabetic retinopathy and who were on follow up at the Jimma University Medical Center. Cases and controls were identified and 311 of them were recruited using systematic random sampling. Data were entered into the Epi-Data version 4.1 and analyzed using SPSS Version 20. Binary Logistic regression analysis was conducted to identify determinants of diabetic retinopathy. Result A total of 106 cases and 205 controls diabetic participated in the study. Being ≥60 years of age (AOR = 5.04,95%CI: 1.83,13.87),being illiterate (AOR = 7.17, 95% CI: 2.61,19.7), poor adherence to medication (AOR =3: 95% CI: 1.29,6.95),having high systolic blood pressure (AOR = 3.38:95% CI: 1.26,9.05), having family history of Diabetes Mellitus (AOR = 3.95: 95% CI: 1.64,9.54), having other micro vascular complications (AOR = 3.76,95% CI: 1.33,10.66), poor glycemic control (AOR = 9.08, 95%CI: 3.7,22.29), poor cholesterol control (AOR = 0.21, 95%CI: 0.08,0.51) and being anaemic (AOR = 2.8, 95%CI: 1.05,7.47) were the independent determinants of diabetic retinopathy. Conclusion This study found that poor adherence to medication, being at the age of 60 years and above, being illiterate patients, having high systolic blood pressure, having a family history of Diabetes Mellitus, having other micro vascular complication, poor glycemic control, poor cholesterol control and being anemic patient were the independent determinants of diabetic retinopathy. Therefore, more attention should be given to older age and illiterate patients. Giving more emphasis for patients poorly adhered to anti-diabetic medications and giving advice for diabetic patients with high systolic blood pressure to follow their blood pressure regularly are also vital. Diabetic patients should also control their Blood sugar and blood cholesterol levels to prevent diabetic retinopathy or reduce its further complications.
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Affiliation(s)
- Dugasa Garoma
- Nekemte College of Health Sciences, Nekemte, Ethiopia
| | - Hailu Merga
- Department of Epidemiology, Institute of Health, Jimma University, Jimma, Ethiopia.
| | - Desta Hiko
- Department of Epidemiology, Institute of Health, Jimma University, Jimma, Ethiopia
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Misra N, Khanna RC. Commentary: Rapid assessment of avoidable blindness and diabetic retinopathy in India. Indian J Ophthalmol 2020; 68:381-382. [PMID: 31957733 PMCID: PMC7003596 DOI: 10.4103/ijo.ijo_1133_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Neha Misra
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care; Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care; Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Badrinath SS, Narayanan A, Hussaindeen JR, Surendran TS. The Sankara Nethralaya Community model - Technology and evidence based comprehensive quality eye care equally to all. Indian J Ophthalmol 2020; 68:288-290. [PMID: 31957709 PMCID: PMC7003583 DOI: 10.4103/ijo.ijo_34_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Sengamedu Srinivasa Badrinath
- Founder and Chairman Emeritus; Sankara Nethralaya, Unit of Medical Research Foundation, No. 41, College Road, Chennai - 600 006, Tamil Nadu, India
| | - Anuradha Narayanan
- Elite School of Optometry, Sankara Nethralaya, Unit of Medical Research Foundation, No. 41, College Road, Chennai - 600 006, Tamil Nadu, India
| | - Jameel Rizwana Hussaindeen
- Elite School of Optometry, Sankara Nethralaya, Unit of Medical Research Foundation, No. 41, College Road, Chennai - 600 006, Tamil Nadu, India
| | - Thandalam Sundararajan Surendran
- Vice Chairman and Director of Pediatric Ophthalmology, Sankara Nethralaya, Unit of Medical Research Foundation, No. 41, College Road, Chennai - 600 006, Tamil Nadu, India
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Chawla R, Madhu SV, Makkar BM, Ghosh S, Saboo B, Kalra S. RSSDI-ESI Clinical Practice Recommendations for the Management of Type 2 Diabetes Mellitus 2020. Indian J Endocrinol Metab 2020; 24:1-122. [PMID: 32699774 PMCID: PMC7328526 DOI: 10.4103/ijem.ijem_225_20] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Rajeev Chawla
- North Delhi Diabetes Centre, Rohini, New Delhi, India
| | - S. V. Madhu
- Centre for Diabetes, Endocrinology and Metabolism, UCMS-GTB Hospital, New Delhi, India
| | - B. M. Makkar
- Dr. Makkar's Diabetes and Obesity Centre, Paschim Vihar, New Delhi, India
| | - Sujoy Ghosh
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Banshi Saboo
- DiaCare - A Complete Diabetes Care Centre, Ahmedabad, Gujarat, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
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Rai BB, Shresthra MK, Thapa R, Essex RW, Paudyal G, Maddess T. Pattern and Presentation of Vitreo-Retinal Diseases: An Analysis of Retrospective Data at a Tertiary Eye Care Center in Nepal. Asia Pac J Ophthalmol (Phila) 2019; 8:481-488. [PMID: 31789651 PMCID: PMC6903420 DOI: 10.1097/01.apo.0000604400.50700.2d] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 06/18/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE We examined patients presenting in a tertiary eye hospital in Nepal, focusing on information relevant to screening and management programs for vitreo-retinal (VR) disease. DESIGN Retrospective, cross-sectional study. METHODS We reviewed all patients presenting for the first time to the VR-clinic over 1 year. We quantified patient demography, symptoms and duration, systemic diseases, ophthalmological examinations, diagnostic investigations, and final diagnoses. RESULTS Of the 1905 cases, 1148 were male (60.3%). The 25th percentile of ages was 29 and 38 years for male and female, respectively; thus, female presented later (P < 0.0001). Hypertension was the commonest systemic disease (40.8%), followed by diabetes (32.5%). Age-related macular degeneration (AMD) and diabetic retinopathy (DR) affected 447 eyes (11.8%) and 416 eyes (10.9%), respectively. Male and female AMD and DR patients did not differ in age or disease duration. Similarly, age or disease duration for DR did not correlate with severity. Asymmetry of disease severity between eyes with AMD and DR was largest in patients with 1 normal eye. Presenting acuity was asymmetric between eyes (P < 0.0001) with people more often reporting once their right eyes had acuity of 6/18 or worse. CONCLUSIONS The screening of blood pressure and glucose levels combined with fundus photography could prevent many from progressing to life-changing visual impairment and blindness. Later reporting by females began at childbearing age; therefore, education and ocular screening could be usefully coupled in reproductive health programs. Clubbing VR disease screening with other established health programs like diabetes control program, hypertension clinics, school health program, and so on, would provide economical and sustainable approach.
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Affiliation(s)
- Bhim B. Rai
- John Curtin School of Medical Research, Australian National University, ACT, Australia
| | | | - Raba Thapa
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Rohan W. Essex
- ANU Academic Unit of Ophthalmology, ANU Medical School; Department of Ophthalmology, Canberra Hospital, ACT Health, Australia
| | | | - Ted Maddess
- John Curtin School of Medical Research, Australian National University, ACT, Australia
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Dsouza B, Prabhu RA, Unnikrishnan B, Shetty A, Reshmi B. A Qualitative Study on Factors Affecting Adherence Among Indian Haemodialysis Patients at a Tertiary Teaching Hospital of Southern India. JOURNAL OF HEALTH MANAGEMENT 2019. [DOI: 10.1177/0972063419868583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Non-adherence to treatment regimen can have a detrimental effect on the heath of dialysis patients, increase mortality, morbidity and increase in healthcare service utilization and cost of hospitalization. This qualitative study explores the factors affecting adherence among the dialysis population visiting a tertiary care teaching hospital in southern India by conducting one-to-one in-depth interviews with the patients as well as key informant interview with the caregivers at the outpatient dialysis facility of a tertiary care teaching hospital. Interview transcripts were thematically analyzed using ATLAS.ti. Patient factors, health financing, cultural beliefs, caregivers’ burden and health systems factors were identified. Understanding the factors affecting adherence can help the healthcare providers and the government to devise strategies to promote adherence and improved well-being among dialysis patients. Universal health coverage for dialysis, regulations to safeguard employment, creating awareness about opting for critical illness policies through private insurance companies when the disease is not pre-existing can reduce the out-of-pocket expenditure; these are some of the important areas for consideration to promote adherence.
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Affiliation(s)
- Brayal Dsouza
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Ravindra A Prabhu
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - B Unnikrishnan
- Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Avinash Shetty
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Bhageerathy Reshmi
- Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
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Bellemo V, Lim G, Rim TH, Tan GSW, Cheung CY, Sadda S, He MG, Tufail A, Lee ML, Hsu W, Ting DSW. Artificial Intelligence Screening for Diabetic Retinopathy: the Real-World Emerging Application. Curr Diab Rep 2019; 19:72. [PMID: 31367962 DOI: 10.1007/s11892-019-1189-3] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW This paper systematically reviews the recent progress in diabetic retinopathy screening. It provides an integrated overview of the current state of knowledge of emerging techniques using artificial intelligence integration in national screening programs around the world. Existing methodological approaches and research insights are evaluated. An understanding of existing gaps and future directions is created. RECENT FINDINGS Over the past decades, artificial intelligence has emerged into the scientific consciousness with breakthroughs that are sparking increasing interest among computer science and medical communities. Specifically, machine learning and deep learning (a subtype of machine learning) applications of artificial intelligence are spreading into areas that previously were thought to be only the purview of humans, and a number of applications in ophthalmology field have been explored. Multiple studies all around the world have demonstrated that such systems can behave on par with clinical experts with robust diagnostic performance in diabetic retinopathy diagnosis. However, only few tools have been evaluated in clinical prospective studies. Given the rapid and impressive progress of artificial intelligence technologies, the implementation of deep learning systems into routinely practiced diabetic retinopathy screening could represent a cost-effective alternative to help reduce the incidence of preventable blindness around the world.
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Affiliation(s)
- Valentina Bellemo
- Singapore National Eye Centre, Singapore Eye Research Institute, 11 Third Hospital Avenue, Singapore, 168751, Singapore
| | - Gilbert Lim
- Singapore National Eye Centre, Singapore Eye Research Institute, 11 Third Hospital Avenue, Singapore, 168751, Singapore
- School of Computing, National University of Singapore, Singapore, Singapore
| | - Tyler Hyungtaek Rim
- Singapore National Eye Centre, Singapore Eye Research Institute, 11 Third Hospital Avenue, Singapore, 168751, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Gavin S W Tan
- Singapore National Eye Centre, Singapore Eye Research Institute, 11 Third Hospital Avenue, Singapore, 168751, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - SriniVas Sadda
- Doheny Eye Institute, University of California, Los Angeles, CA, USA
| | - Ming-Guang He
- Center of Eye Research Australia, Melbourne, Victoria, Australia
| | - Adnan Tufail
- Moorfields Eye Hospital & Institute of Ophthalmology, UCL, London, UK
| | - Mong Li Lee
- School of Computing, National University of Singapore, Singapore, Singapore
| | - Wynne Hsu
- School of Computing, National University of Singapore, Singapore, Singapore
| | - Daniel Shu Wei Ting
- Singapore National Eye Centre, Singapore Eye Research Institute, 11 Third Hospital Avenue, Singapore, 168751, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
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Borgharkar SS, Das SS. Real-world evidence of glycemic control among patients with type 2 diabetes mellitus in India: the TIGHT study. BMJ Open Diabetes Res Care 2019; 7:e000654. [PMID: 31413840 PMCID: PMC6673766 DOI: 10.1136/bmjdrc-2019-000654] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/27/2019] [Accepted: 06/22/2019] [Indexed: 02/03/2023] Open
Abstract
Objective To determine glycemic control in adult patients with type 2 diabetes receiving antidiabetic therapy as part of routine healthcare in India. Research design and methods This was a retrospective analysis of cross-sectional data of patients with type 2 diabetes receiving oral hypoglycemic agents (OHAs) with or without insulin between 2015 and 2017. We assessed proportion of patients with uncontrolled glycemia and performed logistic regression to evaluate its association with various risk factors and microvascular complications. Results A total of 55 639 eligible records were identified; mean age of patients was 54.31 (±11.11) years. One-third of the study population had microvascular complications, predominantly neuropathy. Nearly 76.6% of patients had uncontrolled glycated hemoglobin (HbA1c) ≥7% (53 mmol/mol); 62% of these patients had HbA1c between 7% and 8% (53-64 mmol/mol). Glycemic control from combination of OHAs with or without insulin varied between 14.2% and 24.8%. In multivariate analysis, factors statistically associated with uncontrolled glycemia were obesity (OR: 1.15), hypertension (stage I OR: 1.65 and stage II OR: 2.73) and diabetes duration >5 years (OR: 1.19) (p<0.001). Similarly, the odds of having any microvascular complication increased with duration of diabetes (past 1-2 years, OR: 1.67; 2-5 years, OR: 2.53; >5 years, OR: 4.01; p<0.0001), hypertension (stage I, OR: 1.18 and stage II, OR: 1.34; p<0.05) and uncontrolled HbA1c (OR: 1.28; p<0.0001). Conclusions Indian population with type 2 diabetes has a high burden (76.6%) of poor glycemic control. This study highlights the need for early implementation of optimum diabetes pharmacotherapy to maintain recommended glycemic control, thereby reducing burden of microvascular complications.
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Affiliation(s)
| | - Soma S Das
- Sciformix, A Covance Company, Mumbai, India
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Sasongko MB, Wardhana FS, Febryanto GA, Agni AN, Supanji S, Indrayanti SR, Widayanti TW, Widyaputri F, Widhasari IA, Lestari YD, Adriono GA, Sovani I, Kartasasmita AS. The estimated healthcare cost of diabetic retinopathy in Indonesia and its projection for 2025. Br J Ophthalmol 2019; 104:487-492. [PMID: 31285276 DOI: 10.1136/bjophthalmol-2019-313997] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/10/2019] [Accepted: 06/10/2019] [Indexed: 01/24/2023]
Abstract
PURPOSE To estimate the total healthcare cost associated with diabetic retinopathy (DR) in type 2 diabetes in Indonesia and its projection for 2025. METHODS A prevalence-based cost-of-illness model was constructed from previous population-based DR study. Projection for 2025 was derived from estimated diabetes population in 2025. Direct treatment costs of DR were estimated from the perspective of healthcare. Patient perspective costs were obtained from thorough interview including only transportation cost and lost of working days related to treatment. We developed four cost-of-illness models according to DR severity level, DR without necessary treatment, needing laser treatment, laser +intravitreal (IVT) injection and laser + IVT +vitrectomy. All costs were estimated in 2017 US$. RESULTS The healthcare costs of DR in Indonesia were estimated to be $2.4 billion in 2017 and $8.9 billion in 2025. The total cost in 2017 consisted of the cost for no DR and mild-moderate non-proliferative DR (NPDR) requiring eye screening ($25.9 million), severe NPDR or proliferative DR (PDR) requiring laser treatment ($0.25 billion), severe NPDR or PDR requiring both laser and IVT injection ($1.75 billion) and advance level of PDR requiring vitrectomy ($0.44 billion). CONCLUSIONS The estimated healthcare cost of DR in Indonesia in 2017 was considerably high, nearly 2% of the 2017 national state budget, and projected to increase significantly to more than threefold in 2025. The highest cost may incur for DR requiring both laser and IVT injection. Therefore, public health intervention to delay or prevent severe DR may substantially reduce the healthcare cost of DR in Indonesia.
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Affiliation(s)
- Muhammad Bayu Sasongko
- Department of Ophthalmology, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada-Dr Sardjito General Hospital, Yogyakarta, Indonesia
| | - Firman Setya Wardhana
- Department of Ophthalmology, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada-Dr Sardjito General Hospital, Yogyakarta, Indonesia
| | - Gandhi Anandika Febryanto
- Department of Ophthalmology, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada-Dr Sardjito General Hospital, Yogyakarta, Indonesia
| | - Angela Nurini Agni
- Department of Ophthalmology, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada-Dr Sardjito General Hospital, Yogyakarta, Indonesia
| | - Supanji Supanji
- Department of Ophthalmology, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada-Dr Sardjito General Hospital, Yogyakarta, Indonesia
| | - Sarah Rizqia Indrayanti
- Department of Ophthalmology, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada-Dr Sardjito General Hospital, Yogyakarta, Indonesia
| | - Tri Wahyu Widayanti
- Department of Ophthalmology, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada-Dr Sardjito General Hospital, Yogyakarta, Indonesia
| | - Felicia Widyaputri
- Department of Ophthalmology, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada-Dr Sardjito General Hospital, Yogyakarta, Indonesia
| | - Idhayu Anggit Widhasari
- Department of Ophthalmology, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada-Dr Sardjito General Hospital, Yogyakarta, Indonesia
| | - Yeni Dwi Lestari
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia-Dr Ciptomangunkusumo National Hospital, Jakarta, Indonesia
| | - Gitalisa Andayani Adriono
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia-Dr Ciptomangunkusumo National Hospital, Jakarta, Indonesia
| | - Iwan Sovani
- Department of Ophthalmology, Faculty of Medicine, Universitas Padjajaran-Cicendo National Eye Hospital, Bandung, Indonesia
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Alshareef SM, Aldayel AY, AlKhathlan MA, Alduaij KO, Alshareef FG, Al-Harthi ME, Aldayel AA, Shadid AM, Dahmash AB. Diabetic patients in Saudi Arabia: The evaluation of glycemic control measures based on emergency department utilization and the percentages of adherence to the recommended follow-ups for microvascular complications. Saudi Med J 2019; 40:271-276. [PMID: 30834423 PMCID: PMC6468210 DOI: 10.15537/smj.2019.3.23968] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To determine the association between emergency department (ED) visits, glycemic control and the quality of preventive diabetes care among diabetic patients in a Saudi community. Methods: This study was an observational, cross-sectional study that collected data through interview-based surveys between February and April 2017. Data were collected from 530 diabetic patients in the diabetes clinics at King Saud Medical City, the tertiary center of Riyadh, Kingdom of Saudi Arabia. Results: This study found statistically significant relationships (p<0.05) between ED visits and patient age, the glycated hemoglobin (HbA1c) and education level. Emergency department visits increased by 43% for each unit of increase in HbA1c (odds ratio [OR]=1.43, 95% confidence interval (CI)=1.26-1.62). Graduating from high school decreased the odds of visiting the ED by 43% (OR=0.57, 95% CI=0.34-0.94). Most of the participants were not followed for possible microvascular complications; the majority did not visit nephrology (96.2%), ophthalmology (78.3%) and neurology (97.9%) clinics within the 12 months prior to the interviews. Conclusion: Emergency department visits can indicate poor glycemic control in diabetic patients. Additionally, the current practices of preventive diabetes care in Saudi Arabia are not sufficient, according to the diabetic standards of care recommended by the American Diabetes Association.
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Affiliation(s)
- Saad M Alshareef
- Department of Medicine, Al Imam Mohammad Ibn Saud Islamic University,Ministry of Education, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Elevated serum OxLDL is associated with progression of type 2 Diabetes Mellitus to diabetic retinopathy. Exp Eye Res 2019; 186:107668. [PMID: 31100308 DOI: 10.1016/j.exer.2019.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 03/30/2019] [Accepted: 05/13/2019] [Indexed: 12/11/2022]
Abstract
Hyperlipidemia is associated with the progression of diabetic retinopathy (DR). Paraoxonase 1 (PON1), an esterase is known to prevent systemic LDL oxidation. This study assessed if serum oxLDL is associated with the progression of Type 2 DM to DR. This study is part of a three-year hospital based prospective study where 87 subjects were recruited. This included T2DM without DR (n = 22); Non-Proliferative (NPDR) (n = 21) and Proliferative DR (PDR) (n = 22) along with age/sex matched controls (n = 22). Serum oxLDL-Ab was estimated by ELISA. Serum PON esterase activity and plasma Malondialdehyde (MDA) level were estimated by spectrophotometry and the serum Advanced Glycation End products (AGE) level by spectroflourimetry. The systemic levels of oxLDL, AGE and MDA were increased with the progression of T2DM without DR to DR as seen by ANOVA (P < 0.05). Serum oxLDL-Ab levels showed a positive correlation to total cholesterol (P = 0.04) as evaluated in the DR group. Statin intake was found to lower PON esterase activity (P < 0.05). Based on this pilot study, it is proposed that elevated serum oxLDL should be validated in larger cohort studies to ensure it could be potential risk factor for the progression of T2DM to DR.
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50
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Jin G, Xiao W, Ding X, Xu X, An L, Congdon N, Zhao J, He M. Prevalence of and Risk Factors for Diabetic Retinopathy in a Rural Chinese Population: The Yangxi Eye Study. Invest Ophthalmol Vis Sci 2019; 59:5067-5073. [PMID: 30357401 DOI: 10.1167/iovs.18-24280] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the prevalence and determinants of diabetic retinopathy (DR) among older adults in rural Southern China. Methods Using random cluster sampling, persons aged 50 years or older were randomly selected in rural Yangxi County, Guangdong Province, China. All participants underwent a standardized interview, fundus photography, and point of service glycosylated hemoglobin A1c (HbA1c) testing. Diabetes mellitus (DM) was diagnosed based on confirmed medical history or HbA1c ≥6.5%. Fundus photographs were graded for DR and diabetic macular edema (DME) based on the United Kingdom National Diabetic Eye Screening Program guidelines. Prevalence of and risk factors for DR and vision-threatening diabetic retinopathy (VTDR) were evaluated. Results Among 5825 subjects who participated (90.7% response rate) in the Yangxi Eye Study, 562 (9.6%) were diagnosed with DM, including 79 (14.1%) known and 483 new (85.9%) cases. Among DM cases, 476 (84.7%) had gradable fundus photos. The prevalence of any DR and VTDR were 8.19% (95% confidence interval [CI] 5.9-11.0) and 5.25% (95% CI 3.43-7.66), respectively. These figures were 23.9% and 12.7% for known and 5.43% and 3.95% for new DM cases. Risk factors for any DR were higher HbA1c level (OR [odds ratio] per unit 1.34, P < 0.001), longer duration of DM (OR per year = 2.29, P < 0.001) and having previously undergone cataract surgery (OR 4.11, P < 0.030). Conclusions Our study found a lower prevalence of DR among adults 50 years and older than in previously reports. Perhaps this difference can be explained by the short duration of most cases.
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Affiliation(s)
- Guangming Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Wei Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaohu Ding
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiao Xu
- Rehabilitation Administration Department, National Institute of Hospital Administration, Chinese National Health and Family Planning Commission, Beijing, China
| | - Lei An
- Rehabilitation Administration Department, National Institute of Hospital Administration, Chinese National Health and Family Planning Commission, Beijing, China
| | - Nathan Congdon
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Translational Research for Equitable Eye Care, Centre for Public Health, Royal Victoria Hospital, Queen's University Belfast, Belfast, United Kingdom.,Orbis International, New York, New York, United States
| | - Jialiang Zhao
- Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Centre for Eye Research Australia, Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
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