Abstract

Background: Diabetic nephropathy (DN) is a debilitating microvascular complication of diabetes mellitus that often progresses before becoming symptomatic, highlighting the importance of screening during comprehensive diabetes management. Therefore, we captured a snapshot of DN screening in a country caught in the whirlwind of a pandemic and a severe economic crisis limiting access to healthcare facilities and adherence to screening schedules.

Methods: We conducted a cross-sectional study that assessed the adherence of 258 Lebanese patients with diabetes to the recommended DN screening guidelines in a tertiary medical center. Medical records were analyzed for patient demographics, medication profile and laboratory indicators of glycemic control, e.g. glycated hemoglobin (HbA1c), and kidney function.

Results: Less than half of patients in our cohort screened for DN with almost two-thirds recording abnormal markers of kidney function. Only half of the screened cohort underwent follow-up testing. Multivariate analysis revealed that lower HbA1c, lower age, outpatient status and year of first abnormal HbA1c were independently associated with DN screening.

Conclusion: National-scale interventions through funding an annual screening and awareness campaign, while institutional-level interventions by implementing a quality improvement process to detect and address gaps in practice, are needed to increase adherence to screening recommendations.