Personalized Screening for Kidney Disease Evaluated in T1DM
THURSDAY, Nov. 10, 2022 (HealthDay News) — For persons with type 1 diabetes, a personalized alternative to annual urinary albumin screening can reduce the time spent with undetected kidney disease, according to a study published online Nov. 2 in Diabetes Care.
Bruce A. Perkins, M.D., from the University of Toronto, and colleagues used urinary albumin excretion measurements from 1,343 participants in the Diabetes Control and Complications Trial and its long-term follow-up to establish risk profiles and evaluate the optimal frequency of urinary albumin screening in type 1 diabetes. Individualized screening schedules were identified based on the likelihood of onset of moderately or severely elevated albuminuria and its risk factors.
The researchers found that the three-year cumulative incidence of elevated albuminuria following normoalbuminuria was 3.2 percent at any time during the study, which was strongly associated with higher glycated hemoglobin (HbA1c) and with albumin excretion rate (AER). Compared with annual screening, personalized screening in two years for those with current AER ≤10 mg/24 hours and Hba1c ≤8 percent (low risk), in six months for those with AER 21 to 30 mg/24 hours or HbA1c ≥9 percent (high risk), and in one year for all others (average risk) was associated with a decrease of 34.9 percent in time spent with undetected albuminuria and a 20.4 percent decline in testing frequency. Reductions of lesser magnitude were seen on stratification by categories of HbA1c or AER alone.
“The findings of these analyses provide strong justification for a personalized screening schedule as an alternative to the current practice of routine annual screening for elevated albuminuria in all people with type 1 diabetes,” the authors write.
One author disclosed financial ties to the pharmaceutical and medical device industries. Industry contributors provided free or discounted supplies or equipment to support participants’ adherence to the study.