Estimating the magnitude of diabetes mellitus and diabetic retinopathy in an older age urban population in Pune, western India

Abstract

ObjectiveTo estimate magnitude of diabetes mellitus (DM) and diabetic retinopathy (DR) in a high risk population in Pune, western India.MethodsDR module in rapid assessment of avoidable blindness (RAAB) survey methodology was used. Sample size of 3527 was calculated based on estimates from previous studies in India. A certified RAAB trainer conducted a training of survey teams. Random cluster sampling with probability proportionate to size was adapted to select 60 clusters consisting of 60 individuals each. Two teams visited door to door until they finished visiting 60 persons each day. Visual acuity testing, torch light examination, red glow test were carried out to determine persons with visual impairment and its cause. Every participant then underwent a random blood sugar level testing. All diabetics (known and newly detected) underwent dilated retina evaluation with indirect ophthalmoscopy to determine their DR status. Data were entered into RAAB6 software and descriptive statistics generated.ResultsResponse rate was 89.5 % (3221/3600), females (55.3%). The prevalence of DM in the sample was (706/3221) 21.9 %(95 CI 20.1 to 23.7). Prevalence of DR was 14.3 % (95% CI 11.7 to 16.9). Most diabetics (401/579, 69.3%) never had an eye examination for DR in the past. Cataract was the principal cause of blindness (50 % cases) among diabetics.ConclusionDM affects over fifth of persons above 50 years of age in western India. Nearly seventh of the diabetics have DR, but coverage of screening is poor in Pune.

Generating evidence for planning eye care service delivery in an urban underprivileged population setting in Pune, Western India

“…In the present paper, results pertaining only to RAAB module are presented. Findings of the DR module are presented elsewhere 14. Each survey team consisted of an ophthalmologist, an optometrist, a study coordinator and a technician.…”

“…Fundus was examined by a trained ophthalmologist using indirect ophthalmoscope (Appasamy Associates, India) and a 20 D lens (Volk, Germany) to ascertain DR status. Details of the methods of DR module are presented in another paper 14. For the rest of the subjects with early VI or worse, if no obvious cataract/anterior segment or obvious posterior segment cause (such as age-related macular degeneration (ARMD), DR) was identified, eyes were labelled as having ‘other’ posterior segment disease (PSD).…”

Impact of treatment of diabetic macular edema on visual impairment in people with diabetes mellitus in India

“…Diabetic retinopathy (DR) is the most common microvascular complication of DM and is emerging as an important cause of visual impairment (VI) in the working-age group. [ 2 3 4 5 6 ] With increasing prevalence of DM, the absolute numbers of patients with DR are likely to increase in the next two decades in India. [ 1 ] Prevalence of DR in India ranges from 17.6% to 28.2%.…”

“…[ 2 3 4 5 6 7 ] and less than 10% of the persons with diabetes (PwDM), suffer from sight-threatening DR (STDR) which includes diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR). [ 2 5 6 7 ] Nevertheless, all PwDM need regular screening as they are at risk of progressing to STDR. [ 8 ] Lack of compliance is a major limiting factor in ensuring universal coverage of systematic DR screening.…”

“…[ 8 ] Lack of compliance is a major limiting factor in ensuring universal coverage of systematic DR screening. In a recent report,[ 2 ] nearly 70% of PWD had never had their eyes screened for DR. The same study reported the prevalence of any DME among PWD to be 8.9% and that of referable DME as 2.4%.…”