title: Estimating the proportion of persons with diabetes developing diabetic retinopathy in India: A systematic review and meta-analysis.
abstract: BACKGROUND
  Available evidence from India shows that the control of diabetes is poor in majority of the population. This escalates the risk of complications. There is no systematic review to estimate the magnitude of diabetic retinopathy (DR) in India.
  
  
  METHODS
  A systematic literature search was carried out in Ovid Medline and EMBASE databases using Mesh and key search terms. Studies which reported the proportion of people with diabetes with DR in a representative community population were included. Two independent reviewers reviewed all the retrieved publications. Data were extracted using a predefined form. Review Manager software was used to perform meta-analysis to provide a pooled estimate. Studies included were assessed for methodological quality using selected items from the STROBE checklist.
  
  
  RESULTS
  Seven studies (1999-2014; n = 8315 persons with diabetes) were included in the review. In the meta-analysis, 14.9% (95% confidence interval [CI] 10.7-19.0%) of known diabetics aged ≥30 years and 18.1% (95% CI 14.8-21.4) among those aged ≥50 years had DR. Heterogeneity around this estimate ranged from I(2)= 79-87%. No linear trend was observed between age and the proportion with DR. The overall methodological quality of included studies was moderate.
  
  
  CONCLUSIONS
  Early detection of DR is currently not prioritized in public health policies for noncommunicable diseases and blindness programs. Methodological issues in studies suggest that the proportion of diabetics with DR is underestimated in the Indian population. Future research should emphasize more robust methodology for assessing diabetes and DR status.
authors.affiliation: South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Madhapur, Hyderabad, Telangana, India; Department of Health Services and Population Research, Center for Global Mental Health, Institute of Psychiatry, King's College, London, UK.
authors.forename: A T
authors.initials: AT
authors.lastname: Jotheeswaran
authors.affiliation: South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Madhapur, Hyderabad, Telangana, India.
authors.forename: Nukala
authors.initials: N
authors.lastname: Lovakanth
authors.affiliation: South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Madhapur, Hyderabad, Telangana, India.
authors.forename: Shruthi
authors.initials: S
authors.lastname: Nadiga
authors.affiliation: South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Madhapur, Hyderabad, Telangana, India.
authors.forename: Raghupathy
authors.initials: R
authors.lastname: Anchala
authors.affiliation: South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Madhapur, Hyderabad, Telangana, India; Department of Clinical Research, International Centre for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: G V S
authors.initials: GV
authors.lastname: Murthy
authors.affiliation: Department of Clinical Research, International Centre for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Clare E
authors.initials: CE
authors.lastname: Gilbert
keywords: Diabetes; India; diabetic retinopathy; meta-analysis; screening