Dr Tarun Sharma speaks on the current issues with relation to diabetes in India, and what can be done to offset it.

1. Dr Tarun Sharma, MD, FRCSEd, MBA Director, Sri Bhagwan Mahavir Vitreoretinal Services Sankara Nethralaya, Chennai, TN, India Diabetic Retinopathy What needs to be done?

4. Source: Hossain et al. NEJM 2007. Country GLOBAL Estimates from 2000-2030 (million) 2000 2030 % increase Developed nations US and Canada 19.7 33.9 72% Latin America and Caribbean 13.3 33 148% Europe 28.3 37.4 32% Sub Saharan Africa 7.1 18.6 162% Australia 0.9 1.7 89% Developing nations South East Asia 22.3 58.1 161% India 31.7 79.4 150% China 20.7 42.3 104% Eastern Mediterranean and Middle East 20 52.8 164%

6. Senior Resident Ramachandran A. Current status of Diabetes in India and need for novel therapeutic strategies. JAPI; 58: 2010, Suppl

7. Prevalence studies in India 1975-2006

8. 2001 In crore (%) 2011 In crore (%) Difference India 102.9 121 18.1 Rural 74.3 (72.18%) 83.3 (68.84%) 9.0 Urban 28.6 (27.82%) 37.7 (31.16%) 9.1

9. RURAL = 7% URBAN = 30% Population above 40 year age group RURAL = 68.4% (19.7 Cr) URBAN = 31.6% (9.1 Cr) Total population load (>40 years) with DM RURAL 1.4 Cr URBAN 2.71 Cr Prevalence of DM in > 40 years age group Total population = 121 Cr Diabetic load at present…. 2011 Census Total population All ages Total population > 40 years Total population = 28.8 Cr

12. K. Kaliyaperumal , I.E.C. Expert, Diabetic Retinopathy Project. Guideline for Conducting a Knowledge, Attitude and Practice (KAP) Study. Community Ophthalmology Vol. IV, No.1, Jan - Mar 2004 What is KAP? The Knowledge: refers to understanding of any given topic – DM/DR The Attitude: refers to their feelings or any preconceived ideas The Practice: translating their knowledge and attitude through their actions

13. It highlights the lacunae in our health care systems and the foci of concern. How to use KAP data?

14. N = 204 Paramedical personnel (PAP); 201 Community members (CM) KAP study (2002-2007) Before questionnaire After questionnaire Knowledge Awareness of Diabetes 59% PAP 28% CM 62% PAP 77% CM Awareness of Diabetic Retinopathy 55% PAP 7% CM 79% PAP 68% CM Awareness of treatment options of DR 24% PAP 3% CM 84% PAP 65% CM Knowledge regarding diet in DM/DR 70% PAP 46% CM 76% PAP 100% CM Attitude Positive attitude for DR 88% PAP 52% CM 94% PAP 83% CM Practice Advocating allopathy for DM/DR 80% PAP 83% CM 96% PAP 96% CM

15. PK Rani, R Raman, S Subramani, G Perumal, G Kumaramanickavel, T Sharma. Rural Remote Health 2008 Jul-Sep;8(3):838.

16. Association of knowledge of diabetic retinopathy on Attitude and Practice Factors Knowledge (n = 718) No knowledge N = 1220) P value Attitude: Should persons with DM go for regular eye examinations YES 93.3% 65.9% <0.0001 NO 6.7% 34.1% Practice: Persons with DM with control of their blood sugar can avoid visiting an ophthalmologist YES 36.5% 55.5% <0.0001 NO 63.5% 44.5%

17. Knowledge of available treatment for DR *Knowledge level of factors in the ascending level of importance Factor level* Factor Knowledge (n = 718) No knowledge (n = 1220) P value 4 Laser treatment 50.1% 22% <0.0001 3 Good control of diabetes 53.2% 34.1% <0.0001 2 Surgery 38.2% 18.4% <0.0001 1 Don’t know 9.2% 22.5% <0.0001

18. *Knowledge level of factors in the ascending level of importance Choice of health care professional in the event of eye problem Factor level* Factor Knowledge (n = 718) No knowledge (n = 1220) P value 4 Ophthalmologist 82.6% 69.8% <0.0001 3 Optometrist 48.3% 41.1% <0.0019 2 Non-ophthalmologist 39.6% 33.4% <0.0060 1 Don’t know 4.0% 9.3% <0.0001

20. WHO 1982 Techn. Rep. Ser. No 678

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