medwireNews: Screening people with type 1 diabetes for albuminuria at intervals determined by their baseline albumin excretion rate (AER) and glycated hemoglobin (HbA1c) level reduces the time spent with undetected kidney disease, show DCCT/EDIC data.
It would also reduce the overall number of screenings required, with potential cost savings, report Ionut Bebu (The George Washington University, Rockville, Maryland, USA) and co-researchers.
Their analysis, published in Diabetes Care, involved 1343 people with type 1 diabetes who had participated in DCCT and subsequently EDIC, spanning the period of 1983–2017 during which 27% developed albuminuria (AER ≥30 mg/24 h).
Although “numerous covariates” were associated with risk for and time to albuminuria, the researchers found that baseline AER and HbA1c had “by far the largest effects,” and so they used these factors as their basis for risk-based screening intervals.
People with an AER no higher than 10 mg/24 h and HbA1c of no more than 8% (64 mmol/mol) were classed as being at low risk, with a 3-year cumulative albuminuria incidence of just 0.6%.
Those with an AER of 21–30 mg/24 h and/or HbA1c of at least 9% (75 mmol/mol) were classified as being at high risk, and had a 3-year cumulative albuminuria incidence of 8.9%. And people with intermediate levels of these risk factors had an albuminuria incidence of 2.4%.
Screening every 2 and 1 years for the low- and moderate-risk groups, respectively, and every 3 months in the high-risk group reduced the time spent with undetected albuminuria by 52.0% and the number of required screenings by 13.6% relative to annual screening for all study participants.
Allowing a less frequent interval of every 6 months for the high-risk group gave corresponding reductions of 34.9% for time with undetected albuminuria and 20.4% for the number of screenings needed.
The researchers note that the current consensus to screen annually starting from 5 years’ diabetes duration is not supported by “high-quality observational or interventional evidence.”
They say: “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].”
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