To Study the Incidence of Diabetic Retinopathy in Different Stages of Diabetic Nephropathy in Type 2 Diabetes Mellitus.

India being a developing country and undergoing socioeconomic growth on fast pace is at a higher risk of catering diabetic population owing to the unhealthy lifestyle with a significant fraction belonging to the urban population. According to IDF, estimated population with diabetes in India as in 2019 is 77.0056 million which accounts for around 10.4% of the population. Keeping in mind the population of our country, this population proportion can give us an idea about the disease burden and is rightly regarded as the 'Diabetic Capital' of the world. Majority of morbidity and mortality associated with diabetes can be attributed to its complications. These can be categorised into vascular as well as non-vascular complications. Vascular complications are further divided into microvascular and macrovascular complications. Microalbuminuria is the earliest clinically detectable stage of diabetic kidney disease at which appropriate interventions can retard, or reverse, the progress of the disease. Diabetic nephropathy (Kimmelstiel-Wilson syndrome) is the leading cause of end-stage renal disease (ESRD) worldwide, and it is estimated that 20% of type 2 diabetic patients reach ESRD during their lifetime. Here, this study explores the incidence of different stages of diabetic retinopathy in relation to different stages of nephropathy among type 2 Diabetes mellites patients.

MATERIAL: A prospective study done with 50 patients with long standing history of Type 2 Diabetes Mellitus (more than 5 years) attending Medicine OPD at our hospital with informed consent fitting the inclusion and exclusion criteria were taken up for the study. Albuminuria estimation as well as fundoscopy was done with informed consent. All patients underwent a thorough clinical examination and a proper history was taking into account their BMI, their details of medications like OHAs / Insulin as well as presence of other co morbid conditions.

OBSERVATION: With the above data in hand, the incidence of diabetic retinopathy in different stages of diabetic nephropathy, CKD stages were calculated and analysed. 2 (66.7%) of Grade II Nephropathy, 3(60%) of Grade IIIa, 11(55%) of Grade IIIb, 2 (12.5%) of grade IV and none among Grade V had a normal fundus. 1(33.3%) of Grade II, 1(20%) of Grade IIIa, 5(25%) of Grade IIIb, 4(25%) of Grade IV and nil had Mild NP 1(20%) of Grade IIIa, 3(15%) of Grade IIIb, 4(25%) of Grade IV and 1(16.7%) of Grade V had Moderate NP 1(5%) of Grade IIIb, 3(18.8%) of Grade IV and 2(33.3%) of Grade V had severe NP 3(18.8%) of Grade IV and 3(50%) of Grade V had P Statistical analysis by Fisher Exact testing showed that the above data is significant with a P value of 0.016.

CONCLUSION: This study showed severity of diabetic retinopathy by assessing its different stages in relation to different stages of diabetic nephropathy. Data shows that severe forms of diabetic retinopathy is more linked to long standing history of diabetes causing kidney damage among those with good glycaemic control. Hence it is advisable to include fundoscopy & albuminuria as the screening tool in the evaluation of long-standing diabetes, so that we can predict the development of diabetic retinopathy and treat them in early stages.