Screening for chronic diabetes complications

The screening and interventions for chronic diabetes complications recommended by the ADA have a strong evidence base and are cost-effective (54). However, as is the case for many diabetes interventions, the underlying evidence generally comes from studies of younger adults. When considering chronic complications, the issues of incident versus prevalent diabetes and diabetes heterogeneity again need to be raised. Some older adults have long-standing diabetes with associated microvascular and macrovascular complications. Others have newly diagnosed diabetes with evidence of complications (on screening tests) at initial presentation, while still others have newly diagnosed diabetes without evidence of complications. For relatively healthy older adults with long life expectancy, following the screening recommendations for all adults with diabetes is reasonable. For very old patients and/or those with multiple comorbidities and short life expectancy, it is prudent to weigh the expected benefit time frame of identifying early signs of complications and intervening to prevent worsening to end-stage disease. For the latter group, particular attention should be paid to screening for risk factors of complications that might further impair functional status or quality of life over a relatively short period of time, such as foot ulcers/amputations and visual impairment. Considerations in clinical decision making should also include prior test results. For example, there is evidence, including in the older adult population, that dilated eye examinations that are initially normal can safely be repeated every 2–3 years instead of yearly .