The value of screening for retinopathy and microalbuminuria in patients with type 2 diabetes in primary health care.

Abstract

Patients with type 2 diabetes (NIDDM) attending the Primary Care Centre in Mölnlycke, Sweden, were evaluated regarding their metabolic status, microalbuminuria (UAER), and hypertension. An ophthalmological examination was performed, and two diagnostic methods, slit-lamp biomicroscopy and fundus photography, were compared. Nearly half the patients (42%) had diabetic retinopathy, mainly of the background type. Retinopathy was associated only with the duration of the disease, but the prevalence was as high as 20% within 0-4 years of the diagnosis. Fundus photography was easy to apply, except in the age groups above 80 years, in otherwise healthy and mentally cooperative patients. Fundus photography could not be applied in only 7% of the patients for ophthalmological reasons. The prevalence of microalbuminuria (20-200 micrograms/min) was high--34%--with another 8% above that range. Male sex, mode of antidiabetic treatment, and hypertension were associated with an increased UAER. Screening for retinopathy and microalbuminuria is valuable in primary health care in order to detect treatable diabetic retinopathy and to trace patients with microalbuminuria, a risk factor for clinically overt nephropathy as well as for cardiovascular diseases.