Clinical guidelines for diabetic retinopathy in Kenya: an executive summary of the recommendations

All persons living with Diabetes Mellitus (DM) have a lifetime risk of developing Diabetic Retinopathy (DR), a potentially blinding microvascular complication of DM. The risk increases with the duration of diabetes. The onset and progression of DR can be delayed through optimization of control of blood glucose, blood pressure and lipids. The risk of blindness from DR can be reduced through cost-effective interventions such as screening for DR and treatment of sight-threatening DR with laser photocoagulation and anti-VEGF medications. Several factors make it important to provide guidance to clinicians who provide services for diabetes and diabetic retinopathy in Kenya. First, the magnitude of both DM and DR is expected to increase over the next decade. Secondly, as the retina is easily accessible for examination, the early signs of retinopathy may provide clinicians with the first evidence of microvascular damage from diabetes. This information can be used to guide subsequent management of both DM and DR. Thirdly, there are notable gaps in service delivery for the detection, treatment and follow-up of patients with DR, and the services are inequitable. Strengthening of service delivery will require close collaboration between diabetes services and eye care services. Following a systematic and collaborative process of guideline development, the first published national guidelines for the management of diabetic retinopathy have been developed. The purpose of this paper is to highlight the recommendations in the guidelines, and to facilitate their adoption and implementation. Key words: Clinical practice guidelines, Diabetic retinopathy, Kenya