Are diabetes patients at highest risk for developing complications getting screened?

Purpose Poor glycemic control, hypertension and poor lipid control are associated with the development of all the major diabetes complications. Patients with these risk factors are therefore at higher risk for developing complications than those without these risk factors, and it especially important that these individuals get proper screening for complications. We analyzed 404 subjects from the Pittsburgh Epidemiology of Diabetes Complications Study type 1 diabetes cohort to examine whether or not patients at highest risk for developing complications are getting screened. Methods Clinical exam data for subjects collected in 1992 was used to determine risk, and consisted of blood pressure reading, HbA1c, and total cholesterol level. Blood pressure readings above 130/80mmHg, HbA1c values above 9.5% and total cholesterol levels above 200 mg/dL were considered high risk values. Patients with 2 or more high risk values were classified as being at high risk. Data on screening tests, complications, and health status were collected via self-report surveys in 2000. Screening tests assessed included dilated eye exam, fasting lipid test, foot exam, urine protein test. Self-reported complications included the presence of diabetic eye disease requiring laser therapy, myocardial infarction, stroke, diabetes-related renal failure, or amputation. Logistic regression analysis was used to examine the association between high risk and receipt of screening test. Models were adjusted for disease duration and diabetes complications. Results In unadjusted analysis, high risk was associated with receipt of fasting lipid test (OR = 1.785, p = .038); foot examination (OR = 1.956, p = .012), urine test for protein (OR = 1.998, p = .017), and receipt of all screening tests (OR = 2.07, p = .005). In adjusted analysis, high risk remained a significant predictor of urine test for protein (OR = 2.0, p = .022), foot exam (OR = 2.0, p = .01), and receipt of all screening tests (OR = 1.9, p = .015). Conclusion It appears as though individuals at high risk are more likely to get recommended screening tests.