Diabetes is a significant contributor to both morbidity (illness) and mortality (death). Individuals with diabetes experience a higher risk of various health problems, including cardiovascular disease, kidney disease, nerve damage, and vision loss, leading to increased morbidity [1]. Diabetes is also a direct cause of death, contributing to a substantial number of fatalities globally. 

The increasing burden of diabetes has significant implications for healthcare systems and public health efforts. Prevention and early detection are crucial for managing the diabetes epidemic. Strategies to address obesity, promote healthy lifestyles, and improve access to diabetes care are essential. 

Diabetes epidemiology studies the distribution, patterns, and determinants of diabetes in populations. Globally, the prevalence of diabetes is rising, with projections indicating a significant increase by 2045 [2-9]. Key factors contributing to the rising burden of diabetes include population aging, urbanization, and increased prevalence of obesity and unhealthy lifestyles. Type 2 diabetes, which accounts for over 90% of diabetes cases, is particularly influenced by these modifiable factors [10-14]. The global prevalence of diabetes is estimated to be 9.3% (463 million people) in 2019, projected to reach 10.2% (578 million) by 2030 and 10.9% (700 million) by 2045.Prevalence is higher in urban areas and high-income countries. A significant portion of individuals with diabetes remain undiagnosed [15-18].India has a high prevalence of diabetes, with estimates suggesting 77 million adults living with the condition in 2019. The prevalence is projected to continue rising, with estimates reaching 134 million by 2045. A significant number of individuals in India are also at risk of developing diabetes (prediabetic) [18-23]. The high incidence in India is attributed to a combination of genetic factors and the adoption of unhealthy lifestyles by the growing middle class. 

Diabetes mellitus can cause a range of ocular problems, the most common being diabetic retinopathy, followed by cataracts, and glaucoma [19] [20]. Other less common but still significant complications include diabetic macular oedema, optic neuropathy, and ocular surface diseases. 

AIMS & OBJECTIVE

To Study the diabetes related ocular changes in patients with type 2 diabetes mellitus in a tertiary care hospital

METHODOLOGY

The study was conducted in a tertiary hospital. After obtaining institutional ethical committee approval It was a Observational prospective study conducted on 150 patients with Diabetes Mellitus in the department of Ophthalmology, at a tertiary care centre, from April 2020 to October 2020.

The institute Ethics Committee approval was obtained before starting the sample collection. A written and informed consent was taken from the patient regarding the study in his/her vernacular language and English. In this study Patients were subjected to: A detailed history of sign & symptoms and its duration. Detailed history of systemic diseases and its duration, medication were noted. Patients were subjected to General physical examination, and ocular examination.

Participants Visual acuity was recorded by Snellen’s chart, Slit lamp bio-microscopy of anterior segment was done, Pupillary reactions were noted. Participants Detailed examination of the posterior segment was done with Direct and indirect ophthalmoscopy and also with 90D Lens. Colour vision test was done with Ishihara pseudo-isochromatic plates. Visual field with full threshold HVF 30-2 test done. MRI brain imaging done. The results of these 30 patients were collected, tabulated and analysed.

Inclusion Criteria: All newly diagnosed cases of diabetes mellitus (irrespective of age, sex, type, duration of disease) were included.

Exclusion Criteria: Diabetic patients (i) who had other systemic diseases like Renal Diseases, Hypertension, Tuberculosis and coagulopathies etc. (ii) those having history of any previous intraocular surgery except, Cataract surgery were excluded from study.

The data collected was entered in excel spread sheet. The data was analysed by using SPSS statistical software version 20. Statistical analysis in the form of percentages was done. Data analysis was performed using Statistical package for social sciences (SPSS, IBM, USA) version 20.0. Results were reported as mean ± standard deviation for quantitative variables.

Categorical data were compared using Chi-square test. The value of P < 0.05 was considered statistically significant.

RESULT

In our study it was seen that out of 150 participants 35 patient are suffered of Diabetic Retinopathy. And their median duration of years are 05 to 07 years and its prevalence is 23.33%. In the sameway 30 participants were suffered of cataract and their prevalence and median duration is 20% and 06 to 08 Years. Among 150 participants only 2 participants were suffered of Optic neuropathy and its prevalence is 1.33%. In our study majority of participants were suffered of Diabetic Retinopathy and least participants were suffered of optic neuropathy (Table 1)

Table 1: Various ocular manifestations in diabetic patient

In this study it was shown only 30% patients were literate and rest 70% were Illiterate. It has been seen that majority of participants suffered of occurmanifestation who were illiterate (Table 3) and Figure 1. In this study Most common ocular manifestation was diabetic retinopathy (23%) followed by cataract (20%), Meibomitis

(16.66%), dry eye (12%) and Neovascularization of iris (4.62%) etc

Table 2: Distribution of patients according duration of diabetes wise distribution of patients in study.

Table 3: Possible ocular complications

Table 4: Educational status of the patients who had ocular complications (n=150)

Figure: 1

The high poverty, low literacy and low health care facilities affected the study results. First of all, good blood glucose control is main goal to prevention of diabetic cataract. It has however been suggested that cataract genesis can be prevented through nutrition and supplementation, including high content of nutritional antioxidants lower dietary carbohydrate and linolenic acid intake.

DISCUSSION

The 150 diabetic patients who were selected forstudy underwent a comprehensive examination throughout assess visual disorders Retinopathy was identified as the most prevalence disease that causes visual impairment inindividuals with diabetes mellitus. Extensive prospective clinical studies have demonstrated arobust association between glycemic control and the incidence and progression of retinopathy.

In the present study we found retinopathy to be the most common ocular complication occurring in diabetes subjects [21-23]. The prevalence of Diabetic Retinopathy was 23.3% followed by Cataract (20%) and Mebibits (16.6%). The prevalence of diabetic retinopathy varied from 23.3% in persons who had diabetes for less than seven years in this study, similar study is conducted by Klein et al [24-27]. Findings similar our present study glaucoma prevalence was found in studies conducted by Armstrong et al [28-30].

Diabetes is the underlying cause in 25–30% of patients aged 45 years and older who develop acute extra ocular muscle palsy (Rush JA) (7). In a study by Watanabe K, 1% of patients with diabetes were found to have cranial nerve palsies, compared with only 0.13% of control subjects. [31].

In this study it was shown only 30% patients were literate and rest 70% were Illiterate. It has been seen that majority of participants suffered of occur manifestation who were illiterate (Table 3) and Figure 1. In this study Most common ocular manifestation was diabetic retinopathy (23%) followed by cataract (20%), Meibomitis. In this study we get to know that  the different spectrum of ocular manifestation of patients with Type 2 diabetes mellitus In our study, majority of them were history of 5 to 10 years duration of DM  (26.6%) .They have more complication than others Similar study is done by many universities Klein BE, et al. The high poverty, low literacy and low health care facilities affected the study results. First of all, good blood glucose control is main goal to prevention of diabetic cataract. It has however been suggested that cataract genesis can be prevented through nutrition and supplementation, including high content of nutritional antioxidantslower dietary carbohydrate and linolenic acid intake.

To prevent ocular manifestations in diabetics, prioritize managing blood sugar, blood pressure, and cholesterol levels, along with maintaining a healthy lifestyle through diet and exercise. Regular eye exams are also crucial for early detection and management of diabetic retinopathy, a common ocular complication.

In   this study it was found that diabetes is a larger among males, literate, middle income group and in those who are employed in occupations requiring skill. Diabetic retinopathy and cataract are much more common in persons having diabetes for a longer duration. Healthcare providers need to refine their preventive strategies to focus on persons belonging to the categories stated above.

To prevent ocular manifestations in diabetics, prioritize managing blood sugar, blood pressure, and cholesterol levels, along with maintaining a healthy lifestyle through diet and exercise. Regular eye exams are also crucial for early detection and management of diabetic retinopathy, a common ocular complication

 Diabetes patients need to be screened for diabetic retinopathy and cataract as early as possible for initiating treatment that would reduce complications.

Due to lack of knowledge & awareness, delayed diagnosis and treatment the prevalence of diabetes and its ocular consequences are drastically increased in this region. We have to communicate with diabetic and pre-diabetic.

Preventive measures for diabetes include maintaining a healthy weight, engaging in regular physical activity, following a balanced diet, and avoiding smoking. Focusing on these lifestyle changes can significantly reduce the risk of developing type 2 diabetes.

SOURCE OF FUNDING: No

CONFLICT OF INTEREST

The authors report no conflicts of interest

SUBMISSION DECLARATION

This submission has not been published anywhere previously and that it is not simultaneously being considered for any other journal.

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