Introduction and Objective:IntroductionAdvancements in blood glucose measurement and insulin dosing over the past two decades have improved outcomes for individuals with Type 1 diabetes (T1D). However, chronic kidney disease (CKD) remains a significant management challenge. The frequency of specialist outpatient (OP) appointments could serve as a proxy for disease severity. This study aimed to determine whether glycaemic control (HbA1c) or renal function (eGFR and ACR) better predicts the need for intensive specialist care in T1D.Methods: Health records of T1D individuals were analysed over 15 years (2008-2023). Cross-sectional and longitudinal analyses examined associations between glycaemic control (HbA1c), renal function (eGFR and ACR), and the number of diabetes OP appointments per year. Patients requiring >4 OP appointments annually were classified as needing intensive input. Odds ratios (OR) were calculated to assess the likelihood of intensive input based on glycaemic and renal parameters.Results: 348 patients with average age 51 years of whom 151 were female had sufficient data to analyse. There was no link between relative level of HbA1c (<65mmol/mol vs ≥65mmol/mol) and relative number of specialist OP appointments/year.Patients with lower eGFR (<60ml/min/1.73m²) had a significantly higher likelihood of needing >4 OP appointments/year (OR 2.9). Elevated ACR (≥3.0mg/mmol) was also associated with increased likelihood (OR 1.4). A rapid decline in eGFR (>6.4ml/min/1.73m² over six years) further increased the odds of intensive input (OR 1.4).Conclusion:Renal function markers (eGFR and ACR) are better indicators than glycaemic control for predicting the need for intensive specialist support in T1D patients. This emphasises the importance of comprehensive kidney function monitoring and targeted renal protective intervention alongside glycaemic optimisation in T1D management. Prioritisation and allocation of healthcare resources to this is essential.
M. Stedman: None. A.H. Heald: None. M.B. Whyte: None. J.M. Gibson: None. E.B. Jude: Research Support; Abbott Diagnostics. Speaker’s Bureau; AstraZeneca, A. Menarini Diagnostics, Novo Nordisk. Research Support; Sanofi. H.H. Habte-Asres: None.
Source link
Leave a Reply