|Year : 2019 | Volume
| Issue : 3 | Page : 199-202
Awareness about diabetic retinopathy among doctors not specialized in ophthalmology
Ramya Chelliah, Ravikumar Rangasamy, Karthikeyan Mahalingam, Sheela Ramani, Soundarya N Sriram, V Ganesh
Department of Ophthalmology, Tagore Medical College and Hospital, Chennai, Tamil Nadu, India
|Date of Submission||19-Jun-2019|
|Date of Acceptance||14-Jul-2019|
|Date of Web Publication||11-Nov-2019|
Dr. Karthikeyan Mahalingam
Department of Ophthalmology, Tagore Medical College and Hospital, Rathinamangalam, Chennai - 600 127, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Introduction: Diabetic retinopathy is the most common microvascular complication of diabetes mellitus. Proper screening for diabetic retinopathy(DR) and appropriate management could prevent the occurrence of blindness. As doctors treating diabetes patients play a vital role in referring the patients to ophthalmologists for retinopathy screening, we decided to assess the level of awareness about DR. Methods and Materials: We conducted a cross-sectional study among doctors working in a tertiary care hospital with at least 2 years of experience. A set of questionnaire regarding DR was presented to participants to choose the answer of their choice. Analysis was done using SPSS software version 23. Results: Only 18.4% of them have referred all diabetic patients for retinopathy screening. Only 19 to 35% of participants were aware of the correct screening time for DR. 90 to 97% of the participants knew that DR is the most common microvascular complication of diabetes, and that it can even lead to blindness. 85 to 95 % of the participants were aware that both duration and level of glycemic control is associated with development of DR and glycemic control is the first step to prevent its progression. Conclusion: This study emphasizes the fact that awareness programs are necessary not only for diabetic patients, but also for the first contact health care professionals.
Keywords: Awareness, diabetic retinopathy, non-ophthalmologist, screening
|How to cite this article:|
Chelliah R, Rangasamy R, Mahalingam K, Ramani S, Sriram SN, Ganesh V. Awareness about diabetic retinopathy among doctors not specialized in ophthalmology. TNOA J Ophthalmic Sci Res 2019;57:199-202
|How to cite this URL:|
Chelliah R, Rangasamy R, Mahalingam K, Ramani S, Sriram SN, Ganesh V. Awareness about diabetic retinopathy among doctors not specialized in ophthalmology. TNOA J Ophthalmic Sci Res [serial online] 2019 [cited 2020 Jun 4];57:199-202. Available from: http://www.tnoajosr.com/text.asp?2019/57/3/199/270693
| Introduction|| |
Diabetes mellitus (DM) is a chronic metabolic disorder characterized by raised blood glucose level either due to insulin deficiency or insulin resistance. The global prevalence of diabetes in 2017 was estimated to be approximately 425 million and is estimated to increase to approximately 630 million in 2045. Diabetes, if not controlled, leads to various microvascular (nephropathy, retinopathy, and neuropathy) and macrovascular (cardiovascular disease, stroke, and peripheral artery disease) complications, with microvascular complications having a higher prevalence., Retinopathy is the most common microvascular complication of diabetes. The prevalence of diabetic retinopathy (DR) among patients with diabetes varies from 28.5% to 39.6% in different parts of the world.,,,, DR is one of the leading causes of moderate-to-severe visual impairment and preventable blindness.,
One of the most important factors in early diagnosis and management of DR is increasing the awareness of retinopathy as a complication of diabetes. There are many studies conducted to assess the awareness about DR among patients with diabetes.,,,, As doctors treating diabetic patients play a vital role in referring the patients to ophthalmologists for retinopathy screening, we decided to assess the level of awareness about DR among doctors who are not specialized in ophthalmology.
| Materials and Methods|| |
We conducted a cross-sectional study among doctors working in a tertiary care hospital during June 2019.
- All doctors working in the specified tertiary care hospital
- With minimum of 2 years of work experience after completing MBBS or equivalent undergraduate degree.
- Doctors specialized in ophthalmology
- Doctors working in the ophthalmology department
- Doctors who have not come across diabetic patients
- Doctors who did not give consent for the study.
The study was started after getting approval from the ethical committee. After obtaining consent, a set of questionnaire was presented to participants to choose the answer of their choice. The questionnaire was developed by the authors to test the awareness of DR as the complication of DM, its risk factors, and management [Figure 1]. The analysis was done using SPSS software version 23.
| Results|| |
One hundred and three participants gave consent for the study. The mean age of the participants was 34.3 ± 6.2 years. 52.4% of the participants were male and 47.6% of the participants were female. All the participants were aware that diabetes can cause retinopathy. 18.4% (19) of them have referred all diabetic patients for retinopathy screening, 64.1% (66) of them had referred at least 50% of diabetic patients for retinopathy screening, and 17.4% (18) of them have not referred to any diabetic patients for retinopathy screening [Figure 2]. 9.4% (8) of the participants had referred the diabetic patients specifically to retina specialists for retinopathy screening.
|Figure 2: Referral rate of their diabetic patients for retinopathy screening|
Click here to view
30.1% (31) of the participants felt that screening should be done immediately in Type 1 DM, 9.7% (10) chose the option of screening within 1 year, 19.4% (20) wanted screening to be done within 5 years, 2.9% (3) replied that screening should be done within 10 years of detection of diabetes, and 37.8% (39) were not aware. In Type 2 diabetes, 35.9% (37) chose to screen immediately, 17.5% (18) within 1 year, 6.8% (7) within 5 years, 0.9% (1) replied that screening should be done within 10 years of detection of diabetes, and 38.8% (40) were not sure about when the patient should be referred for screening.
8.7% (9) of the participants knew that the duration of diabetes is a risk factor for DR, 5.8% (6) agreed on the fact that the level of glycemic control is associated with the development of DR, and 85.4% (88) considered both factors to be associated with DR. 95.1% (98) of the participants believed that glycemic control is the first and foremost step to prevent the progression of DR. Only 3.9% (4) of the participants were known diabetic and they were screened for DR immediately or within 1 year of diagnosis of diabetes. Two of them underwent retinopathy screening on their own choice and the other two of them were advised by their ophthalmologist to undergo screening.
44.7% (46) of the participants had at least one family member suffering from diabetes. Of these 46 participants, 82.6% (38) said that their diabetic family members were screened for DR, 13% (6) said that their diabetic family members were not screened for DR, and rest of the participants (4.3%) were not aware of their screening status. 42.1% (16) of the participants had advised their diabetic family members for retinopathy screening. 18.4% (7) of diabetic family members went for DR screening on their own. In 21% (8) of the cases, the treating physician had referred them, and in 18.4% (7) of the cases, ophthalmologist had referred them. 81.6% (31) of those people were screened by any ophthalmologist and 18.4% (7) were screened by retina specialist.
89.3% (92) of the participants believed that any ophthalmologist can screen for DR, but 7.7% (8) of the participants believed that only retina specialist would screen for DR. A few participants thought that screening done by optometrist (1.9%) or general physician (0.9%) would be sufficient [Figure 3]. 90.3% (93) of the participants thought that DR can be treated, while the rest (9.7%) thought that there is no treatment for DR. 97.1% (100) of the participants believed that DR can lead to blindness, while the rest (2.9%) believed that it cannot cause blindness. 95.1% (98) of the participants knew that retinopathy is the most common microvascular complication.
|Figure 3: According to the participants, the person sufficient to screen for diabetic retinopathy|
Click here to view
| Discussion|| |
There is a global increase in the prevalence of diabetes., According to the World Health Organization, by 2030, India will have the largest number of diabetic patients in the world. Almost two-thirds of all Type 2 and almost all Type 1 diabetics are expected to develop DR over a period of time.,,
DR is the leading cause of visual loss in working-age population worldwide. The prevalence of DR was 21.7% according to a nationwide screening program done by All India Ophthalmological Society (AIOS) in 2014. Adequate awareness about the disease among the public, timely referral by the treating physician, and appropriate treatment can save from vision-threatening complications. For all these to happen, creating awareness about the disease and educating the public about the need for keeping their blood sugars under control and also the necessity for annual eye checkups even if they did not develop retinopathy play a remarkable role. There have been a number of awareness camps and screening camps for the general public. However, since the first contact doctor plays a major role in referring the patients for screening, awareness among them is of utmost importance. Hence, we decided to study the knowledge of doctors not specialized in ophthalmology about DR.
In our study, though all the participants knew that diabetes can cause retinopathy, only 18.6% of the participants have referred all of their diabetic patients for retinopathy screening and 16.7% have not referred any of their diabetic patients for retinopathy screening. This is a major concern as this can delay early detection and prompt treatment. In a study conducted by Raman et al. in South India, the awareness about referral among general practitioners was 54%. We have not analyzed the reasons behind the nonreferral in our study but realize the importance of increasing awareness among health-care professionals too.
Screening for DR should be done within 5 years after diagnosis in Type 1 diabetes and immediately in case of Type 2 diabetes. In our study, only 19.4% of the participants were sure regarding screening time in Type 1 diabetes and 35.9% of the participants regarding screening time in Type 2 diabetes [Figure 4]. Only 42.1% of the participants have advised their diabetic family members to undergo retinopathy screening. This reveals that training of doctors is essential to improvise their knowledge on this disease and their important role in preventing the vision-threatening complications. Awh et al. concluded that after a 4-h course, there was an increase in detection and appropriate referral of DR patients.
|Figure 4: Participants who knew the correct screening time for diabetic retinopathy|
Click here to view
Ghosh et al. assessed the awareness of DR among nonophthalmology physicians in three sections (magnitude of problem, risk factors, and management) and graded the knowledge of 74%–78% of the physicians as not acceptable. In our study, though only 19%–35% of the participants were aware of the correct screening time, 90%–97% of the participants knew that DR is the most common microvascular complication of diabetes and that it can even lead to blindness. They were aware that it can be treated. 85%–95% of the participants were aware that both duration and level of glycemic control are associated with the development of DR, and glycemic control is the first step to prevent its progression. Although they were aware of the risk factors and also that diabetes can cause such complications, the referral rate was less. This is a point to ponder on. We have not dealt with the impeding factors for referral in our study.
| Conclusion|| |
This study emphasizes the fact that awareness programs are necessary not only for diabetic patients but also for the first-contact health-care professionals. There should be programs conducted for the general physicians to reiterate the importance of prompt referral of DM patients for DR screening. Furthermore, hindering factors for referral should be studied and dealt with appropriately.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
DeFronzo RA, Ferrannini E, Zimmet P, Alberti KG. International Textbook of Diabetes Mellitus. 4th
ed.., Vol. 2. Oxford UK: Wiley-Blackwell; 2015.
International Diabetes Federation. IDF Diabetes Atlas. 8th
ed.. International Diabetes Federation; 2017. Available from: http://www.diabetesatlas.org/
. [Last accessed on 2019 May 01].
Deshpande AD, Harris-Hayes M, Schootman M. Epidemiology of diabetes and diabetes-related complications. Phys Ther 2008;88:1254-64.
Lotfy M, Adeghate J, Kalasz H, Singh J, Adeghate E. Chronic complications of diabetes mellitus: A mini review. Curr Diabetes Rev 2017;13:3-10.
Fowler MJ. Microvascular and macrovascular complications of diabetes. Clin Diabetes 2008;26:77-82.
Zhang X, Saaddine JB, Chou CF, Cotch MF, Cheng YJ, Geiss LS, et al.
Prevalence of diabetic retinopathy in the United States, 2005-2008. JAMA 2010;304:649-56.
Kostev K, Rathmann W. Diabetic retinopathy at diagnosis of type 2 diabetes in the UK: A database analysis. Diabetologia 2013;56:109-11.
Jaross N, Ryan P, Newland H. Prevalence of diabetic retinopathy in an aboriginal Australian population: Results from the Katherine Region Diabetic Retinopathy Study (KRDRS). Report no. 1. Clin Exp Ophthalmol 2003;31:32-9.
Kawasaki R, Tanaka S, Tanaka S, Yamamoto T, Sone H, Ohashi Y, et al.
Incidence and progression of diabetic retinopathy in Japanese adults with type 2 diabetes: 8 year follow-up study of the Japan Diabetes Complications Study (JDCS). Diabetologia 2011;54:2288-94.
Abougalambou SS, Abougalambou AS. Risk factors associated with diabetic retinopathy among type 2 diabetes patients at teaching hospital in Malaysia. Diabetes Metab Syndr 2015;9:98-103.
Cheung N, Mitchell P, Wong TY. Diabetic retinopathy. Lancet 2010;376:124-36.
Bourne RR, Stevens GA, White RA, Smith JL, Flaxman SR, Price H, et al.
Causes of vision loss worldwide, 1990-2010: A systematic analysis. Lancet Glob Health 2013;1:e339-49.
Gupta S, Gupta I, Kalra S. Study of awareness of diabetic retinopathy among the patients of type 2 diabetes mellitus: A prospective study. Indian J Clin Exp Ophthalmol 2018;4:483-6.
Bakkar MM, Haddad MF, Gammoh YS. Awareness of diabetic retinopathy among patients with type 2 diabetes mellitus in Jordan. Diabetes Metab Syndr Obes 2017;10:435-41.
AlHargan MH, AlBaker KM, AlFadhel AA, AlGhamdi MA, AlMuammar SM, AlDawood HA. Awareness, knowledge, and practices related to diabetic retinopathy among diabetic patients in primary healthcare centers at Riyadh, Saudi Arabia. J Family Med Prim Care 2019;8:373-7.
] [Full text]
Khandekar R, Harby SA, Harthy HA, Lawatti JA. Knowledge, attitude and practice regarding eye complications and care among Omani persons with diabetes – A cross sectional study. Oman J Ophthalmol 2010;3:60-5.
] [Full text]
Cetin EN, Zencir M, Fenkçi S, Akın F, Yıldırım C. Assessment of awareness of diabetic retinopathy and utilization of eye care services among Turkish diabetic patients. Prim Care Diabetes 2013;7:297-302.
Balasubramaniyan N, Ganesh Kumar S, Ramesh Babu K, Subitha L. Awareness and practices on eye effects among people with diabetes in rural Tamil Nadu, India. Afr Health Sci 2016;16:210-7.
Kaiser AB, Zhang N, Pluijm WV. Global Prevalence of type 2 diabetes over the next ten years (2018-2028). Diabetes 2018;67:202.
Animaw W, Seyoum Y. Increasing prevalence of diabetes mellitus in a developing country and its related factors. PLoS One 2017;12:e0187670.
Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030. Diabetes Care 2004;27:1047-53.
World Health Organization. Prevention of Blindness from Diabetic Retinopathy. Report of a WHO Consultation. Geneva: World Health Organization; 2005.
Guidelines for the Comprehensive Management of Diabetic Retinopathy in India. A VISION 2020 the Right to Sight India Publication; July, 2008.
Raman R, Paul PG, Padmajakumari R, Sharma T. Knowledge and attitude of general practitioners towards diabetic retinopathy practice in South India. Community Eye Health 2006;19:13-4.
Solomon SD, Chew E, Duh EJ, Sobrin L, Sun JK, VanderBeek BL, et al.
Diabetic retinopathy: A position statement by the American Diabetes Association. Diabetes Care 2017;40:412-8.
Awh CC, Cupples HP, Javitt JC. Improved detection and referral of patients with diabetic retinopathy by primary care physicians. Effectiveness of education. Arch Intern Med 1991;151:1405-8.
Ghosh S, Mukhopadhyay S, Maji D, Halder D. Awareness of diabetic retinopathy among physicians and optometrists in a district of West Bengal. Indian J Public Health 2007;51:228-30.
] [Full text]
[Figure 1], [Figure 2], [Figure 3], [Figure 4]