I agree that every opportunity should be taken to discuss with
patients with diabetes how they can reduce the risk of complications, and
that screening can present one such opportunity. However, because the
effectiveness of this approach has not been tested in an RCT, it was not
included in the review on which this Effective Health Care Bulletin was
The authors point out the effectiveness and need for retinopathy screening and foot care in diabetes. However, as in much of the "screening" literature, the opportunity for intervention during the screening visit is not ephasised.
We know that by achieving an HbA1c of 6% and blood pressure of 130/80 or below, not smoking, and having a hyperlipidaemia treated, most retinopathy could be avoided or delayed (U...
We know that by achieving an HbA1c of 6% and blood pressure of 130/80 or below, not smoking, and having a hyperlipidaemia treated, most retinopathy could be avoided or delayed (UKPDS and DCCT studies). But few patients are aware of this information, fewer still know their own levels, and fewer still know how to achieve such levels. By providing such information, regarding the importance of the levels and finding them out and the need for medical care to reach the required targets, patients would not only be screened but an intervention would have been carried out that would enable many patients to avoid retinopathy and other complications.
Surely it is time to consider that retinopathy screening visits provide the opportunity for vastly improved quality of care, not simply a check up. Indeed, the authors note the success of foot intervention programs in preventing amputations, whilst it is only a very small further step to prevent many diabetic complications by informing patients of the need for good control of their diabetes, and the need to check control with HbA1c and blood pressure checks.
(1) Diabetes Control and Complications Trial (DCCT) Research Group. The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long Term Complication in Insulin-Dependant Diabetes Mellitus. N Engl J Med 1993;329:977-86.
(2) Adler, AI, et al, on behalf of the UK Prospective Diabetes Study Group. Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36). BMJ 2000;321:412-19.
(3) Stratton, IM, et al, on behalf of the UK Prospective Diabetes Study Group. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35). BMJ 2000;321:405-12.