Diabetic retinopathy (DR) remains a leading cause of preventable blindness, with variability in screening and treatment practices across settings. In this modified three-round Delphi process, 19 endocrinology experts from diverse geographic regions evaluated 19 evidence-based statements related to DR screening, diagnosis, and systemic therapy. Consensus was predefined as greater than 75% agreement. The study was published in the Journal of Diabetes.

All 19 statements achieved consensus, with 14 receiving more than 80% agreement. The panel supported risk-based screening frequency according to diabetes type and risk level. Experts endorsed early initiation of fenofibrate in patients with mild to moderate non-proliferative diabetic retinopathy and continuation of therapy to maintain retinal protection. Fenofibrate’s pleiotropic effects were recognized, and consensus indicated that transient increases in serum creatinine with fenofibrate are not indicative of renal injury and should not prompt discontinuation

The consensus emphasized multidisciplinary care, coordinated care pathways, and patient education in DR management.

Limitations include the opinion-based nature of Delphi methodology, potential underrepresentation of certain regions, and limited reflection of real-world heterogeneity.

This consensus provides unified, evidence-informed recommendations for endocrinologists in DR management. Further empirical studies are needed to strengthen and validate these recommendations globally.