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Abstract:
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Periodic evaluations in the clinical management of chronic diseases provide opportunities for early treatment that can avert further progression/complications. For example, patients with T1DM are screened annually for the onset of microalbuminuria, an early sign of chronic kidney disease, and for the onset of proliferative diabetic retinopathy (PDR) or clinically significant macular edema (CSME), two retinopathy complications requiring immediate intervention to preserve vision. As our understanding of the etiology of diseases improves, there is the opportunity to design personalized schedules for future visits based on the estimated risk of progression, instead of a fixed schedule for the entire population. Approaches are discussed to account for covariate effects on the risk of progression of the disease during the time between visits. A screening interval can then be selected to optimize some function such as limiting the probability that the event will occur (e.g. < 0.05) prior to the next visit, or limiting the time that progression might go undetected before the next visit. The methods are illustrated using screening for microalbuminuria and PDR/CSME in the DCCT/EDIC study.
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