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Shaukat Ali Jawaid
 

Prevention and Treatment
of Diabetic Retinopathy

ShaukatJawaid

Prevalence of diabetes mellitus is spreading fast all over the world and in the coming two three decades, most of the increase in people with diabetes, it is said, will be in the developing third world and Asian countries. A vast majority of the people with diabetes are not aware of the fact that they are suffering from this disease and when they are diagnosed, some complications have already taken place. Unlike Bangladesh where there is a truly national representative Diabetic Associaton with a democratic set up having a chain of diabetic clinics, centers in almost every district, the situation is quite different in Pakistan. Here the activities of Diabetic Association of Pakistan are confined to Karachi or at the most to the province of Sindh for all practical purposes but there are various groups doing a commendable job in different parts of Pakistan but the need to have a representative National Diabetic Association with democratic set up, linked with diabetic clinic/centers in every district, is what we should aim at.

Despite these shortcomings, over the years enough awareness about diabetes has been created but a lot more needs to be done which needs a concerted effort. Diabetic retinopathy is an important complication of diabetes but even most of the diagnosed people with diabetes seldom regularly consult an ophthalmologist. Like diabetes, many a times when diabetic retinopathy is diagnosed, enough damage to the eye sight has occurred. If the people with diabetes are educated and convinced that they must have a regular ophthalmic check up, diabetic retinopathy can be diagnosed at an early stage when its treatment is also possible and easy for which adequate facilities are available at a number of institutions both in public and private sector.

Diabetic Retinopathy is likely to become the leading cause of blindness the world over in the coming two decades and by 2035, it is estimated that 177 million of people which is almost 50% of people living with diabetes will be at risk of developing diabetic retinopathy.1 In some cases diabetic retinopathy may be difficult to diagnose until it is too late. One can live with diabetes undiagnosed for almost ten years which necessitates the need to create more awareness about diabetes. Similarly once diagnosed, these people with diabetes can be treated with diet and oral anti-diabetic agents for almost a decade but then insulin therapy becomes essential to control blood glucose but here again patients are reluctant to use insulin and the treating physicians also do not insist on the patients to opt for insulin therapy for various reasons. This is despite the fact that now it is proven that early initiation of insulin therapy offers many advantages in not only control of diabetes but also arresting or delaying the complications.

According to Michael Hirst, President of International Diabetes Federation, Time2DoMore Global Survey “highlights the clinical inertia among people with Type 2 Diabetes and doctors who treat them. This survey estimates that 42% of people with Type 2 diabetes do not reach blood glucose, putting them at high risk of complications including blindness”1 Women with Gestational Diabetes Mellitus are considered at greater risk of developing diabetes as compared to the general population, hence this group needs to be worked upon and the treating physicians must convince them about the need of having proper blood glucose levels to prevent the development of diabetes thereby saving them from the diabetic complications including diabetic retinopathy.

China with highest population in the world is reported to have estimated prevalence of diabetes of 11.6% in the adult population. This means there are about 113.9 million Chinese adults with diabetes which accounts for one third of the world’s diabetic population.2 It is high time that government agencies as well as healthcare professionals in all these countries where prevalence of diabetes is high, promote investment in innovative, cost effective technology for screening and treatment services for diabetic retinopathy. Concentrate on building the professional capacity of those caring for the diabetics besides extending these services throughout the country. We can have a diabetic clinic in each and every healthcare facility; people coming to these hospitals can be screened for diabetes as well. The professional specialty organizations should also realize their responsibilities in this regard. Pakistan Endocrine Society in collaboration with Ophthalmological Society of Pakistan and Diabetic AssociatIon of Pakistan can formulate Guidelines on screening, early detection and treatment of Diabetic Retinopathy as well as other complications of diabetes. Once these guidelines are finalized, they should be extensively circulated through the media to educate the healthcare professionals along with an awareness campaign about diabetes, diabetic retinopathy and other likely complications so that people with diabetes can be helped at a time when the disease is in its early phase and no complications has yet taken place. At the same time efforts should be made to have a truly representative national Diabetic AssociatIon of Pakistan with a democratic set up, something where we have failed so far. That is one of the reasons that our performance in the field of diabetes is far below than Bangladesh which was a part of Pakistan before 1971. There is no harm in learning some lessons from Bangladesh on how to organize the National Diabetic Associaton in Pakistan benefiting from their experience. One of the major difference has been that while Bangladesh had a committed, devoted and dedicated person in the name of late Prof. Mohammad Ibrahim the founder of BIRDEM the world’s largest hospital for diabetes which has now developed and expanded into a huge medical complex with numerous institutions including medical colleges and state of the art postgraduate medical institutions but we in Pakistan could not produce any person of his caliber and commitment.

REFERENCE

1. Michael Hirst. United in our Vision to Save Sight. Diabetes Voice 2014;59:4-5.
2. Ming-Xia, Shen-yuan Yuan. Integrated efforts for Optimal Diabetes Care in China. Diabetes Vloice 2014;59:36-39.{jcomments on}

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