ORNATE - India

Increasing eye research capacity and capabilities to tackle the burden of blindness in India: a research-based UK-India Collaboration

Map of prevalence of diagnosed diabetes in districts of India (Akhtar SN, Dhillon P. J Soc Health Diabetes 2017;5:28-26) 

Facts about diabetes in India

  • 69m diagnosed in India with diabetes.
  • Predicted to double in next decade.
  • Estimated one in every ten adult affected by diabetes (9.3%).
  • 47% of people with diabetes are undiagnosed.
  • The average age of onset is 42.5 years.
  • Nearly one million Indians die due to diabetes every year.
  • Diabetes is more common among people with higher socio-economic status, compared to people with low socio-economic.
  • Diabetes twice as common in urban areas (11.2%) compared to rural areas (5.2%).

Complications of diabetes

Diabetes complications are divided into microvascular (due to damage to small blood vessels) and macrovascular (due to damage to larger blood vessels). Microvascular complications include damage to eyes (retinopathy) leading to blindness, to kidneys (nephropathy) leading to renal failure and to nerves (neuropathy) leading to impotence and diabetic foot disorders (which include severe infections leading to amputation). Macrovascular complications include cardiovascular diseases such as heart attacks, strokes and insufficiency in blood flow to legs. There is evidence from large randomized-controlled trials that good metabolic control in both type 1 and 2 diabetes can delay the onset and progression of these complications.

Diabetic retinopathy

Diabetic retinopathy is the most common complication of diabetes, whereby blood vessels in the retina leak or die and, if left untreated, this leads to visual loss. The prevalence of diabetic retinopathy in India is around 22%; the strongest predictor being the duration of diabetes. Sight threatening diabetic retinopathy is the leading cause of blindness in the working age group causing loss of productivity, affecting individual households and the national economy. The prevalence of diabetic retinopathy in India is 20%; the strongest predictor being the duration of diabetes.

Unless the complications of diabetes are identified early and treated, the impact of blindness on the quality of life and productivity of the Indian population will continue to have a negative impact on the nation's economy.

In the UK annual eye screening of all people with diabetes with retinal photography and prompt treatment of sight threatening diabetic retinopathy has been shown to decrease the rate of blindness in the UK.  However, the technology involved is costly, requires trained manpower and is impractical as a method for screening 69 million people in India annually, when the major proportion of health expenses have to borne by the patients.

The ORNATE-India aims to tackle this by evaluating cost-effective measures for screening for diabetes and its complications and will examine the potential impact of a reduction in the prevalence of blindness due to diabetic retinopathy on the Indian economy. 

This 4 year project is funded by the Global Challenge Research Fund (GCRF) and UK Research and Innovation (UKRI).

Project update – 2019:

As a result of a research project completed by the ORNATE India project team, the Government of Kerala has implemented a policy in the Kerala public health system to screen all people with diabetes registered in the primary care clinics for diabetic retinopathy.

Last updated: 10th December 2019