Same-Day Screening of Diabetic Complications in Outpatient Clinics: ASystematic Review

Abstract

Background: Fragmented, multi-visit screening for diabetic retinopathy, kidney disease, and neuropathy in routine care leads to missed tests and delayed referral. Same-day, multi-component screening in outpatient clinics is proposed to improve completion and diagnostic yield.

Methods: A PRISMA-guided review searched PubMed from inception to September 2024 (Humans, English). Eligible designs were clinical trials or cohorts evaluating same-day screening bundles assessing ≥2 complication domains (retina, kidney, foot/neuropathy) within one outpatient encounter, versus usual care or pre-implementation periods. Primary outcome was completion of all eligible screens during the visit; secondary outcomes included detection yield, referral/process measures, patient experience, and
safety.

Results: Ten studies (all observational cohorts; 5 before-after, 3 prospective, 2 quasi-experimental) met criteria, from the UK, Europe, North America, and the Middle East. Sample sizes ranged 236-4,022. Integration models most commonly combined non-mydriatic retinal imaging with foot/neuropathy testing and urine albumin-to-creatinine ratio. Across studies, same-day programs increased multi-domain completion versus prior workflows (reported directionally in 6/10). Detection yields at the index visit were substantial: moderate/high-risk foot 56.6%, new painful neuropathy 25%, peripheral artery disease 19-26%, and sensory neuropathy 3-31%, while retinal imaging identified previously unrecognized diabetic retinopathy in routine primary-care pathways.

Conclusions: Same-day, bundled screening in outpatient clinics was feasible and acceptable, with consistent gains in completion and meaningful same-visit detection of microvascular complications. Health systems should pilot co-located models with standardized referral protocols and measure completion, yield per 100 screened, time-to-referral, and costs.