Prevalence of diabetic retinopathy in urban and rural India: A systematic review and meta-analysis

Effectiveness of "Rule of Seven" intervention in improving control status in diabetes mellitus protocol of a randomized controlled trial

BACKGROUND

We developed the "rule of seven" intervention because different targets related to diabetes control can somehow be calculated by multiplication of seven. This study aimed to evaluate the effectiveness of the "rule of seven" in improving glycemic control in patients diagnosed with diabetes by measuring fasting plasma glucose and 2 hours postprandial plasma glucose.

MATERIALS AND METHODS

This two-arm randomized controlled trial will compare the effectiveness of the "rule of seven" intervention in achieving glycemic control in diabetes mellitus patients. The patients in the control arm will receive routine patient counseling related to diabetes mellitus. Patients registered with the noncommunicable disease (NCD) clinics of All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Community Health Center (CHC) Tangi, and CHC Mendhasala will be recruited consecutively during clinic hours after fulfilling eligibility criteria and obtaining written informed consent. The sample size was estimated as 426 in each group. The ethical permission was obtained from the Institutional Ethics Committee (IEC) and prospectively registered in the Clinical Trial Registry of India (CTRI/2023/07/055522).

DISCUSSION

After the intervention, we will find out the change in knowledge regarding parameters related to glycemic status; discover the change in biochemical parameters after 1, 3, and 6 months; and conclude whether those changes are statistically significant or not.

Knowledge, attitude, and practice of diabetes in patients with and without sight-threatening diabetic retinopathy from two secondary eye care centres in India

BACKGROUND/AIMS

Good knowledge, Attitude, and Practice (KAP) of diabetes influence its control and complications. We examined the KAP of diabetes in patients with sight-threatening diabetic retinopathy (STDR) and non-sight-threatening diabetic retinopathy (NSTDR) attending two different referral hospitals in India.

METHODS

400 consecutive patients (mean age = 58.5 years ± 10.3) with diabetic retinopathy attending retina referral clinics in Chennai (private) and Darjeeling (public) were recruited. A validated questionnaire on diabetic KAP was administered in English or the local language. Data were analysed using an established scalar-scoring method in which a score of 1 was assigned to the correct answer/healthy lifestyle and 0 to an incorrect answer/unhealthy lifestyle/practice. Clinical data included fasting blood sugar, blood pressure, retinopathy, and visual acuity. Retinopathy was graded as STDR/NSTDR from retinal images using Early Treatment of Diabetic Retinopathy Study criteria.

RESULTS

Usable data from 383 participants (95.8%) were analysed. Of these, 83 (21.7%) had STDR, and 300 (78.3%) had NSTDR. The NSTDR group reported a significantly lower total KAP score (mean rank = 183.4) compared to the STDR group (mean rank = 233.1), z = -3.0, p < 0.001. A significantly greater percentage in the NSTDR group reported to being unaware that diabetes could affect eyes, did not know about possible treatment for DR, and checked their blood sugar less frequently than once a month.

CONCLUSION

Patients who had not developed STDR had poorer KAP about diabetes and diabetes-related eye diseases. This is an important issue to address as the risk of their progressing to STDR is high unless appropriate steps to improve their knowledge/awareness and lifestyle practice are introduced early.

Relationship between Diabetic Nephropathy and Development of Diabetic Macular Edema in Addition to Diabetic Retinopathy

This study aimed to examine the relationship between diabetic retinopathy (DR) and systemic factors. We evaluated 261 patients (143 men, 118 women, aged 70.1 ± 10.1 years) with type 2 diabetes. All participants underwent a fundus examination, fundus photography using spectral domain optical coherence tomography (SD-OCT), and blood tests. For glycated hemoglobin (HbA1c) levels, the average and highest values in the past were used. We observed DR in 127 (70 men and 57 women) of 261 patients. Logistic regression analyses revealed a significant correlation between DR development and the duration of diabetes (OR = 2.40; 95% CI: 1.50), average HbA1c level (OR = 5.57; 95% CI: 1.27, 24.4), highest HbA1c level (OR = 2.46; 95% CI: 1.12, 5.38), and grade of diabetic nephropathy (DN) (OR = 6.23; 95% CI: 2.70, 14.4). Regression analyses revealed a significant correlation between the severity of DR and duration of diabetes (t = -6.66; 95% CI: 0.21, 0.39), average HbA1c level (t = 2.59; 95% CI: 0.14, 1.02), and severity of DN (t = 6.10; 95% CI: 0.49, 0.97). Logistic regression analyses revealed a significant correlation between diabetic macular edema (DME) development and DN grade (OR = 2.22; 95% CI: 1.33, 3.69). DN grade correlates with the development of DR and DME, and decreased renal function predicts the onset of DR.

Prevalence of diabetic retinopathy in Brazil: a systematic review with meta-analysis

AIMS

To evaluate the prevalence of diabetic retinopathy (DR) in Brazilian adults with diabetes mellitus via a systematic review with meta-analysis.

METHODS

A systematic review using PubMed, EMBASE, and Lilacs was conducted, searching for studies published up to February 2022. Random effect meta-analysis was performed to estimate the DR prevalence.

RESULTS

We included 72 studies (n = 29,527 individuals). Among individuals with diabetes in Brazil, DR prevalence was 36.28% (95% CI 32.66-39.97, I2 98%). Diabetic retinopathy prevalence was highest in patients with longer duration of diabetes and in patients from Southern Brazil.

CONCLUSION

This review shows a similar prevalence of DR as compared to other low- and middle-income countries. However, the high heterogeneity observed-expected in systematic reviews of prevalence-raises concerns about the interpretation of these results, suggesting the need for multicenter studies with representative samples and standardized methodology.