Inclusion of diabetic retinopathy screening strategies in national-level diabetes care planning in low- and middle-income countries: a scoping review

Abstract

Background Diabetes is a major public health concern, with approximately 80% of the burden falling on low- and middle-income countries (LMICs). Diabetic retinopathy (DR) is one of the most common microvascular complications of diabetes, and early detection through diabetic eye screening programmes is essential to prevent visual impairment and blindness. Careful planning at a national level is crucial for effective implementation of such programmes. Methods A scoping review was conducted, and the protocol was published previously to explain the methods in detail. Data were collected from databases and searches, including grey literature. Furthermore, consultations were conducted with key informants from LMICs. Results Lower-middle-income countries (29/50, 58%) and upper-middle-income countries (27/59, 45.8%) are making more progress than low-income countries (4/29, 13.8%) in terms of DR policy planning. However, no identified data for published policies have actually implemented national DR policies. Compared to low-income and lower-middle-income countries, upper-middle-income countries are making the most progress in implementing national diabetic eye screening programmes; however, their progress is still slow, with only 5/59 (8.5%) having such programmes. Conclusion There are significant gaps in the literature, with no data reported for 78/138 (56.5%) LMICs. Further research is clearly needed to support and document DR policy development in LMICs.

Present and future screening programs for diabetic retinopathy: a narrative review

“…Curran et al [41] found that of 29 identified lowincome countries, only four had data available on DR policy planning, and just one had a partially rolled out DESP. Among the 50 lower-middle-income countries, 21 had begun a DR policy cycle, with a single nation having a national DESP and 18 with DESPs in the early implementation phase.…”

The Value of White Cell Inflammatory Biomarkers as Potential Predictors for Diabetic Retinopathy in Type 2 Diabetes Mellitus (T2DM)

“…The World Health Organization (WHO) Universal Eye Health: A Global Action Plan 2014-2019 outlines the need to achieve a reduction in the prevalence of avoidable visual impairment and blindness, including that related to diabetes, which is currently among the five most common causes of both moderate or severe visual impairment and blindness [5]. DR is listed as a priority eye disease in the 2030 IN SIGHT strategy [6]. However, an effective screening may be challenging due to limited available retina specialists.…”