Prevalence and determinants of complications of type 2 diabetes in a community screening program in Kerala

This study aims to estimate the prevalence and identify the determinants of peripheral neuropathy (PN), retinopathy and peripheral arterial disease (PAD) among persons with type two diabetes mellitus.

A cross-sectional study with a two-stage cluster sampling was conducted in Kerala in 33 clusters among individuals with type 2 diabetes. The first 85-90 participants who visited the camp with a duration of diabetes of more than a year were enrolled in the study from 33 camps. Thus, a total of 3083 persons with diabetes were enrolled. Mixed effects logistic regression was used to find the factors associated with diabetic retinopathy (DR), PN and PAD.

The prevalence of PN, DR and PAD was found to be 48.5% (95% CI 46.74 to 50.26), 28.9% (95% CI 27.36 to 30.56) and 46.3% (95% CI 42.65 to 49.95) respectively. Increased risk of PN was observed among participants with age >60 years (aOR 1.71; 95% CI 1.41 to 2.03), diabetes duration >15 years (aOR 1.88; 95% CI 1.04 to 3.38), unsatisfactory glycosylated haemoglobin (HbA1c) (aOR 1.29, 95% CI 1.05 to 1.61) and unemployment (aOR 1.3, 95% CI 1.09 to 1.59). Women appeared to have a lower risk of 0.68 (95% CI 0.50 to 0.92) compared with men. PAD was higher among those from urban areas (aOR 1.56, 95% CI 1.08 to 2.27). The independent determinants of retinopathy were increasing duration of diabetes from 1.4 (95% CI 1.01 to 1.97) at 6-10 years to 3.58 (95% CI 2.48 to 5.15) more than 15 years and an unsatisfactory HbA1c had a two times (95% CI 1.50, 2.67) higher risk of retinopathy.

There is a high prevalence of peripheral vascular disease, PN and retinopathy in Kerala. Retinopathy is more likely with longer duration of type two diabetes and high HbA1c levels. Older age and longer diabetes duration increase the risk of neuropathy, while PAD is more common in urban areas. This highlights the need to include regular screening through the public health system.