Diabetes Intervention Research Education Clinical trials Training (DIRECT)

The ultimate goal is to make the early diagnosis of diabetic retinopathy more accessible to rural inhabitants of India in order to prevent needless visual loss and blindness from diabetes.

Diabetes is one of the main threats to human health in the 21st century. India leads the world today with the largest number of diabetics of about 30 million. Prevalence of diabetes among urban Indians has risen from 2.1% in the 1970’s to about 12.1% today. The World Health Organization (WHO) estimated that there would be 300 million diabetics worldwide by the year 2025.

Diabetic retinopathy is a common complication of diabetes. Elevated blood sugar damages the retinal blood vessels causing them to breakdown, leak, or become blocked. Over time, this causes retinal hemorrhage and impaired oxygen delivery to the retina that can lead to the growth of abnormal vessels. These new vessels are fragile and can easily break, causing permanent vision loss. Diabetic retinopathy is a largely preventable condition.

Objective

• To establish comprehensive diabetic care network across the District of Coimbatore.
• To reach out to the rural population, screen and treat for diabetic eye disease
• Train personnel to screen and raise awareness of diabetes and related eye Problems
• Use existing cataract camps to test and find those with diabetes and eye related diseases and treat at the hospital
• To establish a mobile screening team and network the hospitals in Tamilnadu
• Link with Rural Development NGOs in Coimbatore District and with PHCs to monitor and assist the diabetic patients

Target Population The thrust of the project would be to screen the entire population of Pollachi, Udumalpet, Avinashi and Palladam blocks, where no facility exists for provision of treatment for diabetic eye diseases. The initial phase would have Sangampalayam village as the centre.

The Approach There are two approaches to the project. The first is to screen for diabetes through the existing “Gift of Vision” rural outreach programme. The second is to systematically identify diabetic patients through a door to door survey in Pollachi, Udumalpet, Avinashi and Palladam taluks of Coimbatore District covering a total population of 15,78,952.

Methodology At the field level, 4 field workers for a population of 10,000 identified from the villages.

They would be selected and trained to work for a period of one month to interact and conduct door-to-door survey of the rural population. Perform urine examination for sugar and blood sugar estimation with glucometer. Every Saturday and Sunday they would assemble the identified diabetic patients in a common place for the screening by the Sankara Team.

This would comprise of two eye surgeons, an optometrist and a nursing assistant along with a project coordinator. They would examine all the patients identified as diabetics. Perform a fundus examination and in those patients with diabetic retinopathy perform fundus photography. They would enlist the patients with Diabetic Retinopathy, who would require laser treatment.

A Senior Retinal Consultant would go through all the fundus photographs and perform the laser therapy on those patients who require them.

The village heads in each of the villages have to be appraised in a group meeting and the importance of the programme has to be impressed on them. Support from the PHCs and the PMOAs and MPHWs attached to the PHCs would further strengthen the field work.

The experience gained at each level would further help the Institution to plan the subsequent programmes more effectively.

Realising that Diabetic patients present to diabetologists, general practitioners, and pharmacists, adequate coverage will involve more than one professional group. The large potential benefits of detecting diabetic retinopathy (and other eye diseases) mean that a collaborative approach may provide the best care for the patients. During the course of the project we hope to increase awareness among all caregivers.