Diabetic Retinopathy Awareness and Prevention Programme (ARUDRAPP)
People from Asian backgrounds have a significantly higher risk of diabetes compared to Caucasians.
Research led by Prof Shahina Pardhan, working with over 1,800 patients, showed higher levels of sight-threatening diabetic retinopathy in Asians linked to poor health literacy, language barriers and lower uptake of retinal screening.
Prof Pardhan and her team showed that different barriers for diabetic control exist in different demographics (for example, age, literacy, gender, culture) and that a 'one size fits all' intervention does not work efficiently.
The research has led to: (i) the development and dissemination of evidence-led, culturally and linguistically appropriate awareness and lifestyle interventions by policy makers and community organisations; and (ii) change in patient care practices by healthcare professionals.
These have led to behaviour change and improved outcomes in more than 110,417 people in the UK, India, Nepal, China and Thailand, evidenced by an 87–98% uptake of retinopathy screening from a baseline of 20–36%, and a reduced risk of blindness by 60–90%.
Prof Pardhan and her team’s work has formed impact case studies for the REF2014 (which was rated as 100% "world-leading" and "internationally excellent") and REF2021.
Prof Pardhan and her team, with the help of a large number of healthcare providers developed and disseminated evidence-led, culturally and linguistically appropriate diabetic and diabetic retinopathy awareness workshops (in Hindi, Urdu, Nepali, and English) in collaboration with a number of stakeholders from UK, Nepal and India.
Media coverage
To help improve awareness of diabetes and diabetic retinopathy. Professor Pardhan and her team have been interviewed by ITV Anglia, the College of Optometrists Podcast, Salam Radio, online services (OS) Nepal.com, British Force Broadcasting Service (BFBS) Gurkha Radio and Nepali Association in the UK. These interviews, which were also broadcast on social media, have been viewed more than 25,000 times.
Our collaborators/community champions
UK
- Mr. Ghulam Shabbir, Chairman, Pakistan Community Association of Peterborough
- Dr Dilip Kumar Yadav, Health Coordinator (2017-2019). Non-Residential Nepalese Association (NRNA), UK
- Mr Lil B Thapa, Chairman, Shanti Nepalese Community, Birmingham, UK
- Mr Bharat Thapa, Chairman, Nepalese Community, Hayes and Harlington, London
- Mr Harish Jyawali, General Secretary, Bexley Nepalese Community, London
- Mrs Asma Sajid, Dietician, Cambridgeshire and Peterborough Foundation Trust
- Mrs Yasmin Ilahi, Manager, Gladstone District Community Association (GLADCA), Peterborough
- Mrs Qamar Nizam, Trustee, Khidmat Sisters, Cambridge
- Mr Tulat Raja, Cambridge City Council
- Mr Mohammed Hanif, General Secretary, Birmingham Central Mosque, Birmingham
- Mrs Rokeya Noor, Project Co-ordinator, My time Active, London
- Mrs Fatima Nessa, Project Co-ordinator, Shanthona Women’s Group, Luton
- Dr Manzar Saeed, Consultant Ophthalmic Surgeon
- Mrs Fauzia Sattar Occupational Therapist, Cambridgeshire County Council
- Dr Afshan Salim, Diabetic Lead, Birmingham
- Dr Hena W Haque - Health Promotion Professional, Cambridge
Nepal
- Dr Robin Maskey, Vice-president, Diabetes and Endocrinology Association of Nepal (DEAN)
- Dr Bhojraj Adhikari, Vice-president, Nepal Health Research Council
- Dr Tirthalal Upadhyaya, Endocrinologist, Gandaki Medical College and Teaching Hospital, and Diabetes, Thyroid and Endocrinology Care Centre, Pokhara
- Mrs Tara Sharma, Dietician, Gandaki Medical College and Teaching Hospital, Pokhara
- Mr Niraj D Joshi, President, Nepalese Association of Optometrists
- Dr Hara Maya Gurung, Ophthalmologist, Himalaya Eye Hospital, Pokhara
- Professor Nirmal Lamichhance, Director, Bhuvana-Govinda (BG) Hospital and Research Centre, Pokhara
- Miss Pratiksha Chalise, Research Assistant, Diabetes, Thyroid and Endocrinology Care Centre, Pokhara
India
- Lions Club International Programme
- Medical Research Institute Chennai
- Professor Rajiv Raman, Ophthalmologist, Sankhara Netaralaya Hospital, Chennai
- Dr Anupama Biswas, Kurseong Sub-divisional Hospital, Darjeeling
China
- Dr Zhiqing Chen, Ophthalmologist, Second Affiliated Hospital, Zhejiang University, Hangzhou
Thailand
- Dr Paisan Ruamvibooksuk, Rajavithi Hospital, Bangkok
Workshops/diabetic training programmes
We run workshops in the UK and internationally to improve awareness of diabetes and diabetic retinopathy.
Programmes in the UK
Working with various stakeholders, we hold diabetic retinopathy awareness programmes in community centres, religious festivals, mosques and community gatherings in cities that have high prevalence of South Asian population. These have been delivered collaboratively (with VERI) by the following communities (with joint membership of over 15,150 people):
- Non-Resident Nepali Association (NRNA), UK, 25 May 2018
- Non-Resident Nepali Association (NRNA), Aldershot, 26 May 2019
- Pakistan Community Association of Peterborough, 17 June 2019
- Nepalese Community of Hayes and Harlington, 22 September 2019
- Nepalese Society (Shanti Nepali Samaj), Birmingham, 14 October 2019
- Bexley Nepalese Society, 8 February 2020
- Gladstone District Community Association, Peterborough, 18 February 2020
- Khidmat Sisters, Cambridge, 5 March 2020
- Shanthona Women's Group, Luton, 9 March 2020
- Syrian refugees, Cambridge, 3 July 2020
- Non-Resident Nepali Association on the impact of COVID-19 on diabetes and diabetic eye health, 19 July 2020 (online event)
- Central Mosque, Birmingham, 2021
- My Time Active, London, 2021
- Nepali Community, Nottingham, 2021
- Hatfield Shia Ismaili Mosque, 6 July 2021 (online event)
- Diabetes Chai Chat - Silver Star Diabetes, 3 November 2021 (online event)
- Central Mosque, Cambridge, 5 March 2022
- Bangladeshi Ethnic Forum, Cambridge, 20 June 2022
Peterborough
Right: Professor Pardhan talking about diabetes and its eye complications to members of Pakistan Association Community of Peterborough, June 2019
"We will share this knowledge and awareness about diabetes and importance of attending retinal screening to our family members and friends who have diabetes."
Members of the Pakistan Association Community of Peterborough at VERI's workshop about diet, good control of diabetes and retinal screening uptake to reduce the risk of diabetic retinopathy, February 2020.
"I now know that I should go for eye screening."
"Please can we have some more of these sessions?"
Aldershot
Dr Sapkota talking to a resident about diabetes and diabetic retinopathy at an annual health camp organised by Non-Resident Nepali Association UK, May 2019.
"We were ignoring letters by doctors inviting to have regular eye check-ups, but we will not ignore them now - we have now had our eyes photographed and we will continue to do so on a regular basis."
Hayes and Harlington, London
"We now know that diabetes can damage our eyes silently. Therefore, we will not ignore any letters that are sent to us asking to attend diabetic eye examinations."
Birmingham
"We did not know that if diabetes is not controlled, the back of our eyes can bleed and our vision will be disturbed significantly."
Bexley and Welling, London
Participants at a diabetic workshop organised by Bexley Nepali Society, London, February 2020
"We did not know that diabetes can become worse if we are stressed and that we can go blind if diabetes is bad."
"I did not know that there is a difference between having my eyes tested for spectacles and for diabetes - I know now."
Cambridge Central Mosque
L-R: Prof Pardhan giving a presentation; Hena W Haque (community champion) talking to a diabetic patient; Prof Pardhan, Hena, Dr Sapkota and Iman of Cambridge Central Mosque
Prof Pardhan and her team were invited by Cambridge and Peterborough Integrated Care Partnership and new Cambridge Central Mosque to deliver a series of talks and workshops at their Diabetes Wellness Day 2022, based on VERI's research on the high risk of diabetic retinopathy in South Asians in the UK.
The event was attended by over 400 people from across the region.
Bangladeshi Ethnic Forum, Cambridge
Right: Prof Shahina Pardhan and Dr Sapkota with participants at the Cambridge Bangladeshi Health Fair
Prof Pardhan and Dr Sapkota helped improve health literacy around eye complications at the first-ever Cambridge Bangladeshi Health Fair at Meadows Community Centre in Arbury on 20 June 2022.
Visitors were offered free diabetic eye screenings and could access a culturally appropriate video training programme in Bengali language developed by VERI.
The health event was organised by Cambridge Ethnic Community Forum in Partnership with the Karim Foundation and Clinical Commissioning Group (CCG). The event was hugely successful in increasing awareness about diabetic-related eye complications in those most at risk.
Programmes in Nepal
Professor Pardhan was invited by the The Diabetes and Endocrinology Association of Nepal (DEAN) and the Nepal Health Research Council to hold the first multidisciplinary workshop for professionals involved in the management of diabetes and eye complications in Pokhara on 29-30 October 2018.
This saw the development of a framework for a culturally-appropriate, multidisciplinary intervention programme to control diabetes and reduce blindness due to diabetic retinopathy.
The programme is being delivered through the Diabetes, Thyroid and Endocrine Care Centre, Pokhara, Gandaki Medical College and the Nepalese Association of Optometrists in seven different provinces and over 50 villages of Nepal.
Prof Pardhan and her team with health care practitioners to develop the framework for the training program in Nepal
"This has led us to target those patients who are more at risk of blindness."
"This work has led to improved strategies ... we need to address the different barriers for an illiterate female compared to a younger working male."
A clinical trial is being conducted to see how training videos help to improve people's awareness about diabetes and diabetic retinopathy screening. Our results show that the video-based training program increased the uptake of retinal screening in 98% of people compared to 36% in the control group.
Professor Pardhan, Dr Sapkota and healthcare professionals and collaborators at the Diabetes, Thyroid, and Endocrine Care Centre, Pokhara, Nepal
"The centre now delivers the training program to all newly diagnosed patients attending. Before training only 28% had their eyes photographed – now 89% have requested a retinal screening. This has already reduced the risk of blindness in over 50, 000 people."
Pratishka Chalise and Deepika Karki from VERI delivering a retinopathy awareness programme to diabetic patients in Nepal
We are also conducting community workshops in different villages of Nepal on how to improve control of diabetes and reduce the risk of diabetic blindness in collaboration with the Nepalese Association of Optometrists.
"We did not know that diabetes can lead to blindness."
The VERI team was invited by the Lions Club of Pokhara, Nepal to mark World Diabetic Day on 14 November 2019.
Informed by VERI’s recent research publication on sight-threatening retinopathy in patients most at risk, Dr Tirtha Lal Upadhyaya, from Gandaki Medical College and Diabetes, Thyroid, and Endocrine Care Centre, Pokhara, Nepal, stressed the importance of culturally-appropriate diabetic diet, exercise, lifestyle, and need for attending diabetic eye check-up to more than 100 members of the public.
This was very well received by participants.
"We learnt new knowledge about diabetes by attending the event, which was presented in simple Nepali language."
"We now know that diabetes can cause blindness, so we will not neglect to go to an eye doctor for check-ups."
Programmes in India
Chennai
Right: Dr Rajiv Raman from Sankara Nethralaya
Our collaboration with Sankara Nethralaya Hospital (Chennai) led to development of a bespoke one-to-one counselling service for patients with sight-threatening retinopathy to explain the importance of regular attendance and treatment.
"This has already improved attendance for retinopathy screening and reduced risk of blindness in 90% of all the patients with sight-threatening retinopathy."
Darjeeling
Right: Doctors, nurses and patients being trained on the diabetic awareness program, designed by Prof Pardhan and her collaborators at Kurseong sub-divisional hospital (Darjeeling). The training program is now delivered to all patients who attend the clinic
Kurseong sub-divisional hospital (Darjeeling) have worked with us and use our training videos to improve awareness about diabetes and diabetic retinopathy in their patients.
"We thought our own herbal medicines are enough - now we know that we need to take the medicine given by our doctors."
"We will go and have a diabetic eye check today - we don’t want to go blind by delaying it..."
"I should go to my doctor instead of traditional healers for my diabetes."
Programmes in China
Our collaboration with Second Affiliated Hospital in Hangzhou in the eastern region of China, serving 600,000 outpatients annually from a catchment area of greater than one million square kilometres, has led to the development of strategies to address the significantly high profile of diabetic blindness in patients attending the eye clinics.
"This has highlighted the lack of awareness amongst diabetic patients on how important it is to look after their diabetes."
Programmes in Thailand
We are collaborating with Rajavithi Hospital in Bangkok to tackle the current low levels of retinal screening uptake by diabetic patients in Thailand.
Publications
A full list of VERI publications, including on diabetes and diabetic retinopathy, can be found on our publications page.