title: Diabetic retinopathy and its risk factors in patients with type 2 diabetes attending rural primary healthcare facilities in Tamil Nadu.
abstract: BACKGROUND
  India has a high burden of diabetic retinopathy ranging from 12.2% to 20.4% among patients with type 2 diabetes mellitus (T2DM). A T2DM management programme was initiated in the public sector in Tamil Nadu. We estimated the prevalence of diabetic retinopathy and its associated risk factors.
  
  
  METHODS
  We did a cross-sectional survey among patients with T2DM attending two primary health centres for treatment and follow-up in Kancheepuram, Tamil Nadu in January- March 2013. We did a questionnaire-based survey, and measured blood pressure and biochemical parameters (serum creatinine, plasma glucose, etc.) of the patients. We examined their eyes by direct and indirect ophthalmoscopy and defined diabetic retinopathy using a modified classification by Klein et al. We calculated the proportion and 95% CI for the prevalence and adjusted odds ratio (AOR) for risk factors associated with diabetic retinopathy.
  
  
  RESULTS
  Among the 270 patients, the mean (SD) age was 54.5 (10) years. The median duration of T2DM was 48 months. The prevalence of diabetic retinopathy was 29.6%. Overall, 65.9% of patients had hypertension, 14.4% had nephropathy (eGFR <60 mg/dl) and 67.4% had neuropathy. Among patients with comorbid conditions, 60%, 48%, 32%, and 3% were already diagnosed to have hypertension, neuropathy, retinopathy, and nephropathy, respectively. The risk factors for diabetic retinopathy were hypertension (AOR 3.2, 95% CI 1.7-6.3), duration of T2DM >5 years (AOR 6.5, 95% CI 3.6-11.7), poor glycaemic control (AOR 2.4, 95% CI 1.4-4.4), and nephropathy (AOR 2.3, 95% CI 1.1-4.6).
  
  
  CONCLUSIONS
  There was a high burden of undetected retinopathy and other comorbid conditions among patients with T2DM. Early detection of comorbid conditions and glycaemic control can be improved by training care-providers and educating patients.
authors: National Institute of Epidemiology (Indian Council of Medical Research), # R-127, 3rd Avenue, Tamil Nadu Housing Board, Ayapakkam, Chennai 600077, Tamil Nadu, India.
authors: Tony
authors: T
authors: Fredrick
authors: National Institute of Epidemiology (Indian Council of Medical Research), # R-127, 3rd Avenue, Tamil Nadu Housing Board, Ayapakkam, Chennai 600077, Tamil Nadu, India.
authors: Prabhdeep
authors: P
authors: Kaur
authors: National Institute of Epidemiology (Indian Council of Medical Research), # R-127, 3rd Avenue, Tamil Nadu Housing Board, Ayapakkam, Chennai 600077, Tamil Nadu, India.
authors: Manoj V
authors: MV
authors: Murhekar
authors: National Institute of Epidemiology (Indian Council of Medical Research), # R-127, 3rd Avenue, Tamil Nadu Housing Board, Ayapakkam, Chennai 600077, Tamil Nadu, India.
authors: Yuvaraj
authors: Y
authors: Jayaraman
authors: Directorate of Public Health and Preventive Medicine, Tamil Nadu, India.
authors: K
authors: K
authors: Kolandaswamy
authors: National Institute of Epidemiology (Indian Council of Medical Research), # R-127, 3rd Avenue, Tamil Nadu Housing Board, Ayapakkam, Chennai 600077, Tamil Nadu, India.
authors: Sudha Ramachandra
authors: SR
authors: Rao
authors: National Institute of Epidemiology (Indian Council of Medical Research), # R-127, 3rd Avenue, Tamil Nadu Housing Board, Ayapakkam, Chennai 600077, Tamil Nadu, India.
authors: Joseph K
authors: JK
authors: David
mesh_terms: D000328:Adult; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003930:Diabetic Retinopathy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care; D012307:Risk Factors; D019035:Rural Health Services