Diabetic Retinopathy (DR), a diabetes-related complication affecting the eyes, has emerged as a significant threat to vision and public health globally. It is a silent but progressively debilitating condition, often overshadowed by the broader concerns associated with diabetes mellitus. Diabetic Retinopathy can lead to severe vision impairment and blindness if not detected and managed promptly. Thus, raising awareness about DR and its strong association with blood sugar control is crucial in mitigating its impact, particularly in regions like District Kangra, Himachal Pradesh [1-3].

Diabetes mellitus is a chronic metabolic disorder characterized by elevated blood sugar levels and its prevalence is on the rise worldwide. According to the International Diabetes Federation, over 463 million adults were living with diabetes in 2019 and this number is projected to rise to 700 million by 2045. India bears a significant burden, with over 77 million diabetic individuals, making it the second-largest diabetic population globally [4-8].

One of the most devastating complications of diabetes is DR, a microvascular disease affecting the retina. It develops gradually, beginning with mild non-proliferative stages and potentially progressing to sight-threatening proliferative DR. The process involves damage to blood vessels in the retina due to prolonged exposure to high blood sugar levels, leading to leaking or abnormal blood vessel growth [9-11].

Early stages of DR are often asymptomatic, making it challenging for individuals to recognize the problem until vision is significantly affected. This insidious nature highlights the importance of regular eye examinations, especially for those with diabetes, to enable early detection and intervention [12-14].

District Kangra, situated in the picturesque landscapes of Himachal Pradesh, is home to a diverse population. While healthcare services have improved, understanding the levels of awareness and knowledge about DR and the critical role of blood sugar control remains essential. This study aims to investigate the current status of DR awareness in District Kangra and emphasize the significance of maintaining optimal blood sugar levels to prevent or delay its onset.

By assessing the awareness and understanding of DR within the community, including knowledge of its risk factors and the importance of blood sugar management, this study seeks to identify knowledge gaps and areas where public health interventions can be directed. Empowering individuals with knowledge about DR and the importance of blood sugar control is essential to protect vision and improve overall quality of life.

In this context, we aim to contribute to the growing body of knowledge on eye health and advocate for initiatives that promote regular eye examinations, blood sugar monitoring and awareness campaigns tailored to the unique needs of District Kangra's population.

Objectives of the Study

The objective of this study is to gauge the levels of awareness and knowledge about Diabetic Retinopathy and the importance of blood sugar control among the general population of District Kangra, Himachal Pradesh.

• Research Approach: Descriptive

• Research Design: Cross-sectional survey design

• Study area: District Kangra, Himachal Pradesh

• Study duration: Between April 2023 to July 2023

• Study population: The study's target population encompassed all adults aged 18 and above who had been residents of District Kangra for a minimum of 12 months

• Sample size: A robust sample size of 400 adults was determined using a 95% confidence level, an estimated knowledge level of 50% regarding Diabetic Retinopathy, a precise 5% absolute error margin and a conservative 5% non-response rate

• Study tool: A google form questionnaire consisting of questions regarding socio-demography and knowledge regarding Diabetic Retinopathy was created. The questionnaire was initially pre-tested on a small number of participants to identify any difficulty in understanding by the respondents

• Description of Tool:

• Demographic data survey instrument: The demographic form elicited information on participants’ background: age, marital status, religion, employment, education and many more

• Questionnaire: The questionnaire contains 20 structured knowledge related questions regarding Diabetic Retinopathy. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero. Scoring was done on the basis of marks as >80% (16-20) = very good,60-79%(12-15) = Good,41-59% (8-11) = Fair, <40% (<8) = poor

• Validity of tool: By the experts in this field

• Data collection: Data was collected under the guidance of supervisors. The google form questionnaire was circulated among the residents of District Kangra, Himachal Pradesh for responses using online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin till the 400 responses were collected

• Data analysis: Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage. 

• Ethical Considerations: Participants confidentiality and anonymity was maintained

The primary objective of this study was to gauge the understanding of Diabetic Retinopathy among the general population of District Kangra. A total of 400 participants took part in the study, with 276 (69%) residing in urban areas and 124 (31%) in rural areas (Table 1).

Table 1: Knowledge Regarding Diabetic Retinopathy Among Study Participants

Table 2: Knowledge Scores Towards Diabetic Retinopathy Among Study Participants

In the present study 21.75% (87) participants had very good knowledge (16-20 marks) towards Diabetic Retinopathy, 26% (104) had good knowledge (12-15 marks), 30.75% (123) had fair knowledge (8-11 marks) and 21.5% (86) having poor knowledge (<8 marks) (Table 2).

Diabetic Retinopathy (DR) is a diabetes-related complication that poses a significant threat to vision and public health. This discussion interprets the study's findings on the awareness and knowledge of DR among the general population of District Kangra, Himachal Pradesh and provides a comparison with existing research, highlighting knowledge gaps and potential areas for improvement.

The study revealed varying levels of knowledge among the participants regarding Diabetic Retinopathy (DR) and its associated factors. While some participants demonstrated a reasonable understanding, notable gaps in knowledge exist, particularly in recognizing risk factors and prevention strategies.

Approximately 49.5% of participants correctly understood what DR is and how it affects the eyes. This indicates a need for increased awareness about the nature and consequences of DR. Around 45.5% of participants could name common symptoms associated with DR. Recognizing these symptoms, such as blurred vision and floaters, is crucial for early detection. A significant proportion 46.25% correctly identified individuals at risk of developing DR, including those with diabetes. This knowledge is essential for targeting high-risk populations for screening. Approximately 46.5% understood the relationship between high blood sugar levels and the development of DR. Knowledge about blood sugar control is critical in preventing or delaying the onset and progression of DR. A substantial number of participants 48% correctly believed that DR is a preventable condition. This awareness is encouraging, as prevention is a key strategy in managing DR [1-6].

Around 44.5% recognized that lifestyle modifications can help prevent or delay the onset of DR. Public education should emphasize the role of a healthy lifestyle in preserving eye health. Approximately 47.25% were aware of the recommended target range for blood sugar levels in individuals with diabetes to reduce the risk of DR. This knowledge is vital for diabetes management and DR prevention. About 40.5% correctly understood that once DR develops, it cannot be reversed or cured. Realistic expectations are essential for individuals living with DR ^8^. Just 34.5% knew how often individuals with diabetes should undergo eye examinations to detect DR. Enhanced awareness about the importance of regular screenings is needed [7-9].

A quarter of participants 25.5% were aware of advanced diagnostic tests for DR. Expanding knowledge in this area can encourage individuals to seek comprehensive eye exams. About 43.25% understood the potential consequences of untreated DR on vision, including vision loss and blindness. Nearly 44.75% recognized that early detection and treatment of DR can prevent vision loss. This understanding underscores the importance of timely intervention. A significant majority 58.75% knew about lifestyle modifications and dietary recommendations specifically for individuals with diabetes to protect their eye health. This knowledge empowers individuals to take proactive measures. Around 30% were aware of support groups or resources in District Kangra for individuals living with diabetes and DR. Expanding access to such resources is essential for providing support and information. Only 25.5% could describe the typical treatment approaches for DR. Comprehensive patient education regarding treatment options is necessary. Just 24.5% were aware of surgical options available for advanced cases of DR. Knowledge in this area can help patients make informed decisions about their treatment [10-14].

An encouraging 69% considered DR awareness a priority in their community. This positive perception can drive community-based awareness campaigns. Approximately 67.25% recognized the potential complications of uncontrolled blood sugar levels in diabetes, besides DR. Understanding the broader health implications of diabetes is essential for comprehensive diabetes management. About 41.5% had personal experiences or knew someone who had experienced changes in vision due to diabetes or DR. Personal experiences often motivate individuals to prioritize eye health. A substantial 47.25% of participants shared opinions on improving awareness about DR and the importance of blood sugar control in their community. These insights can guide targeted awareness campaigns tailored to local needs [15-17].

The findings from this study align with previous research on DR awareness, emphasizing the need for comprehensive education campaigns and enhanced public awareness [12-17]. While knowledge levels vary, this study provides a valuable assessment of the current understanding of DR and its risk factors in District Kangra.

This study assessed the awareness and knowledge levels of Diabetic Retinopathy among the general population of District Kangra, Himachal Pradesh. While some participants demonstrated a reasonable understanding, there are significant knowledge gaps, particularly regarding risk factors, prevention and the importance of regular eye examinations and blood sugar control. Enhancing public education about DR, early detection, blood sugar management and available treatments is imperative to ensure that individuals seek timely eye care, preserve their vision and manage their diabetes effectively. By addressing these knowledge gaps, we can contribute to reducing the burden of DR-related vision impairment in the community, ultimately improving the overall quality of life for its residents.

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16. Zheng, Y. et al. “The worldwide epidemic of diabetic retinopathy.” The Lancet Global Health, vol. 7, no. 12, 2019, pp. e1603–e1604.

17. Ruta, L.M. et al. “Prevalence of diabetic retinopathy in type 2 diabetes in developing and developed countries.” Diabetic Medicine, vol. 30, no. 4, 2013, pp. 387–398.