Diabetes guide to prevent kidney issues

The ADVANCE study assessed over 10,000 people living with type 2 diabetes across 20 countries. The study has identified the benefits of tight blood pressure and blood glucose control for people with diabetes, and has influenced guidelines for diabetes care globally.

The library of evidence established through the study has also allowed researchers to develop a new risk prediction guide to identify patients at risk of one of the leading complications, major kidney disease.

“In order to prevent complications of diabetes, we need to detect risks early. Using the ADVANCE dataset, we were able to design a risk prediction guide. The guide allows physicians to review a patients information against a list of factors and calculate an individualised estimate of the risk of kidney complications over the next five years”, said Senior Research Fellow Dr Meg Jardine at The George Institute for Global Health.

An estimated 250 million people are living with diabetes. Kidney disease is particularly common with more than half of type 2 diabetes patients developing renal impairment. The condition is often a devastating complication of diabetes with up to 20% of people with diabetes dying of renal failure.

“The progression of type 2 diabetes can be slow, and should be managed continually to assess an individual’s risk of an array of conditions. This guide should help physicians identify those more likely to benefit from interventions to prevent major kidney complications”.

Dr Jardine and her team hope to develop an online version of the guide to make it easy for physicians to adopt the guide and track patients’ progress.

The guide was reported recently in the American Journal of Kidney Disease, where Dr Jardine and the team at The George also discovered a number of new risk factors for individuals with diabetes, which they believe, will be helpful news for health systems planning. “We found early kidney complications were more common among patients of Asian ethnicity. There was also a high correlation of end stage kidney disease and the least well educated group of patients. These factors predicted risk even after accounting for the clinical variables commonly measured by GPs and specialists”, added Dr Jardine.

The guide also outlines for the first time the factors that accounted for most of the risk. “We looked at a wide range of factors relating to diabetes, other clinical conditions, laboratory results, and social and demographic information. The two most important factors were the level of kidney function and the level of albuminuria. Both of these factors can be influenced by proven treatments. These results reinforce guidelines for practitioners on the importance of these two conditions.”