From the Editor's Desk
Dr. Saravana Bharathy. S. P
Internal Medicine
Dear Mehta's Family
This July, Dr. Mehta’s Multi-Speciality Hospital is raising awareness about the silent complications of diabetes, neuropathy, retinopathy, and nephropathy. With over 101 million Indians living with diabetes, these organ-threatening conditions often progress unnoticed until they become severe or irreversible. Early screening for nerve damage, vision changes, and kidney health is essential to protect long-term wellbeing.
"Diabetes doesn’t shout—your organs whisper. Learn to listen."
Diabetes Complications in India: The Silent Triad You Can’t Ignore
- Neuropathy
- Retinopathy
- Nephropathy
India currently has approximately 101 million people living with diabetes, a number that has risen sharply over the last decade. This epidemic is manifesting earlier and progressing faster than many clinics can track, resulting in a surge of “silent” end-organ damage that often remains asymptomatic until it becomes severe, disabling, or irreversible.
Why this matters? Key figures from India:
- Retina (Diabetic Retinopathy, DR): Nationally representative data estimate that 12–17% of Indians with diabetes have DR, with around 4% having vision-threatening disease. This translates to roughly 3 million adults at risk of severe vision loss.
- Nerves (Diabetic Peripheral Neuropathy): Clinic-based studies in India report prevalence rates of 20–40%. Early screening using monofilament testing or vibration perception can identify risk before ulcers or amputations occur.
- Kidneys (Diabetic Kidney Disease / Microalbuminuria): Reported prevalence ranges from 12–50% depending on the study, with most cohorts clustering around 25–35%. A simple annual urine albumin-to-creatinine ratio (ACR) test can detect early kidney involvement.
"See, feel, and filter—see the retina, feel the feet, filter the urine."
Clinic-friendly guidance:
- Every 6 months: Foot examination with a 10-g monofilament and vibration perception testing.
- Every 12 months: Dilated retinal examination or fundus photography, plus urine ACR and eGFR assessment.
- Immediate attention: Loss of protective sensation, new floaters or blurred vision, or rising creatinine/ACR levels should prompt further evaluation.
Red flags to monitor closely:
- Neuropathy: Burning sensations in the feet, painless injuries, callus or ulcer formation, loss of ankle reflexes.
- Retinopathy: Sudden appearance of floaters, distorted vision, difficulty seeing at night.
- Nephropathy: Rising blood pressure, ankle edema, ACR ≥30 mg/g, and decline in eGFR.
Effective strategies to protect organs beyond glucose control:
- Maintain tight glycaemic control without hypoglycaemia and keep blood pressure below 130/80 mmHg (use of ACE inhibitors or ARBs if albuminuria is present).
- Statin therapy for cardiovascular prevention, which also protects the retina and kidneys.
- Smoking cessation and proper footwear reduce ulcer risk.
- Timely interventions such as anti-VEGF therapy or laser treatment can prevent vision loss in severe retinopathy, while SGLT2 inhibitors and RAS blockade slow kidney disease progression.
India snapshot:
- Diabetes burden: ~101 million (ICMR-INDIAB 2023)
- Retinopathy: 12–17% DR; ~4% vision-threatening; ~3 million adults at immediate risk
- Neuropathy: 20–40% prevalence in clinics; early testing prevents ulcers and amputations
- Nephropathy: Microalbuminuria reported in 12–50% of patients; annual ACR/eGFR testing recommended
