The 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
The growing burden of diabetes has increased the prevalence of microvascular and macrovascular complication. With proper management of diabetic retinopathy (DR), more than 90% of vision loss can be prevented. Still, we lack studies that have documented the complete spectrum of eye disorders, including the sight-threatening DR (STDR) in Indian diabetics. The author Rajalakshmi and colleagues (2020) published their study in the Indian Journal of Ophthalmology under the title “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”. The summary of findings is below:
Objective:
To investigate the complete spectrum of eye diseases in Indian diabetics.
Method:
Data of T2DM people, who appeared for the first time in the retina clinic of eye-care facilities across India is collected. In 2016, data was collected in 6 months. Collected data includes information on systemic, clinical, and ocular parameters. DR grading was classified using the International Clinical Diabetic Retinopathy (ICDR) scale. The study defined STDR as the presence of severe non-proliferative (NPDR), proliferative diabetic retinopathy (PDR), and/or diabetic macular oedema (DME).
Findings:
1 out of 3 Indians presented at the eye-care facility had DR. Additionally, the study reports that about 1/5 of people with T2DM had STDR. More than half of the patients with DR may have STDR. Preventive measures such as tight glycemic control immediately after diagnosis of diabetes, early detection, and timely treatment of STDR even before the patient is symptomatic is necessary to minimize vision loss due to STDR. Age at diagnosis of T2DM, poor glycemic control, and duration of diabetes are some notable risk factors for DR.
To reduce the risk of development and progression of retinopathy, it is suggested to maintain strict glycemic control (HbA1c < 7%) and near-normal blood pressure.
Limitations:
Causal directions are unclear as it is a cross-sectional hospital-based observational data-based study. As the study included data of patients who willingly visited eye-care facilities, hence the findings might not be generalized to the population. There are some missing data of the systemic co-morbidities as few eye-care facilities were unable to get access to complete systemic evaluation of the patients. Lastly, there was heterogeneity in the data collection and inter-observer variation in retinopathy grading and assessment across different eye-care facilities.
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