Type 2-diabetes - Sundhedsstyrelsen

Diagnosis and screening for late complications
of Type 2 diabetes
Background
Type 2 diabetes entails an increased risk of a number of late diabetic complications,
including blindness, renal failure, coronary thrombosis and cerebral
thrombosis. These complications can exist at the time of diagnosis, and not
uncommonly it is detection of the »late diabetic« complication that leads to
diagnosis of the Type 2 diabetes itself. Thus undetected diabetes is often found
in patients with acute coronary thrombosis. As the number of Type 2 diabetes
patients is great relative to the number of patients with Type 1 diabetes, and
as the number is increasing, it is not surprising that it is exactly the Type 2
diabetes patients who now account for the greatest number of undetected late
diabetic complications.
This section examines our knowledge about diagnosis and screening of late
diabetic complications. As the diagnostic procedure is usually equivalent to the
screening method employed, diagnosis and screening are examined together.
A common feature of all late diabetic complications is that they each start with
an asymptomatic period. As it has concomitantly been shown that it is exactly
during this »asymptomatic« period that the effect of treatment on late diabetic
complications is greatest, it is rational to screen for these complications. The
treatment modality has not been subjected to a regular HTA, as was done for
screening for late complications, but treatment of each diabetic complication
is described.
In this report the late diabetic complications are subdivided into:
H Diabetic retinopathy
H Diabetic nephropathy
H Diabetic neuropathy
H The diabetic foot
H Cardiovascular disease (atherosclerosis).
The report’s conclusions and recommendations are presented below for each
of these complications.
Diabetic retinopathy
Diabetic retinopathy is often present already at the time of diagnosis. Thus
between 9 and 46% of the patients have retinopathy at that time. After the
diagnosis Type 2 diabetes has been made, the annual average incidence of new
cases of retinopathy is approx. 3% during the first 10 years (1a).
From a review of the literature it is concluded that:
H Sight-threatening diabetic retinopathy can be identified by screening (1a),
86 Type 2-diabetes. Medicinsk teknologivurdering af screening, diagnostik og behandling