Screening

Screening

The IDF estimates that globally about 50% of people with diabetes (approximately 232 million people in 2019) are undiagnosed. The majority of the undiagnosed cases (84.3%) are from low- and middle-income countries. Undiagnosed and untreated diabetes increases the risk of progression and complications.

IDF Recommendations for screening of diabetes complications

T2D Complication/comorbidityIDF Screening Recommendation
Retinopathy– Screen the retina every 1 to 2 years using the best available test, preferably a nonmydriatic retinal photography.
Neuropathy– Screen for albumin in urine every year (microalbuminuria).
– Measure serum creatinine every year to calculate estimated glomerular filtration rate (eGFR).
– Diabetic kidney disease (diabetic nephropathy) is identified when eGFR is <60 mL/min/1.73 m² and albuminuria >30 mg/g (3.4 mg/mmol) creatinine.

Resource: https://www.kidney.org/professionals/kdoqi/gfr_calculator
Peripheral neuropathy– Screen for neuropathy using the 5.07 monofilament to identify if the foot is at risk. 
– Inspect the feet at every visit when they are at risk and educate the patient on prevention of diabetes-related foot problems.
Macrovascular disease– Screen for coronary artery disease when the patient has typical or atypical symptoms.
– Screen for peripheral artery disease by palpating the foot pulses and/or measuring the systolic blood pressure to calculate the ankle/brachial index.
Depression– The depressive state can affect treatment adherence and may worsen prognosis. Screen for depression using a validated tool such as the patient health questionnaire-2 (PHQ2)

Resource: https://www.hiv.uw.edu/page/mental-health-screening/phq-2