|Year : 2012 | Volume
| Issue : 2 | Page : 64-67
Prevalence of diabetic retinopathy and associated risk factors among diabetic patients attending Pravara Rural Hospital, Loni, Maharashtra
Purushottam A Giri1, Surekha V Bangal2, Deepak B Phalke1
1 Department of Community Medicine (PSM), Rural Medical College and Pravara Rural Hospital, Pravara Institute of Medical Sciences, Deemed University, Loni, Ahmednagar, Maharashtra, India
2 Department of Ophthalmology, Rural Medical College and Pravara Rural Hospital, Pravara Institute of Medical Sciences, Deemed University, Loni, Ahmednagar, Maharashtra, India
|Date of Web Publication||21-Sep-2013|
Purushottam A Giri
Department of Community Medicine (PSM), Rural Medical College, Loni - 413 736, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: The World Health Organization (WHO) describes Diabetes Mellitus (DM) as the most common endocrine disease in the world. The most common complication of DM is diabetic retinopathy. Diabetic retinopathy is increasingly becoming a major cause of blindness throughout the world in the age group of 20-60 years.
Objectives: This study was conducted to assess the prevalence of diabetic retinopathy and its associated risk factors among diabetic patients attending Pravara Rural Hospital, Loni, Maharashtra.
Materials and Methods: A cross-sectional study was carried out in the Department of Ophthalmology of Pravara Rural Hospital, Loni, Maharashtra from 1 st October 2011 to 31 st December 2011. A total of 88 diabetic patients who attended the Department of Ophthalmology of Pravara Rural Hospital, Loni during the study period were included and underwent pupil dilatation for fundus examination to screen retinopathy; after screening, it was classified according to the stages of diabetic retinopathy and associated history of hypertension, addictions and presence of family history was also noted. Data was analyzed by using Statistical Package of Social Sciences (SPSS) 16.0.
Results: In the present study, the prevalence of diabetic retinopathy was 39 (44.4%). Of the 39 patients who had signs of diabetic retinopathy, 25 (64.10%) were males and 14 (35.89%) were females. Non-proliferative diabetic retinopathy was documented in 71.79%, while 5.12% had proliferative diabetic retinopathy.
Conclusion: This study demonstrated that prevalence was 44.4% and poor control of diabetic retinopathy. This suggests the need for adequate prevention and treatment in patients with diabetes.
Keywords: Diabetes mellitus, diabetic retinopathy, prevalence, rural India
|How to cite this article:|
Giri PA, Bangal SV, Phalke DB. Prevalence of diabetic retinopathy and associated risk factors among diabetic patients attending Pravara Rural Hospital, Loni, Maharashtra. J Acad Med Sci 2012;2:64-7
|How to cite this URL:|
Giri PA, Bangal SV, Phalke DB. Prevalence of diabetic retinopathy and associated risk factors among diabetic patients attending Pravara Rural Hospital, Loni, Maharashtra. J Acad Med Sci [serial online] 2012 [cited 2020 Jan 25];2:64-7. Available from: http://www.e-jams.org/text.asp?2012/2/2/64/118662
| Introduction|| |
Diabetes mellitus (DM) is a major cause of avoidable blindness in both the developing and the developed countries. Patients with diabetic retinopathy (DR) are 25 times more likely to become blind than non-diabetics.  Diabetes mellitus is a common disease and occurs in one of two forms: Type 1, previously referred to as insulin-dependent diabetes mellitus or IDDM, and Type 2, previously termed as non-insulin-dependent diabetes mellitus or NIDDM. , In two studies from South India, the prevalence rates of DR in NIDDM patients were 34.1% and 37%. [4 ] India has 31.7 million diabetic subjects at present as per the World Health Organization (WHO) estimates.  In the Andhra Pradesh Eye Disease Study (APEDS) of self-reported diabetics, the prevalence of DR was 22.4%.  Chennai Urban Rural Epidemiology Study (CURES) evaluated urban sample of diabetic patients and estimated the overall prevalence of DR as 17.6%.  Diabetic retinopathy is increasingly becoming a major cause of blindness throughout the world in the age group of 20-60 years.  Retinopathy can be found in as many as three-quarters of individuals who have had diabetes mellitus for more than 15 years. Diabetic retinopathy is a leading cause of visual impairment among diabetic (DM) people.  Hence, the present study was conducted to assess the prevalence of diabetic retinopathy and associated risk factors among diabetic patients attending Pravara Rural Hospital, Loni, Maharashtra.
| Materials and Methods|| |
A cross-sectional study was carried out at Ophthalmology Department of Pravara Rural Hospital (PRH) Loni, a small village, situated in western Maharashtra, India from 1 st October 2011 - 31 st December 2011. A total of 88 diabetic patients who were referred from Medicine department for screening of diabetic retinopathy during the study period were included in the study. Pravara Rural Hospital is a tertiary level health care center attached as a teaching hospital of Rural Medical College, Loni that caters to the needs of the Ahmednagar district and comes under the aegis of Pravara Medical Trust. The majority of the patients at PRH come from rural areas. In addition, it serves a large number of patients from the adjoining districts of Aurangabad, Dhule, Jalgaon, and Nashik. The objectives of the study were explained to all the participants prior to the interview and their consent was taken for examination. No single participant objected to answering the questionnaire after the interviewers had explained the purpose of the study. All patients were examined for evidence of diabetic retinopathy by ophthalmologist and their fundi were examined using slit lamp examination, and fundus photography of each eye was taken through dilated pupils. Fundus examination was performed for screening of diabetic retinopathy. As per the fundus findings, cases were classified according to the stages of diabetic retinopathy. Additional information regarding associated history of hypertension, addictions, and presence of family history was also noted. Institutional Ethical Committee approval was obtained for the study. Data were entered in MS Excel and analyzed using Statistical Package of Social Sciences (SPSS) 16.0. Statistical significance was set at P ≤ 0.05. Percentages and proportions were calculated wherever appropriate.
Definition of Variables
Diabetes mellitus was defined as a fasting plasma glucose of ≥7.0 mmol/l (126 mg/dl) or more, use of diabetic medications, or a physician's diagnosis of diabetes.
The international clinical diabetic retinopathy severity scale adopted by the American Academy of Ophthalmology (AAO)  and the International Council of Ophthalmology (ICO)  were used to classify patients into non-proliferative diabetic retinopathy (NPDR) versus proliferative diabetic retinopathy (PDR).
Proliferative diabetic retinopathy (PDR) was defined as neovascularization of the disc (NVD) or neovascularization elsewhere (NVE).
Diabetic Maculopathy was defined as diabetic retinopathy situated in and around the macula, which can result in significant visual impairment.
Duration of DM was defined as the time period between the time of diagnosis and the time of examination. They were categorized into the following groups: Group 1: <5 years, Group 2: 5-10 years, Group 3: 11-15 years, and Group 4: >15 years.
| Results|| |
It can be seen from [Table 1] that in study sample of 88 diabetic patients, 57 (64.77%) were males and 31 (35.22%) were females. Only 6 (6.81%) were 20-40 years old followed by 35 (39.77%) aged between 40-60 years and 47 (53.40%) aged above 61 years. Mean age of all patients were 58.24 ± 13.76 years. About 34 (38.63%) had studied up to primary level schooling, 8 (9.09%) up to secondary and 4 (4.54%) up to higher secondary. Majority 67 (76.13%) patients had type 2 DM followed by 21 (23.86%) with type 1 DM. About 67 (76.14%) patients had history of DM of less than 5 yrs, and 17 (19.31%) patients had DM for more than 15 yrs. Only 15 (17.04%) patients had positive family history of diabetes, and 45 (51.13%) had associated hypertension.
It can be seen from [Table 2] that, out of the 88 diabetic patients, 39 (44.4%) were observed with complication of retinopathy, while 49 (55.6%) showed no indication of retinopathy. Of the 39 patients who had signs of diabetic retinopathy, 25 (64.10%) were males and 14 (35.89%) were females. Out of the 88 diabetic patients, 45 (51.13%) had associated hypertension, of which 25 (55.55%) had signs of DR; and 43 (48.86%) patients did not have associated hypertension, of which 14 (32.55%) had signs of DR. In present study, 58 (65.90%) patients had addiction to tobacco in form of smoking or tobacco chewing, of which 29 (50%) patients had signs of DR. In our study, 71.79% patients had NPDR, 5.12% patients had PDR, 15.38% patients had CSME, and 7.69% patients had maculopathy.
|Table 2: Prevalence of diabetic retinopathy by sociodemographic profile and associated risk factors in study population|
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| Discussion|| |
In our study, the prevalence of diabetic retinopathy was 44.4%. Similarly, studies conducted by Aggarwal et al.,  Zhang et al.,  Maskari et al.,  Raman et al.,  Javadi et al.,  and Gunnlaugsdottir et al.,  revealed that the prevalence of diabetic retinopathy were 28.9%, 28.5%, 19%, 18%, 37%, and 27%, respectively.
It was found that diabetic retinopathy was higher among the males (64.10%), elderly patients, and those having longer duration of diabetic mellitus. There is significant association between gender and diabetic retinopathy (P=0077). Similarly, studies conducted by Zhang et al.,  Maskari et al.,  and Raman et al.  also found that diabetic retinopathy was slightly more prevalent among men than women i.e. 31.6%, 24.2%, and 23.9%, respectively.
In the present study, majority 71.79% patients with diabetic retinopathy had NPDR (Non - Proliferative Diabetic Retinopathy) followed by 15.38% patients had CSME (Clinically Significant Macular Edema), 7.69% patients had maculopathy, and 5.12% patients had PDR. Similarly, study conducted by Aggarwal et al.  showed that 79.8% patients had NPDR, 14.6% patients had PDR, and 5.8% patients had maculopathy. In study conducted by Javadi et al.,  72.9% patients had NPDR, 27.1% patients had PDR, and 15.8% patients had CSME. Another study conducted by Gunnlaugsdottir et al.  revealed that 92.75% patients had NPDR, 3.6% patients had PDR and 3.6% had CSME.
In our study, there is significant association between duration of diabetes and diabetic retinopathy (P<0.0001). The study conducted by Maskari et al.  states that as the duration of DM increases, the incidence of DR increases. Another study conducted by Raman et al.  also shows that longer duration of diabetes has greater risk of diabetic retinopathy.
In the present study, there is significant association between hypertension and diabetic retinopathy (P=0.019). The study conducted by Maskari et al.  says that retinopathy was higher among patients with hypertension.
| Conclusion|| |
The prevalence of diabetic retinopathy in the present study was (44.4%) and significantly affected elderly males. Retinopathy is strongly associated with age of the patient, duration of diabetes, and having history of hypertension. Regular screening to detect diabetic retinopathy is highly recommended as with the early detection of proliferative retinopathy and timely laser photocoagulation, which are known to prevent most of the diabetes-related blindness.
| Acknowledgment|| |
We express our deep sense of gratitude to the Management, Pravara Medical Trust and The Principal, Rural Medical College Loni. We also acknowledge the help and support of medical interns- Divyaa Dhingra and Divya Mahajan.
| References|| |
|1.||Singh R, Ramasamy K, Abraham C, Gupta V, Gupta A. Diabetic retinopathy: An update. Indian J Ophthalmol 2008;56:179-88. |
|2.||Thylefors B, Negrel AD, Pararajasegaram R, Dadzie KY. Global data on blindness. Bull World Health Organ 1995;73:115-21. |
|3.||Wild S, Roglic G, Green A. Global prevalence of diabetes, estimates for the year 2000 and projections for 2030. Diabetes Care 2004;27:1047-53. |
|4.||Rema M, Ponnaiya M, Mohan V. Prevalence of retinopathy in non insulin dependent diabetes mellitus at a diabetes centre in southern India. Diabetes Res Clin Pract 1996;34:29-36. |
|5.||Sharma RA. Diabetic eye disease in southern India. Community Eye Health 1996;9:56-8. |
|6.||Dandona L, Dandona R, Naduvilath TJ. Population based assessment of diabetic retinopathy in an urban population in southern India. Br J Ophthalmol 1999;83:937-40. |
|7.||Rema M, Premkumar S, Anitha B. Prevalence of diabetic retinopathy in urban India: The Chennai Urban Rural Epidemiology Study (CURES) eye study. Invest Ophthalmol Vis Sci 2005;46:2328-33. |
|8.||Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. The Wisconsin epidemiologic study of diabetic retinopathy. III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years. Arch Ophthalmol 1984;102:527-32. |
|9.||Viswanath K, McGavin DD. Diabetic Retinopathy: Clinical findings and management. Community Eye Health 2003;16:21-4. |
|10.||American Academy of Ophthalmology: International Clinical Classification of Diabetic Retinopathy severity of diabetic macular edema. Available from: http://www.icoph.org/pdf/Macular-Edema-Detail.pdf. [Last accessed on 2012 Sep 11]. |
|11.||International Council of Ophthalmology (ICO) international clinical guideline: Diabetic retinopathy (initial and follow up evaluation). Available from: http://www.icoph.org/:/guide/guidedi.htmlat. [Last accessed on 2012 Sep 15]. |
|12.||Aggarwal RP, Ranka M, Beniwal R, Gothwal SR, Jain GC, Kochar DK et al. Prevalence of diabetic retinopathy in type 2 diabetic in relation to risk factors: Hospital based study. Int J Diab Deb Ctries 2003;23(1):16-19. |
|13.||Zhang X, Saaddine JB, Chou CF, Cotch MF, Cheng YJ, Geiss LS, et al. Prevalence of diabetic retinopathy in United States. 2005-2008. JAMA 2010;304:649-56. |
|14.||Maskari FA, Sadig ME. Prevalence of diabetic retinopathy in United Arab Emirates: A cross sectional survey. BMC Ophthalmol 2007;7:11. |
|15.||Raman R, Rani PK, Reddi Rachepalle S, Gnanamoorthy P, Uthra S, Kumaramanickavel G, et al. Prevalence of diabetic retinopathy in India: SankaraNaithralaya diabetic retinopathy epidemiology and molecular genetics, study report 2. Ophthalmology 2009;116:311-8. |
|16.||Javadi MA, Katibeh M, Rafati N, Dehghan MH, Zayeri F, Yaseri M, et al. Prevalence of diabetic retinopathy in Tehran province: A population based study. BMC Ophthalmol 2009;9:12. |
|17.||Gunnlaugsdottir E, Halldorsdottir S, Klein R, Eiriksdottir G, Klein BE, Benediktsson R, et al. Retinopathy in old persons with and without diabetes mellitus: The age, gene/environment susceptibility - Reykjavik study (AGES-R). Diabetologia 2011;54:1298-303. |
[Table 1], [Table 2]