Awareness of Diabetic Retinopathy Among Patients With Diabetes Mellitus in the Ernakulam District, South India: A Hospital-Based Cross-Sectional Study

Abstract

Introduction India is currently experiencing a significant burden of diabetes mellitus, characterized by its high prevalence and associated complications. Diabetic retinopathy (DR) is a major microvascular complication of diabetes, leading to blindness. Awareness regarding this ocular complication of diabetes can help prevent vision loss due to early screening and diagnosis. However, awareness of DR among diabetes patients remains low, especially among developing nations, which affects the smooth functioning of health programs and interventions. This study aimed to determine the independent predictors of awareness regarding DR among patients with diabetes mellitus in the Ernakulam district of Kerala state in South India. Methods A hospital-based cross-sectional study was conducted from June 2024 to July 2024 among patients with diabetes mellitus attending a tertiary care hospital in Kerala. A pre-tested, structured questionnaire was used to collect the data. The patients' responses regarding awareness of DR were scored on a two-point scale, with correct responses receiving a score of 2 and incorrect responses receiving a score of 1. The total score ranged from 20 to 40. The data were entered into Microsoft Excel (Microsoft® Corp., Redmond, WA, USA), numerically coded, and analyzed using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, NY, USA). Descriptive analysis was carried out to characterize the study participants and was expressed in frequencies, percentages, and mean (±standard deviation (SD)). Independent samples t-test and one-way analysis of variance (ANOVA) were used for bivariate analyses. A multivariable linear regression model was used to determine the independent predictors of DR awareness score. A p-value <0.05 was considered statistically significant. Results The study included a total of 253 patients. The mean ± SD age of the study participants was 58.74 ± 12.51 years, and the majority (55.7%) were females. While 161 (63.6%, 95% CI: 57.71-69.56) patients were not aware that DR was due to the abnormal changes in the blood vessels of the retina, 219 (86.6%, 95% CI: 82.36-90.76) patients were aware that DR screening includes evaluation of the retina by dilating the eye. The independent predictors that had a positive impact on DR awareness scores were: (1) age (B = 1.46; 95% CI: 1.18-2.35), (2) education (B = 4.32; 95% CI: 3.57-5.06), and (3) family history of diabetes (B = 1.04; 95% CI: -1.79 to -0.29). The independent predictor that had a negative impact on DR awareness scores was the occupation of the patients: (a) semi-professional, skilled, unskilled (B = -1.24; 95% CI: -2.26 to -0.21), and (b) unemployed, retired (B = -1.32; 95% CI: -2.43 to -0.21). Conclusion It is crucial to evaluate the awareness of DR among patients with diabetes in the Ernakulam district of Kerala, South India. Age, graduate and post-graduate levels of education, as well as family history of diabetes, were the positive predictors of awareness, while lower-level occupations, including unemployment and retirement, were the negative predictors. This information is crucial for developing effective strategies for the early detection, treatment, and prevention of this ocular complication of diabetes. Future research should include longitudinal studies coupled with in-depth interviews, which would provide valuable insights into public perception and attitudes toward DR.

Keywords: diabetes; diabetic retinopathy (dr); knowledge; ocular complications; retinal complications.

Figure 1. Awareness of the patients regarding diabetic retinopathy (N = 253)

*Diabetic retinopathy

Figure 2. Sources of patient knowledge regarding diabetic retinopathy (N = 253)

*Diabetic retinopathy; ^Paramedical staff, community workers, other patients

Figure 3. Willingness of the patients to invest in additional tests to diagnose diabetic retinopathy (N = 253)

**Indian rupee