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Regular checks

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ORNATE-India study

ORNATE India is a multidisciplinary, multifaceted UK-India collaborative study,which aims to build research capacity and capability in India and the UK to tackle the global burden of diabetes-related visual impairment, funded by Global Challenges Research Fund and UKRI.

Diabetes is a worldwide epidemic. Nearly 80% of adults with diabetes reside in low-middle income countries (LMIC) where primary care infrastructure is in its infancy, fuelling the global challenge of managing diabetes and its complications. Un-diagnosed diabetes is a significant problem in these countries and a high proportion of people are only diagnosed when they present with a disease-related complication.

Map of prevalence of diagnosed diabetes in districts of India (Akhtar SN, Dhillon P. J Soc Health Diabetes 2017;5:28-26)

Facts about diabetes in India

  • Diabetes is fast gaining the status of a potential epidemic in India with more than 77 million people currently diagnosed with the disease and this is expected to increase to over 100 million by 2030.
  • In addition, there are approximately 44 million with undiagnosed diabetes
  • Diabetes is continuing to increase as a result of rapid cultural and social changes, which include: ageing populations, increasing urbanization, dietary changes, reduced physical activity and unhealthy behaviour
  • The prevalence of the disease ranges from 5–17%, with higher levels found in the southern part of the country and in urban areas.

Complications of diabetes

Diabetes complications are divided into microvascular (due to damage to small blood vessels) and macrovascular (due to damage to larger blood vessels). Microvascular complications include damage to eyes (retinopathy) leading to blindness, to kidneys (nephropathy) leading to renal failure and to nerves (neuropathy) leading to impotence and diabetic foot disorders (which include severe infections leading to amputation). Macrovascular complications include cardiovascular diseases such as heart attacks, strokes and insufficiency in blood flow to legs. There is evidence from large randomized-controlled trials that good metabolic control in both type 1 and 2 diabetes can delay the onset and progression of these complications.

Diabetic retinopathy

Diabetic retinopathy is the most common complication of diabetes, and if left untreated leads to visual loss. It is emerging as a leading cause of vision impairment in working adults in urban India and is predicted to increase from 4.21 million in 2020 to 6.08 million by year 2030. Early detection and prompt treatment will enable prevention of diabetes-related visual impairment. As in most LMIC, there are no systematic national or state-wide screening programmes for diabetic retinopathy in India.

In the UK, annual eye screening of all people with diabetes with retinal photography and prompt treatment of sight threatening diabetic retinopathy has been shown to decrease the rate of blindness. However, the technology involved is costly, requires trained manpower and is impractical as a method for screening the 77 million people with diabetes in India annually, when the major proportion of health expenses have to borne by those with the disease.

Unless diabetic retinopathy is identified early and treated, the impact of blindness on the quality of life and productivity of the Indian population will continue to have a negative impact on the nation’s economy.

Project update – 2019:

As a result of a research project completed by the ORNATE India project team, the Government of Kerala has implemented a policy in the Kerala public health system to screen all people with diabetes registered in the primary care clinics for diabetic retinopathy.


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Latest News

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screening for diabetic retinopathy