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      Prevalence and risk factors for diabetic retinopathy in rural India. Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetic Study III (SN-DREAMS III), report no 2

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          Abstract

          Objective

          The study was aimed at estimating the prevalence of type 2 diabetes mellitus and diabetic retinopathy in a rural population of South India.

          Design

          A population-based cross-sectional study.

          Participants

          13 079 participants were enumerated.

          Methods

          A multistage cluster sampling method was used. All eligible participants underwent comprehensive eye examination. The fundi of all patients were photographed using 45°, four-field stereoscopic digital photography, and an additional 30° seven-field stereo digital pairs were taken for participants with diabetic retinopathy. The diagnosis of diabetic retinopathy was based on Klein's classification.

          Main outcome measures

          Prevalence of diabetes mellitus and diabetic retinopathy and associated risk factors.

          Results

          The prevalence of diabetes in the rural Indian population was 10.4% (95% CI 10.39% to 10.42%); the prevalence of diabetic retinopathy, among patients with diabetes mellitus, was 10.3% (95% CI 8.53% to 11.97%). Statistically significant variables, on multivariate analysis, associated with increased risk of diabetic retinopathy were: gender (men at greater risk; OR 1.52; 95% CI 1.01 to 2.29), use of insulin (OR 3.59; 95% CI 1.41 to 9.14), longer duration of diabetes (15 years; OR 6.01; 95% CI 2.63 to 13.75), systolic hypertension (OR 2.14; 95% CI 1.20 to 3.82), and participants with poor glycemic control (OR 3.37; 95% CI 2.13 to 5.34).

          Conclusions

          Nearly 1 of 10 individuals in rural South India, above the age of 40 years, showed evidence of type 2 diabetes mellitus. Likewise, among participants with diabetes, the prevalence of diabetic retinopathy was around 10%; the strongest predictor being the duration of diabetes.

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          Most cited references30

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          Obesity and the metabolic syndrome in developing countries.

          Anoop Misra, Lokesh Khurana (2008)
          Prevalence of obesity and the metabolic syndrome is rapidly increasing in developing countries, leading to increased morbidity and mortality due to type 2 diabetes mellitus (T2DM) and cardiovascular disease. Literature search was carried out using the terms obesity, insulin resistance, the metabolic syndrome, diabetes, dyslipidemia, nutrition, physical activity, and developing countries, from PubMed from 1966 to June 2008 and from web sites and published documents of the World Health Organization and Food and Agricultural Organization. With improvement in economic situation in developing countries, increasing prevalence of obesity and the metabolic syndrome is seen in adults and particularly in children. The main causes are increasing urbanization, nutrition transition, and reduced physical activity. Furthermore, aggressive community nutrition intervention programs for undernourished children may increase obesity. Some evidence suggests that widely prevalent perinatal undernutrition and childhood catch-up obesity may play a role in adult-onset metabolic syndrome and T2DM. The economic cost of obesity and related diseases in developing countries, having meager health budgets is enormous. To prevent increasing morbidity and mortality due to obesity-related T2DM and cardiovascular disease in developing countries, there is an urgent need to initiate large-scale community intervention programs focusing on increased physical activity and healthier food options, particularly for children. International health agencies and respective government should intensively focus on primordial and primary prevention programs for obesity and the metabolic syndrome in developing countries.
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            High prevalence of diabetes and impaired glucose tolerance in India: National Urban Diabetes Survey.

            A Ramachandran, C Snehalatha, A. Kapur … (2001)
            There has been no reported national survey of diabetes in India in the last three decades, although several regional studies show a rising prevalence of diabetes. The aim of this study was to assess the prevalence of diabetes and impaired glucose tolerance in six major cities, covering all the regions of the country. Using a stratified random sampling method, 11216 subjects (5288 men; 5928 women) aged 20 years or above, representative of all socio-economic strata, were tested by OGTT. Demographic, anthropometric, educational and social details were recorded using a standard proforma. Physical activity was categorised using a scoring system. Body mass index (BMI) and waist-to-hip ratio (WHR) were calculated. Glucose tolerance was classified using the 2-h values (WHO criteria). Prevalence estimations were made taking into account the stratified sampling procedure. Group comparisons were done by t-test or analysis of variance or Z-test as relevant. Univariate and multiple logistic regression analyses were used to study the association of variables with diabetes and impaired glucose tolerance. Age standardised prevalences of diabetes and impaired glucose tolerance were 12.1% and 14.0% respectively, with no gender difference. Diabetes and impaired glucose tolerance showed increasing trend with age. Subjects under 40 years of age had a higher prevalence of impaired glucose tolerance than diabetes (12.8% vs 4.6%, p < 0.0001). Diabetes showed a positive and independent association with age, BMI, WHR, family history of diabetes, monthly income and sedentary physical activity. Age, BMI and family history of diabetes showed associations with impaired glucose tolerance. This national study shows that the prevalence of diabetes is high in urban India. There is a large pool of subjects with impaired glucose tolerance at a high risk of conversion to diabetes.
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              Prevalence of diabetic retinopathy in India: Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetics Study report 2.

              Rajiv Raman, Padmaja Rani, Sudhir Reddi Rachepalle … (2009)
              The aim of the study was to estimate the prevalence of diabetic retinopathy in an urban Indian population older than 40 years. A population-based cross-sectional study. Five thousand nine hundred ninety-nine subjects residing in Chennai, India, were enumerated. A multistage random sampling, based on socioeconomic criteria, was followed. Identified subjects with diabetes mellitus (based on the World Health Organization criteria) underwent detailed examination at the base hospital. The fundi of all patients were photographed using 45 degrees , 4-field stereoscopic digital photography. The diagnosis of diabetic retinopathy was based on Klein's classification of the Early Treatment Diabetic Retinopathy Study scale. These included age- and gender-adjusted prevalence of diabetes and diabetic retinopathy, and correlation of prevalence with history-based risk factors. The age- and gender-adjusted prevalence rate of diabetes in an urban Chennai population was 28.2% (95% confidence interval [CI], 27.0-29.3), and the prevalence of diabetic retinopathy in general population was 3.5% (95% CI, 3.49-3.54). The prevalence of diabetic retinopathy in the population with diabetes mellitus was 18.0% (95% CI, 16.0-20.1). History-based variables that were significantly associated with increased risk of diabetic retinopathy included gender (men at greater risk; odds ratio [OR], 1.41; 95% CI, 1.04-1.91); use of insulin (OR, 3.52; 95% CI, 2.05-6.02); longer duration of diabetes (>15 years; OR, 6.43; 95% CI, 3.18-12.90); and subjects with known diabetes mellitus (OR, 2.98; 95% CI, 1.72-5.17). Differences in the socioeconomic status did not influence the occurrence of diabetic retinopathy. The prevalence of diabetic retinopathy was 18% in an urban population with diabetes mellitus in India. The duration of diabetes is the strongest predictor for diabetic retinopathy. The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open Diabetes Res Care
                Journal ID (iso-abbrev): BMJ Open Diabetes Res Care
                Journal ID (hwp): bmjdrc
                Journal ID (publisher-id): bmjdrc
                Title: BMJ Open Diabetes Research & Care
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2052-4897
                Publication date Collection: 2014
                Publication date (Electronic): 6 June 2014
                Volume: 2
                Issue: 1
                Electronic Location Identifier: e000005
                Affiliations
                [1 ]Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya , Chennai, Tamil Nadu, India
                [2 ]Department of Preventive Ophthalmology, Sankara Nethralaya , Chennai, Tamil Nadu, India
                Author notes
                [Correspondence to ] Dr Tarun Sharma; drtaruns@ 123456gmail.com

                PRÉCIS The prevalence of DM and DR in a rural south Indian population was 10.1% and 10.3%, respectively. The risk factors for DR were male gender, longer duration of diabetes, higher HbA1c, insulin use, and higher systolic BP.

                Article
                Publisher ID: bmjdrc-2013-000005
                DOI: 10.1136/bmjdrc-2013-000005
                PMC ID: 4212556
                PubMed ID: 25452856
                SO-VID: 3c8a0c50-c3f2-47ae-acfa-e826b15a7526
                Copyright © Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions
                License:

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

                History
                Date received : 25 November 2013
                Date revision received : 22 April 2014
                Date accepted : 29 April 2014
                Categories
                Subject: Epidemiology/Health service research
                Subject: 1506
                Subject: 1867

                Keywords: retinopathy,incidence
                Data availability:
                Keywords: retinopathy, incidence

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