Table 2.

Proposed strategies at different levels of prevention

Levels of Prevention	Health care personnel responsible for implementation of strategies
Primordial Prevention
Education about diabetes and its complications, and the benefits of a healthy lifestyle	Community health workers
Mobilize people at risk for diabetes to attend diabetes screening camps	ASHAs
Primary Prevention
Screen for diabetes and confirm the diagnosis	ANMs
Good control of blood glucose, and hypertension and dyslipidemia, if present	Physicians at all levels
Promote lifestyle changes to improve control of the above	Physicians, counsellors, peer support groups
Secondary Prevention
Referral for retinal screening/retinal examination by an ophthalmologist	NCD staff and physicians at all levels
Integrated visual acuity measurement and retinal screening for DR in vision centers/NCD clinics in CHCs and district hospitals; in physicians and endocrinologists clinics using nonmydriatic digital fundus camera	Screening can be undertaken by the following, if competent after training: ophthalmic officers/assistants or equivalent, NCD nurses, other healthcare professionals
Grading images, with referral of those with signs of mild or more severe DR, or who fail screening for other reasons (e.g., poor image quality; reduced visual acuity). Annual screening for those with no or minimal DR	Ophthalmologists/diabetic eye screeners trained in image grading
Manage vision threatening DR, with regular follow-up	Trained ophthalmologists
Tertiary Prevention
Treat DME associated with loss of vision	Trained ophthalmologists
Manage advanced DR, if indicated, at the discretion of the ophthalmologist	Retina specialists in centers of excellence
Rehabilitation for those with irreversible loss of vision	Rehabilitation workers

ASHA: Accredited Social Health Activist; ANM: Auxiliary Nurse Midwife; DR: Diabetic Retinopathy; NCD: Noncommunicable Diseases; DME: Diabetic Macular Edema