Diabetes and women: Preventive measures

Early-stage retinopathy may not need to be treated, but more advanced retinopathy with bleeding inside the eye may require laser treatment or injections of medicine into the eye

Diabetes is fast becoming one of the most challenging and a major public health problems worldwide and in our country, unfortunately very few are aware of the problems. According to WHO, diabetes affects more than 436,000 people, which will rise to 1,328,000 by 2030.

The percentage of diabetic patients has increased from 19.04% in 2002 to 25.9% in 2009 in Nepal. It was also found to be 25.9% in urban areas in people over 60 years of age. A survey conducted in urban region between 2001 to 2002 showed that 10.8% and 13.2% of males suffered from diabetes and pre-diabetes, with females being 6.9% and 10.2%, respectively.

The Nepal Diabetes Association reported that diabetes affects approximately 15% of people of 20 years and above and 19% of people of 40 or above years of age in urban areas. However, there is no data of diabetic changes in eyes of pregnant women in Nepal.

Educating each individual about diabetes and its preventive measures are very important to lessen the financial burden in the family, in the society hence to the country. World Diabetic Day is celebrated every year on November 14 to mark the birthday of Frederick Banting who, along with Charles Best, first conceived the idea, which led to the discovery of insulin in 1922.

The International Diabetes Federation and the World Health Organization in response to the alarming rise of diabetes around the world introduced the World Diabetes Day (WDD) in 1991. World Diabetic Day became an official United Nations Day in 2007 with the passage of United Nation Resolution 61/225. The day engages millions of people worldwide in diabetes advocacy and awareness. Each year the Day is centered on a theme related to diabetes. Topics covered in the past have included diabetes and human rights, diabetes and lifestyle, and the costs of diabetes. The theme of World Diabetic Day 2017 is “Women and Diabetes- our right to a healthy future”.

In regards to the pregnant women, they require improved access to screening, care and education to achieve positive health outcomes for mother and child. Diabetes affects different parts of the body and leads to complications that include heart disease, stroke, loss of limbs, nephropathy, retinopathy in eyes and complications in pregnancy and fatality. This disease can gradually disturb people’s vision, finally resulting in blindness due to diabetic retinopathy. It is one of the leading causes of visual impairment and blindness in our country. It is indeed an emerging public health issue as patients usually present very late with no possibilities of good visual recovery.

In cataracts the lens inside the eye allows us to see and focus on an image just like a camera. The high blood sugar makes clear lens cloudy causing our vision to be blurred, which is called cataract. People with diabetes can get cataract earlier and progresses very rapidly than those without diabetes. However, cloudy lens can be successfully removed and replaced by a man made lens implant.

In glaucoma the condition of excessive fluid and pressure build up inside the eye is called glaucoma.  It damages nerves and the blood vessels in the eye, and rubs our vision slowly as the patient is usually unaware of any symptoms of headache, pain of the eye, and haloes around the light. Therefore, the damage is found only during the eye examinations in diabetic populations. Retinopathy is the medical term for damage to the tiny blood vessels that nourish the retina, the tissue at the back of our eye that captures light and relays information to our brain.

Early-stage retinopathy may not need to be treated, but more advanced retinopathy with bleeding inside the eye may require laser treatment or injections of medicine into the eye.

One should have eyes examined every year by an ophthalmologist so the condition can be closely monitored. An ophthalmologist is a specialist in identifying and treating eye conditions.

The late stage needs laser treatment as well as Intravitreal anti-VEGF injections, which is given inside the eye. However, both the treatments are expensive and there is no guarantee of visual recovery.

Early examination of the eyes with an Ophthalmologist and early treatment is the most important preventive measure. Early diagnosis is vital so it is always advisable to go for eye check up when diabetes is diagnosed. One should have an eye examination every year even if the eye is normal. The patient should not wait until the vision has deteriorated to have an eye test. Women with diabetes should discuss the risk with her doctor considering pregnancy and should go for regular check up as retinopathy can be precipitated or worsen during pregnancy.

‘Give my sight to a man who has never seen a sunrise, baby’s face or a love in the eyes of a woman’, is a part of a poem by Robert N Test. Today, on the day of world diabetic day, we should all say that let’s try to help women who has lost their sight from diabetes and let them be able to see their kids again.

Once considered as a rich man’s disease, unfortunately poor and lower middle class population and pregnant women are more likely to end up with devastating problems. All women with diabetes require affordable and equitable access to care and education to better manage their diabetes and improve their health outcomes.

Dr Pradhan, MD, MRCSEd Opth,UK is Consultant Medical Retina, Tilganga Institute of Ophthalmology