NATIONAL DIABETES AND DIABETIC RETINOPATHY SURVEY INDIA 2015-2019 – A SUMMARY REPORT SURVEY CONDUCTED BY: Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi National Programme for Control of Blindness &Visual Impairment, Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, New Delhi
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NATIONAL DIABETES AND DIABETIC RETINOPATHY SURVEY INDIA
2015-2019 – A SUMMARY REPORT
SURVEY CONDUCTED BY:
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi
National Programme for Control of Blindness &Visual Impairment,
Directorate General of Health Services,
Ministry of Health & Family Welfare, Government of India, New Delhi
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Key findings for National diabetes and diabetic retinopathy survey among
population aged ≥50 years
Indicators Percentage
Examined population (out of 63000 enumerated) 91.3
Prevalence of diabetes in surveyed population 11.8
Prevalence of known diabetes (KD) 8.0
Prevalence of new diabetes (ND)- Random blood sugar >200 mg/dl 3.8
Prevalence of diabetic retinopathy (DR) among diabetics 16.9
Prevalence of mild retinopathy 11.8
Prevalence of observable retinopathy 2.6
Prevalence of referable retinopathy 1.9
Prevalence of proliferative retinopathy 0.6
Prevalence of diabetic maculopathy 7.0
Prevalence of observable maculopathy 3.6
Prevalence of referable maculopathy 3.4
Prevalence of sight threatening DR 3.6
Introduction
The WHO estimated the global prevalence of diabetes among adults over 18 years of age as 8.5% in
2014. International Diabetes Federation report 2017 estimated there were 425 million diabetics in the
world and this figure is expected to increase to 629 million by year 2045. The increase is
disproportionately high in developing countries. There are estimated 72.96 million cases of diabetes in
adult population of India. The urban prevalence ranges between 10.9%-14.2% and rural prevalence
3.0%-7.8% among population aged 20 years above with a much higher prevalence among individuals
aged over 50 years (INDIAB Study). Diabetes and diabetic retinopathy have been emerging as a
significant non-communicable disease leading to ocular morbidity. It is estimated that diabetic
retinopathy was responsible for 1.06% of blindness and 1.16% of visual impairment globally in 2015.
There are no recent studies on the prevalence of diabetic retinopathy (DR) in different parts of India.
This makes it difficult to identify where DR screening and treatment programs are most needed. Most
available DR prevalence estimates are from diabetic clinics, which is subject to bias limiting their use
in planning ophthalmic services for diabetics in the general population. The present survey was
therefore planned to estimate the burden of diabetic retinopathy in the population aged ≥50 years for
assisting the planning and prioritization of diabetic eye services.
Aims and objectives
1. To assess prevalence of diabetic retinopathy and sight threatening diabetic retinopathy (STDR)
among people with diabetes.
2. To evaluate the coverage of diabetic retinopathy examinations among people with known diabetes
Methods
The survey was conducted using the Rapid Assessment of Avoidable Blindness + Diabetic Retinopathy
(RAAB+DR) survey methodology. Diabetes and DR assessment was carried out in 21 districts of India
selected using probability proportionate to size (PPS) systematic random sampling. A sample size of
3000 was targeted in each district by enrolling 60 individuals per cluster in 50 clusters. With 21 districts
included in the country, the total sample size for survey was 63,000 people aged 50 years and above.
The diagnosis of diabetes was made based on the participant having a history of diabetes, designated
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“Known Diabetes (KD)” or an elevated random capillary blood glucose (>=200 mg %) assigned as
New Diabetes (ND). Random capillary blood glucose (RBG) was assessed using a digital glucometer
by a trained laboratory technician. All the known diabetics and newly diagnosed diabetics aged 50
years and above were assessed for diabetic retinopathy by dilated fundus examination with indirect
ophthalmoscope by ophthalmologists. The Scottish DR grading system was used for classification of
retinopathy and maculopathy in each eye. Presence of laser scars was noted separately.
Results diabetes and diabetic retinopathy survey:
Prevalence of diabetes
Among 63,000 enumerated population aged ≥50 years in 21 districts, 56771 (90.1%) were assessed for
diabetes. The prevalence of diabetes was 11.8%. The prevalence of KD was 8.0% and ND was 3.8%.
Males showed a similar prevalence of diabetes (12%) as females (11.7%). Known diabetics comprised
67.3% participants, while 32.7% were new diabetics. Highest prevalence of diabetes was observed in
70-79 years age group at 13.2%. Nearly 40% of KDs were diagnosed 1-4 years back while 5.3% of
KDs reported diagnosis within past one-year.
Table 1: Prevalence of known and new diabetes among assessed in population aged ≥ 50 years