[Screening for diabetic retinopathy in type 2 diabetes: a critical review of an annual routine].
BACKGROUND
The German diabetes guideline published in 2010 recommends an annual retinopathy screening for all type 2 diabetics. Patients' and physicians' questions about the need for this routine procedure prompted our critical review.


METHODS
Based on guidelines from six industrial nations, recent scientific studies, and from the type 2 disease management programme of North Rhine-Westphalia we reviewed alternative retinopathy screening strategies and their implications for over- and underuse.


RESULTS
A comparison of the English, Australian, US, Swedish, Canadian and German guidelines shows that a fixed screening interval is recommended in four countries, while an individualised, risk profile-adjusted screening interval of up to two to three years is favoured in two countries (Sweden, Canada). Current studies indicate that diabetes patients without retinopathy may safely be screened every two to three years without adverse health outcomes if performed consequently.


CONCLUSIONS
An individualised retinopathy screening based on the patient's risk factor profile may be a reasonable alternative to achieve the best possible health outcome and to avoid overuse.
Institut für Allgemeinmedizin, Universität Duisburg-Essen. Electronic address: birgitta.weltermann@uk-essen.de.
Birgitta
B
Weltermann
Sabrina
S
Reinders
Markus
M
Bettin
Stefan
S
Gesenhues
Martin
M
Hermann
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003431:Cross-Cultural Comparison; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis*; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000453:epidemiology; D042241:Early Diagnosis; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D005858:Germany; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D019564:Unnecessary Procedures / Q000706:statistics & numerical data; D014944:World Health Organization
Diabetic retinopathy; Diabetische Retinopathie; Screening; screening