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

Rajalakshmi, Ramachandran; Behera, Umesh Chandra; Bhattacharjee, Harsha; Das, Taraprasad; Gilbert, Clare; Murthy, G V S; Pant, Hira; Shukla, Rajan

doi:10.4103/ijo.ijo_21_19

Cited by 28 publications

(30 citation statements)

References 22 publications

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“…Unlike reports from the Western countries that show that the prevalence of DR is about 30% in people with diabetes, population-based studies in India over the last two decades report a lower prevalence of DR of approximately 18% in urban areas and 10% in rural areas. [ 6 7 8 9 10 11 12 13 14 ] This is despite known risk factors associated with DR such as uncontrolled hyperglycemia, hypertension, and dyslipidemia being highly prevalent in India. There are possibly inherent genetic and local environmental protective factors for DR that are yet to be elucidated.…”

Section: All Patients With Diabetes Should Be Screened Regularly For mentioning

confidence: 99%

Diabetic retinopathy screening guidelines in India

Raman

Ramasamy

Rajalakshmi

et al. 2021

Indian Journal of Ophthalmology

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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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Section: All Patients With Diabetes Should Be Screened Regularly For mentioning

confidence: 99%

Diabetic retinopathy screening guidelines in India

Raman

Ramasamy

Rajalakshmi

et al. 2021

Indian Journal of Ophthalmology

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“…[ 15 ] Three-quarters of these expenses were made in NAC (North America and the Caribbean), WP (West Pacific), and European region compared to other regions that are home to 41.8% of people with DM. When 1 in 6 people with DM in the world lives in India[ 15 ] and with the knowledge that nearly a third of them is likely to develop DR (and possible risk of vision loss) of over a period of time,[ 16 ] India needs a policy change for greater expenditure for the care of people with DM so that its many debilitating complications (and the subsequent impact on productivity) are reduced.…”

Section: Discussionmentioning

confidence: 99%

The economic burden of diabetic retinopathy care at a tertiary eye care center in South India

Orji

Rani

Narayanan

et al. 2021

Indian Journal of Ophthalmology

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Purpose: The aim of this study was to analyze the cost and factors affecting diabetic retinopathy (DR) care in a tertiary eye care facility in South India. Methods: In a retrospective, observational study, we evaluated the costs incurred in DR management in each stage of retinopathy from electronic medical records. Both medical and indirect costs (transportation and boarding) were calculated. Results: The study evaluated 1000 consecutive patients (2000 eyes) with DR, from January to June 2019. One-third (32%; n = 321) patients were females. The median cost per patient was INR 8,214 (IQR 2,812-29,748). Cost of care was higher in patients with sight-threatening DR (STDR) compared to non-STDR (INR 31,820 vs INR 14,356, P < 0.001). Among 57.3% ( n = 573;1137 eyes) of subjects who completed treatment, there was a statistically significant reduction in visual impairment (427 to 355 eyes) and blindness (<3/60) (132 to 103 eyes) from baseline ( P < 0.001). The number of follow-up visits had a negative association with travel distance and socioeconomic status ( P < 0.001); the positive association was seen with DR severity ( P = 0.002) and total cost ( P < 0.001) on regression analysis. There was a nearly 3-fold difference in the average medical cost per eye for subjects with severe visual loss (<3/60) (INR 26,270) compared to those with good vision (≥6/12) (INR 8,510). Conclusion: Treatment of DR benefits, but the cost of care increases with disease severity and visual impairment. Compliance to care was related to DR severity and treatment cost. Some of the barriers could be reduced with greater advocacy and reduced travel distance.

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“…Although few studies have reported a significant association between sex and DR, an increasing number of studies have confirmed that being male is an independent risk factor for DR [20][21][22] . The United Kingdom Prospective Diabetic Study found that male sex was an independent risk factor for the development of DR 23 .…”

Section: Discussionmentioning

confidence: 99%

Serum progesterone and retinopathy in male patients with type 2 diabetes: A cross‐sectional study

Sun

Wang

Zhou

et al. 2020

J of Diabetes Invest

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Aims/Introduction The aim of this study was to investigate the relationship between serum progesterone (P) and retinopathy in male patients with type 2 diabetes mellitus, and to investigate whether P is associated with its progression. Materials and methods A total of 1,376 male participants with type 2 diabetes mellitus were recruited from Affiliated Hospital of Medical College Qingdao University (Qingdao, China). Through logistic regression analysis after adjusting the potential confounding variation, the odds ratio (OR) and the corresponding 95% confidence interval related to the quartiles of progesterone were obtained. Results According to the quartiles of P levels, the prevalence rate of diabetic retinopathy (DR) in the last quartile is obviously greater to other quartiles (52.5–34.9%, 31.9%, 37.5%, P < 0.001). Compared with those in the first quartile, the prevalence of DR for the last quartile had an OR of 1.85 in the non‐proliferative diabetic retinopathy group, while the OR was 8.35 in the proliferative diabetic retinopathy group (P < 0.001, unadjusted model). When adjusted for age, body mass index, duration of type 2 diabetes mellitus, glycated hemoglobin, blood pressure and other variables, the ORs for DR in the fourth quartile were 2.13 (95% confidence interval 1.49–3.06) in the non‐proliferative diabetic retinopathy group and 8.44 (95% confidence interval 2.69–26.43) in the proliferative diabetic retinopathy group (P < 0.001). The positive association between P and DR risk was independent in adjusted logistic regression. Conclusions High levels of serum progesterone are significantly associated with DR in male hospitalized patients. This could mean that a higher P level in men is a potential clinical factor to identify DR, and the causality remains to be further explored.

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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

Cited by 28 publications

References 22 publications

Diabetic retinopathy screening guidelines in India

Diabetic retinopathy screening guidelines in India

The economic burden of diabetic retinopathy care at a tertiary eye care center in South India

Serum progesterone and retinopathy in male patients with type 2 diabetes: A cross‐sectional study

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