INTRODUCTION:

Diabetes is a heterogeneous group of diseases, characterized by a state of chronic hyperglycemia, resulting from a diversity of aetiologies, environmental and genetic factors. Chronic hyperglycemia leads to a number of complications – CVS, Renal, Neurological, Ocular and others such as intercurrent infection.¹

Uncontrolled diabetes leads to significant macrovascular and microvascular complications. Diabetic Retinopathy (DR) is a well-known microvascular complications of diabetes and the foremost cause of blindness.¹Diabetic retinopathy is the leading cause of blindness in adult 25 to 74 year of age and occur in both type 1 and type 2 diabetic.¹⁰

Awareness about DR and other diabetes related visual complications as reported by different community based studies in India varied in the range from 16.1% to 71.3%. This suggests that there exists a lot of difference in the level of awareness regarding DR among people residing in different areas of the country.²

A study results from the International Diabetes Federation Diabetes Atlas (2019) aimed to provide global estimates of diabetes prevalence for 2019 and projections for 2030 and 2045. A total of 255 high-quality data sources, published between 1990 and 2018 and representing 138 countries were identified. The global diabetes prevalence in 2019 is estimated to be 9.3% (463 million people), rising to 10.2% (578 million) by 2030 and 10.9% (700 million) by 2045. The prevalence is higher in urban (10.8%) than rural (7.2%) areas, and in high-income (10.4%) than low income countries (4.0%). One in two (50.1%) people living with diabetes do not know that they have diabetes.²

An experimental study was conducted to assess the effectiveness of structured teaching programme on knowledge regarding the management of diabetes mellitus among G.N.M. students in selected nursing school at Sikar, Rajasthan. The findings of the study shown that there is need to carry out the interventions to increase the knowledge of G.N.M students regarding management of diabetes mellitus which further will help to increase the diabetes patient care.⁸

OBJECTIVES:

1. To determine the prevalence of diabetes among patients attending Eye OPD in selected Hospitals of Guwahati, Assam.

2. To identify various risk factors for developing Diabetic retinopathy among patients attending Eye OPD in selected Hospitals of Guwahati, Assam.

3. To assess the Awareness regarding Diabetes and Risk Factors for Developing Diabetic Retinopathy among patients attending Eye OPD in selected Hospitals of Guwahati, Assam.

4. To find out the association between Awareness regarding Diabetes and Risk Factors for Developing Diabetic Retinopathy with selected demographic variables.

HYPOTHESIS:

The hypothesis will be tested at 0.05 level of significance

H₁: There is a significant association between Awareness regarding Diabetes with selected demographic variables

H₂: There is a significant association between Awareness regarding Risk Factors for Developing Diabetic Retinopathy with selected demographic variables

MATERIAL AND METHODS:

The study was conducted after obtaining permission from Institutional Ethical Committee. It was a hospital based cross sectional descriptive research study where data collected from 125 samples by convenient sampling technique and starting with collecting Demographic Data through Self Reporting Method, then IDRS to assess prevalence of risk for Diabetes followed with RBS checking with Glucometer by observation and followed with Clinical and Behavioral data assessment to identify various risk factor for developing DR by using BP apparatus, measuring tape, weighing machine and structured Awareness questionnaire for DM and DR by Self Reporting and Interview technique. Ethical clearance was obtained from ethical committee of the institutions. Period of data collection was from 16 Dec 2022 to 21 Feb 2023, study setting was in Eye OPD of the ESIC model hospital, Guwahati. Data were analyzed by using the software package SPSS 2.0 version.

RESULTS:

Distribution of patients attending eye OPD according to their demographic variables.

¨ In the study, majority 41(32.8%) were in 51- 60 years of age followed by 37(29.6%) were in 41-50 years of age and 25(20%) were in 61-70 years of age, 9(7.2%) were in 31-40 years, 8(6.4%) were in age > 70 years and 5(4%) were in the age group of 20-30 years.

· Majority 67(53.6 %) were female and 58(46. 4%) were male.

· Majority 94(75.2%) were Hindu, 29(23.2%) were Muslim and 2 (1.6%) by Religion.

¨ Majority 87(69.6%) were in Nuclear Family and 38(30.4%) belong to Joint Family.

¨ Majority 92(73.6 %) were Married, 20(16%) were widow, 11(8.8%) were unmarried followed with 2(1.6 %) were divorce.

¨ Majority 41(32.8 %) were illiterate, 33(26.4%) were having high school, 22(17.6%) were having intermediate/ diploma, 20(16%) has primary school education, and only 9(7.2%) has education upto graduate level.

¨ Majority 57(45.6%) had Rs 11837 – 17755, 40(32%) has Rs 17756 – 23673, 14(11.2%) had Rs 2391 – 7101, 12(9.6%) had Rs 23674 – 47347, and 2 (1.6%) had Rs 47348 and above.

· Majority 82(65.6%) were unemployed and 43 (34.4 %) were employed.

· Majority 102(81.6%) were Non – Vegetarian and 23 (18.4%) were Vegetarian in dietary pattern.

· Majority 63(50.4%) have a knowledge regarding diabetic eye disease and 62(49.6%) has no knowledge.

· Majority 80(64%) were referred by doctors for eye screening, 22(17.6%) has dimension of vision, 18(14.4%) has reason for self awareness for eye screening and other are 5(4%) had other reason.

· Among 125 samples, Majority 43(34.4%) had Frequency of eye check up at once a month, 37 (29.6%) had once in 6 months, 23(18.4%) has once in year and 22(17.6%) has once in 2 years.

· Majority 72(57.6%) has other associated disease like angina, thyroid disorder, gastritis

Prevalence of diabetes among patients attending Eye OPD in selected Hospitals of Guwahati, Assam N=125

Fig 1: Prevalence of diabetes among patients attending Eye OPD in selected Hospitals of Guwahati, Assam

Above Figure illustrates the prevalence of diabetes among patients attending Eye OPD in selected Hospitals of Guwahati, Assam revealed that majority 69(55.2%) had medium prevalence followed by 53(42.4%) had high prevalence and only 3(2.4%) had low prevalence of diabetes among patients.

Identification of various risk factors for developing Diabetic retinopathy among patients attending Eye OPD:

· Study findings shows that among 125 samples, Majority 73(58.4%) has a history of diabetes and among them 32(43.8%) is known diabetic < 5 years also majority 67(91.8%) are known type II diabetes which is one of the common risk factor.

· Other identified risk factors for developing Diabetic retinopathy are No Physical activity to control blood sugar level i.e 41(56.2%), History of cataract surgery i.e 63(50.4%), History of tobacco consumption i.e 64(51.2%), treatment including insulin/ oral diabetic drugs(among diabetic patients) i. e 39(53.4%) and RBS value is in Prediabetic level (140-200mg/dl) is 61.6%.

· Biochemical parameters that has been collected from patients profile has found that out of 90 samples, there is high total cholesterol and urea level i.e 60(66.6%) and 40(44.5 %) respectively.

Awareness regarding Diabetes among patients attending Eye OPD N=125

Awareness regarding Diabetes	f	%	Score range	Median	MEAN	SD	Mean %
Low	13	10.4	4-15 11	9	8.37	2.507	55.8%
Moderate	83	66.4
High	29	23.2

Data on the Table 1 depicts the awareness regarding Diabetes among patients attending Eye OPD revealed that maximum 83(66.4%) had moderate awareness followed by 29(23.2%) had high awareness and 13(10.4%) had low awareness on Diabetes among patients attending Eye OPD with obtained score range between 4-15 (11), median score of 9, mean score was 8.37with SD=2.507 and mean percentage was 55.8%.

Awareness regarding Diabetic Retinopathy among patients attending Eye OPD N=125

Awareness regarding Diabetic Retinopathy	f	%	Score range	Median	MEAN	SD	Mean %
Low	20	16	0-30 30	18	17.74	7.754	59.13%
Moderate	59	47.2
High	46	36.8

Data on the Table 2 depicts the awareness regarding Diabetic retinopathy among patients attending Eye OPD revealed that maximum 59(47.2%) had moderate awareness, 46(36.8%) had good awareness and 20(16%) had low awareness on Diabetic retinopathy among patients attending Eye OPD with obtained score range between 0-30 (30), median score of 18, mean score was 17.74 with SD=7.754 and mean percentage was 59.13%.

Association between Awareness regarding Diabetes with selected demographic variables:

The study findings show that there is an association between Awareness regarding Diabetes with selected demographic variables which was tested by using chi-square test. Result showed that age, marital status, education, family income, knowledge on diabetic eye disease and frequency of eye check up were found significant at p<0.05 but Gender, religion, type of family, occupation, dietary pattern, reason for eye screening and other associated disease were found to be non significant with Awareness regarding Diabetes. Hence there is a significant association between awareness regarding Diabetes with selected demographic variables we can conclude that H₁is accepted.

Association between Awareness regarding various Risk Factors of Diabetic Retinopathy with selected demographic variables:

The study findings shows there is an association between Awareness regarding risk factors of Diabetic retinopathy with selected demographic variables which was tested by using chi-square test. Result showed that age, religion, type of family, marital status, education, family income, knowledge on diabetic eye disease and reason for eye screening were found significant at p<0.05 but gender, occupation, dietary pattern, frequency of eye checkup and other associated disease were found to be nonsignificant with Awareness regarding risk factors of Diabetic retinopathy. Hence there is a significant association between awareness regarding risk factors for developing Diabetes Retinopathy with selected demographic variables we can conclude that H₂is accepted.

DISCUSSION:

Objective 1: To determine the prevalence of diabetes among patients attending Eye OPD in selected Hospitals of Guwahati, Assam:

The prevalence of diabetes among patients attending Eye OPD in selected Hospitals of Guwahati, Assam revealed that among 125 samples, majority 69(55.2%) had medium prevalence followed by 53(42.4%) had high prevalence and only 3(2.4%) had low prevalence of diabetes among patients attending Eye OPD in selected Hospitals of Guwahati, Assam.

The present study findings was supported by a study done by Aynalem S B and Zeleke A J on to assess the prevalence of diabetes mellitus and its risk factors among individuals aged 15 years and above in Mizan-Aman Town, Southwest Ethiopia, 2016: A Cross Sectional Study. A total of 402 participants were included in the study. The prevalence of DM was found to be 6.5% (26 out of 402). Of which, the proportion of previously undiagnosed diabetes mellitus was 88.5%. The prevalence of prediabetes was also found to be 15.9%. The Waist Circumference (WC), Body Mass Index, Smoking Habit, Hypertension, and Total Cholesterol Level were significantly associated with Diabetes Mellitus.³

Objective 2: To identify various risk factors for developing Diabetic retinopathy among patients attending Eye OPD in selected Hospitals of Guwahati, Assam:

Study findings shows that among 125 samples, Majority 73(58.4%) has a history of diabetes and among them 32(43.8%) is known diabetic < 5 years also majority 67(91.8%) are known type II diabetes which is one of the common risk factor. Other identified risk factors for developing Diabetic retinopathy are No Physical activity to control blood sugar level i.e 41(56.2%), History of cataract surgery i.e 63(50.4%), History of tobacco consumption i.e 64(51.2%), treatment including insulin/ oral diabetic drugs(among diabetic patients) i. e 39(53.4%) and RBS value is in Prediabetic level (140-200mg/dl) is 61.6%.Biochemical parameters that has been collected from patients profile has found that out of 90 samples, there is high total cholesterol and urea level i.e 60(66.6%) and 40(44.5 %) respectively.

This finding of the study was consistent with a study done by Sen S, Ramasamy K, Vignesh TP, Kannan NB, Sivaprasad S, Rajalakshmi R et.al on Identification of risk factors for targeted diabetic retinopathy screening to urgently decrease the rate of blindness in people with diabetes in India (2021). Population based study was conducted in South India between 2001 and 2010, and reclassified individuals above 40 years into known and newly diagnosed diabetes. Multiple regression analysis was done to identify risk factors in people with known and new DM. Results shows that The prevalence of DR in 44, 599 subjects aged ≥40 years was 14.8% (18.4 and 4.7% in known and new DM, respectively), and the prevalence of VTDR was 5.1%. Higher risk factors of VTDR were older age >50 years, diabetes duration >5 years, and systolic blood pressure >140 mm Hg.⁴

Objective 3: To assess the Awareness regarding Diabetes and Risk Factors for Developing Diabetic Retinopathy among patients attending Eye OPD in selected Hospitals of Guwahati, Assam:

In this study, Awareness regarding Diabetes among patients attending Eye OPD revealed that maximum 83(66.4%) had moderate awareness followed by 29(23.2%) had high awareness and 13(10.4%) had low awareness on Diabetes among patients attending Eye OPD with obtained score range between 4-15 (11), median score of 9, mean score was 8.37with SD=2.507 and mean percentage was 55.8%. Whereas Awareness regarding Diabetic retinopathy among patients attending Eye OPD revealed that maximum 59(47.2%) had moderate awareness, 46(36.8%) had good awareness and 20(16%) had low awareness on Diabetic retinopathy among patients attending Eye OPD with obtained score range between 0-30 (30), median score of 18, mean score was 17.74 with SD=7.754 and mean percentage was 59.13%.

This finding of the study was consistent with a study done by Choudhary V S, Chaudhary G. A Descriptive Study to Assess the Knowledge Regarding Diabetes Mellitus, Its Risk Factors and Complication among the Rural Community Sadiq, Faridkot (Punjab). Out of 300 adults subjected to the survey, only 46.66% (140) adults had any awareness of DM. adult with no regular exercise were 69.33% (208) and 73.33%(220) did not have healthy eating habits. Awareness of risk factor was present in 25.33% (76) while awareness about complication associated with the DM was 28.33% (85). Adult which reported as never going for regular checkup to any clinic or hospital were 70% (210). Majority of adults were unaware of DM itself and associated risk factor. Raising public awareness of the disease through outreach programmes and mass media should be planned and implemented.⁵

Objective 4: To find out the association between Awareness regarding Diabetes and Risk Factors for Developing Diabetic Retinopathy with selected demographic variables:

There is an association between Awareness regarding Diabetes with selected demographic variables which was tested by using chi-square test. Result showed that age, marital status, education, family income, knowledge on diabetic eye disease and frequency of eye check up were found significant at p<0.05 but Gender, religion, type of family, occupation, dietary pattern, reason for eye screening and other associated disease were found to be non significant with Awareness regarding Diabetes. Hence there is a significant association between awareness regarding Diabetes with selected demographic variables we can conclude that H₁is accepted.

There is an association between Awareness regarding risk factors of Diabetic retinopathy with selected demographic variables which was tested by using chi-square test. Result showed that age, religion, type of family, marital status, education, family income, knowledge on diabetic eye disease and reason for eye screening were found significant at p<0.05 but gender, occupation, dietary pattern, frequency of eye check up and other associated disease were found to be non significant with Awareness regarding risk factors of Diabetic retinopathy. Hence there is a significant association between awareness regarding risk factors for developing Diabetes Retinopathy with selected demographic variables we can conclude that H₂is accepted.

The present study findings was supported by a study done by Kowski K S, Grudzia J˛˙Kowska S, Pinkas J and Jankowski M(2022) aimed to assess public knowledge and awareness of diabetes, its risk factor and complications among adults in Poland, as well as to identify sociodemographic factors associated with public awareness of diabetes. This cross-sectional survey was carried out between 24 and 27 June 2022, on a non-probability randomquota sample of 1, 051 adults in Poland. The questionnaire included ten questions related to the awareness of risk factors, symptoms, and complications of diabetes. Among the respondents, 10.5% had diabetes and 43.8% declared that they have a history of diabetes in their family. Only 17.3% of respondents declared a good level of knowledge of diabetes. Out of 10 symptoms of diabetes analyzed in this study, high blood sugar (80.7%) and chronic fatigue (74.6%) were the most recognized. Out of 8 diabetes risk factors analyzed in this study, overweight/obesity (80.4%) and unhealthy diet (74.1%) were the most recognized diabetes risk factors, while only 22.7% of respondents indicated tobacco use. The diabetic foot was the most recognized diabetes complication (79.8%), but approximately half of the respondents indicated vision problems (56.9%), kidney damage (52.1%), or cardiovascular diseases (50.2%) as diabetes complications. Female gender, having higher education and having a family member with diabetes were the most important factors associated (p < 0.05) with a higher level of awareness of diabetes. ⁶

This finding of the study was consistent with a study done by Lima V C, Cavalieri G C, Lima M C, Nazario N O and Lima G C (2016) on Risk factors for Diabetic Retinopathy: A case control study. 240 individuals (80 cases and 160 controls) attending the Outpatient Specialty Clinic of the University of South Santa Catarina (UNISUL), between Mar/2010 and May/2014. Data collection occurred through review of medical charts for presence or absence of DR, determined by an ophthalmologist. Study protocol included demographic characteristics, metabolic control, diabetes mellitus (DM) profile and comorbidities. Results show that Mean age of group case was 59.5 years with a slight female predominance. Gender, age, body mass index were not associated with outcome. Individuals with poor glycemic control were more likely to DR (OR 3.83; 95 % CI 1.57–9.37). It was observed a positive relationship between duration of DM and DR, with higher chances in 11–15 years of disease (OR 7.52, 95 % CI 3.03–18.68) and >15 years (OR 9.01, 95 % CI 3.58–22.66). Regarding comorbidities, only diabetic nephropathy showed higher chance for DR (OR 3.32; 95 % CI 1.62–6.79). Diabetic patients after 10 years of disease with poor glycemic control and nephropathy have a greater chance of DR.⁷

ETHICS AND CONSENT:

Ethical approval for this study was obtained from Sri Sankaradeva Netralaya, Guwahati, Assam, Ethical Review Committee. Informed consent: Explanation to the study subjects shortly about the purpose of the study and its outcome. The written informed consent was waived by the Members of the Institutional Academic and Research Committee of Sri Sankaradeva Netralaya, Guwahati, Assam.

CONFLICT OF INTEREST:

None declared.

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Received on 04.01.2024 Modified on 10.05.2024

Int. J. Nur. Edu. and Research. 2024; 12(3):151-156.

DOI: 10.52711/2454-2660.2024.00033