Personalized Kidney Screening Could Reduce Type 1 Diabetes Costs

WASHINGTON — Taking a personalized approach to kidney disease screening for people with type 1 diabetes may reduce the time chronic kidney disease goes undetected and reduce the cost of treatment, according to a new study.

The new analysis, which was performed by the Epidemiology of Diabetes Interventions and Complications study group, was published in the journal Diabetes Care.

According to the study, current chronic kidney disease screening recommendations typically include annual urinary albumin excretion rate testing for anyone who has had T1D for at least five years. 

Albumin is a protein found in the blood and having too much albumin in the urine is a sign of kidney disease. 

The new findings, however, suggest that albumin excretion rate screening could be personalized to optimize testing frequency and early detection of chronic kidney disease.  

Specifically, the researchers suggest, people with T1D who are at low risk of developing chronic kidney disease could be tested for albumin excretion rate less frequently to reduce burden and cost, and those at high risk for chronic kidney disease could be tested more frequently to facilitate earlier detection.

People with T1D have an estimated 50% risk of developing chronic kidney disease over their lifetime. Chronic kidney disease can progress to kidney failure, requiring dialysis or a kidney transplant. 

Using more than 30 years of participant data of albumin excretion rate testing and HbA1c (an integrated measure of blood glucose) from 1,334 participants in the NIDDK-funded Diabetes Control and Complications Trial and the observational follow-up Epidemiology of Diabetes Interventions and Complications study, the study group identified three levels of chronic kidney disease risk that were associated with a later diagnosis. 

They then developed a model to estimate the optimal screening intervals for people with T1D to detect chronic kidney disease at its earliest stages.

According to the model’s findings, people with albumin excretion rate of 21-30 mg per 24 hours and a HbA1c of at least 9% are at high risk for developing chronic kidney disease and could be screened for urine albumin every six months. 

This screening frequency could reduce time with undetected kidney disease so that appropriate interventions can be instituted as early as possible.

Those with albumin excretion rate ≤ 10 mg per 24 hours and a HbA1c ≤ 8% are at lower risk for developing chronic kidney disease and could be screened every two years. This change reduces patient burden and potentially saves millions of dollars compared to annual screening.

All others with T1D ≥ 5 years could continue to be screened annually.

The DCCT, which took place from 1983 to 1993, found that, for people with T1D, keeping blood glucose levels close to normal greatly reduced the chances of developing eye, kidney and nerve disease. Its follow-up study, EDIC, began in 1994 to explore how diabetes affects the body over time and the long-term benefits of early and intensive blood glucose control in the development of later diabetes complications.

The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases, which is part of the National Institutes of Health.

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