The SMART India study is a statistical and economic modelling study on a cross-sectional and prospectively recruited participants from community-based screening in order to accurately identify people at risk of diabetes, pre-diabetes and complications of diabetes in India.
This community screening will be conducted across 20 regions in India, each led by a local clinical centre with a trained ophthalmologist responsible for the study at that site. Each region will have 3 clusters stratified into urban, rural and a pre-defined special category of population such as people with poor access to healthcare, or persons that are presumed high-risk or low-risk of developing diabetes. The study will involve a door-to-door survey, with structured questionnaires and point of care tests (random blood sugar (RBS, HbA1c, urinary albumin) and retinal imaging using non-mydriatic smartphone-based retinal cameras, performed by field workers.
The first objective is to determine the ideal tests that could identify people at risk of diabetes and pre-diabetes in community screening that can be applied to low middle income countries.
Secondary objectives are aimed at guiding future policies on screening of diabetes and its complications. As the study involves a large sample and the setting up of a teleophthalmology model to screen for diabetic retinopathy across 20 regions in India, we will be able to report the regional prevalence of diabetic retinopathy and the associated risk factors, the inter-grader reliability, and the accuracy of using artificial intelligence to grade retinal images.
We will also conduct economic modelling and process evaluation of a holistic model for screening of all complications of diabetes. If sample size permits, we will be able to report on region-specific and diverse population specific rates of diabetes and complications, visual impairment, quality of life and risk models specific to regions to inform local health authorities.
Publications:
Protocol on a multicentre statistical and economic modelling study of risk-based stratified and personalised screening for diabetes and its complications in India (SMART India).Sivaprasad S, Raman R, Rajalakshmi R On behalf of SMART India Study Collaborators, et al. BMJ Open 2020;10:e039657. doi: 10.1136/bmjopen-2020-039657
Prevalence of diabetic retinopathy in India stratified by known and undiagnosed diabetes, urban–rural locations, and socioeconomic indices: results from the SMART India population-based cross-sectional screening study. Rajiv Raman, Joana C Vasconcelos, Ramachandran Rajalakshmi, A Toby Prevost, Kim Ramasamy,Viswanathan Mohan, Deepa Mohan, Padmaja K Rani, Dolores Conroy, Taraprasad Das, Sobha Sivaprasad on behalf of the SMART India Study Collaborators. Lancet Global Health online Oct 31 2022.https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(22)00411-9/fulltext