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Diabetes in Germany - adults

Medical eye examination

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Diabetic eye disease (retinopathy) is one of the most common diabetes-related secondary diseases of the small blood vessels and also one of the main causes of blindness in people with diabetes. Regular ophthalmologic check-ups allow the detection and the treatment of potential retinal damage at an early stage. According to the National Health Care Guideline (NVL) Type 2 Diabetes, people with diabetes should have their ocular fundus examined every one to two years, depending on the general risk constellation and existing retinal changes (NVL 2023).

Key messages

  • In Germany, about two-thirds of people aged 45 and older with type 2 diabetes have their eyes examined by an ophthalmologist at least once a year.
  • The proportion of people with type 2 diabetes examined by ophthalmologists increases with age, especially in women
  • The observed temporal trend of decline in ophthalmologic examinations over the past 12 months is likely due to an update of the NVL.

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By state

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  • By gender

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  • By age

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  • By education group

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Results

In 2021, 64.8% of people (women: 64.1%; men: 65.4%) aged 45 years and older with type 2 diabetes in Germany have had their ocular fundus examined in the past 12 months. Among people with type 2 diabetes, the overall proportion with medical eye examination increases with age and is higher in women in the age groups 65 to 79 years (68.3%) and 80 years and over (70.8%) than in the age group 45 to 64 years (53.1%), while among men no differences are observed between the respective age groups (61.5%, 69.9% and 65.2%). For both women and men, no differences are found regarding ophthalmologic examination by education and region.

Conclusion

In Germany, nearly two-thirds of people aged 45 years and older with type 2 diabetes have their ocular fundus examined by an ophthalmologist at least once a year. A comparison over time with an RKI study based on results for 2010 (Du et al. 2015) shows a decrease (-14.5 percentage points) for the age group of 45 to 79 years, especially in women (-22.3 percentage points) and in the age group of 65 to 79 years (-17.0 percentage points). This decrease is probably due to an update of the NVL. While according to NVL, the recommendation of a once-a-year examination was previously given for people with diabetes without known retino- or maculopathy (NVL 2014), since 2015 the eye examination is recommended at intervals of one to two years depending on the existing risk profile and retinal changes (NVL 2015; NVL 2022). Based on the data presented in the DMP Atlas North Rhine-Westphalia (NRW), the proportion of people aged 18 years and older enrolled in the DMP Type 2 Diabetes NRW in 2021 with a retinal examination in the last 24 months is 64.1 % overall, which is below the target achievement rate of at least 90 % specified in the DMP (DMP 2021).

Show more information on methodology and data sources

Definition

The indicator medical eye examination is defined as the proportion of people with type 2 diabetes who have their ocular fundus examined (with dilating eye drops) by a medical professional in the last 12 months.

Operationalisation

The indicator is based on self-report on the following question for people with known diabetes:

"When was the last time you had your ocular fundus examined by an ophthalmologist?"

Response options (For over 12 months, the figure was given in years):

  • How many months ago: |__|__|
  • How many years ago: |__|__|
  • never
  • do not know
  • not sepcified

Reference population

People with known diabetes in the German-speaking resident population of Germany, aged 45 years and over.

Data source

Nationwide RKI survey GEDA 2021/2022-Diabetes based on a special screening process that focused on the target group ‘people with known diabetes aged 18 years’ (GEDA 2021/2022-Diabetes).

Number of cases

  • GEDA 2021/2022-Diabetes: n = 1,503

For the indicator medical eye examination, data were collected completely among people with known type 2 diabetes aged 45 years and over:

  • GEDA 2021/2022-Diabetes: n = 1,448

People with type 1 diabetes and women with exclusively gestational diabetes were excluded.

Calculation

  • Description: For the indicator, the figures for total, women and men are provided and are stratified by age group, residential area and education as far as the number of cases available for the figure is ≥ 5 and the statistical uncertainty in the estimate of the indicator is not considered too large (a coefficient variation ≤ 33.5%).
  • Stratification: The geographical classification of the residence of the participating person was carried out by region (east = former East Germany, including all of Berlin; west = former West Germany, not including West Berlin). Educational status was determined using the CASMIN index, which takes information on both school and vocational training into account and allows a categorisation into a low, medium and high education group.
  • Weighting: A weighting factor was used to correct for deviations from the underlying reference population due to different participation rates or sampling probabilities. It adjusts the surveys sample to the population structure of the reference population in terms of sex, age and education as of 31 December 2019. The distribution structure of people diagnosed with diabetes from the nationwide RKI survey GEDA 2019/2020-EHIS were used to calculate the weighting factor, since data from the population statistics provided by the Federal Statistical Office do not allow conclusions about people diagnosed with diabetes in the German-speaking resident population aged 18 years and over.

Data quality

The RKI survey GEDA 2021/2022 provides representative results about people with known diabetes from the German-speaking resident population of Germany aged 18 years and over. As with all population-based studies, it can be assumed that the study underrepresents people with serious illnesses and those currently in institutions. In addition, the survey data is based on information provided by the respondents. Comparisons of findings to previous RKI surveys are limited due to differences in methodology.

Data download

References and links

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