National estimates of the prevalence of vision impairment and blindness in people with diabetes are required to inform resource allocation. People with diabetes are more susceptible to conditions such as diabetic retinopathy that can impair vision; however, these are often missed in national studies. This study aims to determine the prevalence and risk factors of vision impairment and blindness in people with diabetes in India. Data from the SMART-India study, a cross-sectional survey with national coverage of 42 147 Indian adults aged 40 years and older, collected using a complex sampling design, were used to obtain nationally representative estimates for the prevalence of vision impairment and blindness in people with diabetes in India. Vulnerable adults (primarily those who did not have capacity to provide consent); pregnant and breastfeeding women; anyone deemed too ill to be screened; those who did not provide consent; and people with type 1 diabetes, gestational diabetes, or secondary diabetes were excluded from the study. Vision impairment was defined as presenting visual acuity of 0·4 logMAR or higher and blindness as presenting a visual acuity of 1·0 logMAR or higher in the better-seeing eye. Demographic, anthropometric, and laboratory data along with geographic distribution were analysed in all participants with available data. Non-mydriatic retinal images were used to grade diabetic retinopathy, and risk factors were also assessed. A total of 7910 people with diabetes were included in the analysis, of whom 5689 had known diabetes and 2221 were undiagnosed. 4387 (55·5%) of 7909 participants with available sex data were female and 3522 (44·5%) participants were male. The estimated national prevalence of vision impairment was 21·1% (95% CI 15·7–27·7) and blindness 2·4% (1·7–3·4). A higher prevalence of any vision impairment (29·2% 19·6%; p=0·016) and blindness (6·7% 1·6%; p<0·0001) was observed in those with ungradable images. In known diabetes, diabetic retinopathy (adjusted odds ratio [aOR] 3·06 [95% CI 1·25–7·51]), vision-threatening diabetic retinopathy (aOR 7·21 [3·52–14·75]), and diabetic macular oedema (aOR 5·41 [2·20–13·33]) were associated with blindness in adjusted analysis. Common sociodemographic risk factors for vision impairment and blindness include older age, lower educational attainment, and unemployment. Based on the estimated 101 million people with diabetes in 2021 and the interpretation of the data from this study, approximately 21 million people with diabetes have vision impairment in India, of whom 2·4 million are blind. Higher prevalence is observed in those from lower socio-economic strata and policy makers should focus on these groups to reduce inequalities in health care. Global Challenge Research Fund of United Kingdom Research and Innovation through the Medical Research Council.

中文翻译：

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全国 40 岁及以上患有已知或未确诊糖尿病的成年人视力障碍和失明的患病率以及相关危险因素：SMART-印度横断面研究的结果


需要对糖尿病患者视力损伤和失明的患病率进行全国估计，以便为资源分配提供信息。糖尿病患者更容易患糖尿病视网膜病变等可能损害视力的疾病；然而，这些在国家研究中经常被忽视。本研究旨在确定印度糖尿病患者视力障碍和失明的患病率和危险因素。 SMART-印度研究是一项横断面调查，覆盖全国 42~147 名 40 岁及以上的印度成年人，采用复杂的抽样设计收集数据，用于获得具有全国代表性的视力障碍和失明患病率估计值。印度的糖尿病患者。弱势成年人（主要是那些没有能力表示同意的人）；孕妇和哺乳期妇女；任何被认为病情太重而无法接受筛查的人；未表示同意的人；患有 1 型糖尿病、妊娠糖尿病或继发性糖尿病的人被排除在研究之外。视力障碍定义为视力为 0·4 logMAR 或更高，失明定义为视力较好的眼睛视力为 1·0 logMAR 或更高。对所有参与者的人口统计、人体测量和实验室数据以及地理分布进行了分析。免散瞳视网膜图像用于对糖尿病视网膜病变进行分级，并评估危险因素。该分析共纳入了 7910 名糖尿病患者，其中 5689 名已知患有糖尿病，2221 名未确诊。在拥有可用性别数据的 7909 名参与者中，4387 名 (55·5%) 为女性，3522 名 (44·5%) 为男性。 估计全国视力障碍患病率为 21·1% (95% CI 15·7–27·7)，失明率为 2·4% (1·7–3·4)。在具有不可分级图像的患者中观察到任何视力障碍（29·2% 19·6%；p=0·016）和失明（6·7% 1·6%；p<0·0001）的发生率较高。在已知糖尿病中，糖尿病性视网膜病变（调整后比值比 [aOR] 3·06 [95% CI 1·25–7·51]）、威胁视力的糖尿病性视网膜病变（aOR 7·21 [3·52–14·75]）和糖尿病性黄斑水肿 (aOR 5·41 [2·20–13·33]) 在调整分析中与失明相关。视力障碍和失明的常见社会人口风险因素包括年龄较大、教育程度较低和失业。根据预计 2021 年将有 1.01 亿糖尿病患者以及对本研究数据的解读，印度约有 2100 万糖尿病患者存在视力障碍，其中 2·400 万人失明。来自较低社会经济阶层的患病率较高，政策制定者应重点关注这些群体，以减少医疗保健方面的不平等。英国研究与创新全球挑战研究基金通过医学研究理事会。