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DC22-1420 Perkins_Renal_OptFreq_Supplement_rev.pdf (509.28 kB)

Optimal Frequency of Urinary Albumin Screening in Type 1 Diabetes

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Version 2 2022-11-28, 16:39
Version 1 2022-10-26, 18:07
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posted on 2022-11-28, 16:39 authored by Bruce A. Perkins, Ionut Bebu, Ian H. de Boer, Mark E. Molitch, Bernard Zinman, John Bantle, Gayle M. Lorenzi, David M. Nathan, John M. Lachin, The Diabetes Control and Complications Trial (DCCT)-Epidemiology of Diabetes Interventions and Complications (EDIC) Research Group

  

Background. Kidney disease screening recommendations include annual urine testing for albuminuria after five years duration of type 1 diabetes. We aimed to determine a simple, risk factor-based screening schedule that optimizes early detection and testing frequency.

Methods. Urinary albumin excretion measurements from 1343 participants in the Diabetes Control and Complications Trial and its long-term follow-up were used to create piecewise-exponential incidence models assuming 6-month constant hazards. Likelihood of the onset of moderately or severely elevated albuminuria (confirmed albumin excretion rate AER ≥30 or ≥300 mg/24h, respectively) and its risk factors were used to identify individualized screening schedules. Time with undetected albuminuria and number of tests were compared to annual screening.

Results. The three-year cumulative incidence of elevated albuminuria following normoalbuminuria at any time during study was 3.2%, which was strongly associated with higher glycated hemoglobin (HbA1c) and AER. Personalized screening in 2 years for those with current AER ≤10 mg/24h and HbA1c ≤8% (“Low-Risk”, 0.6% 3-year cumulative incidence), in 6 months for those with AER 21-30 mg/24h or HbA1c ≥9% (“High-Risk”, 8.9% 3-year cumulative incidence), and 1 year for all others (“Average-Risk”, 2.4% 3-year cumulative incidence) was associated with 34.9% reduction in time with undetected albuminuria and 20.4% reduction testing frequency as compared to annual screening. Stratification by categories of HbA1c or AER alone were associated with reductions of lesser magnitude.

Conclusions. A personalized alternative to annual screening in type 1 diabetes can substantially reduce both the time with undetected kidney disease and the frequency of urine testing.

Funding

U.S. Department of Health and Human Services > National Institutes of Health > National Institute of Diabetes and Digestive and Kidney Diseases U01 DK094157 U01 DK094176

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