Burden of Diabetic Retinopathy amongst People with Diabetes Attending Primary Care in Kerala: Nayanamritham Project.

Sobha Sivaprasad,Rajeev Sadanandan,Dolores Conroy,Simon George,Bipin Gopal,Sundaramuthil Murukaiah Vijayanand,Radha Ramakrishnan,Lakshmi Premnazir,Vasudeva Iyer Sahasranamam,Gopalakrishnan Netuveli,Raphael Wittenberg,Jyotsna Srinath

doi:10.3390/jcm10245903

Abstract

Background: The burden of diabetic retinopathy (DR) in people attending the public health sector in India is unclear. Thirty percent of the population in India is reliant on public healthcare. This study aimed to estimate the prevalence of DR and its risk factors in people with diabetes in the non-communicable disease registers who were attending the family health centres (FHCs) in the Thiruvananthapuram district in Kerala. Methods: This cross-sectional study was conducted over 12 months in 2019 within the framework of a pilot district-wide teleophthalmology DR screening programme. The age- and gender-adjusted prevalence of any DR and sight-threatening DR (STDR) in the whole sample, considering socio-demography, lifestyle and known clinical risk groups, are reported. Results: A total of 4527 out of 5307 (85.3%) screened in the FHCs had gradable retinal images in at least one eye. The age and gender standardised prevalence for any DR was 17.4% (95% CI 15.1, 19.7), and STDR was 3.3% (95% CI 2.1, 4.5). Ages 41–70 years, males, longer diabetes duration, hyperglycaemia and hypertension, insulin users and lower socio-economic status were associated with both DR outcomes. Conclusions: The burden of DR and its risk factors in this study highlights the need to implement DR screening programs within primary care to reduce health inequality.

Highlights

The burden of diabetic retinopathy (DR) and its risk factors in Kerala will provide information on resource allocation for systematic DR screening in the primary care in the public health system. In this cross-sectional study, we report the prevalence of any DR, sight-threatening DR (STDR) and referable retinopathy and associated risk factors in newly screened people with diabetes within the
Screening for DR was offered for people with diabetes attending the family health centres (FHCs) in the Thiruvananthapuram district and treatment for STDR delivered in secondary care hospitals [13]
This is a cross-sectional study of all individuals with diabetes registered in the non-communicable diseases (NCD) register who participated in the teleophthalmology DR screening program of Nayanamritham project in the 16 FHCS of Trivandrum District, Kerala over 12 months in 2019

Summary

Introduction

Kerala has one of highest prevalence of diabetes amongst all states in India. 10% of adults in Kerala are estimated to have type 2 diabetes (T2DM) [1,2]. The triad of increasing wealth, improved lifestyle and reduced physical activity has contributed to the rising prevalence of T2DM and its complications [2]. Approximately 4.5% of blindness in India is due to sightthreatening DR (STDR) [4,5]. The burden of diabetic retinopathy (DR) in people attending the public health sector in India is unclear. This study aimed to estimate the prevalence of DR and its risk factors in people with diabetes in the non-communicable disease registers who were attending the family health centres (FHCs) in the Thiruvananthapuram district in Kerala. The age- and gender-adjusted prevalence of any DR and sight-threatening DR (STDR). The age and gender standardised prevalence for any DR was 17.4%

Objectives

Methods

Findings

Conclusion