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Optimal Frequency of Urinary Albumin Screening in Type 1 Diabetes
Bruce A Perkins1, Ionut Bebu2, Ian H de Boer3
1Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Canada.
Diabetes Care
|November 2, 2022
Summary
Personalized screening for kidney disease in type 1 diabetes can reduce undetected albuminuria and testing frequency. This approach optimizes early detection by tailoring urine test schedules based on individual risk factors like HbA1c and albumin excretion rate (AER).
Area of Science:
- Nephrology
- Endocrinology
- Diabetology
Background:
- Annual urine testing for albuminuria is recommended for type 1 diabetes (T1D) patients after 5 years of disease duration.
- Current screening protocols may not be optimized for early detection or testing frequency.
Purpose of the Study:
- To develop a simple, risk factor-based screening schedule for kidney disease in T1D.
- To optimize early detection and testing frequency for albuminuria.
Main Methods:
- Utilized data from 1,343 participants in the Diabetes Control and Complications Trial (DCCT).
- Developed incidence models based on urinary albumin excretion rate (AER) and glycated hemoglobin (HbA1c) levels.
- Compared individualized screening schedules with annual screening for time with undetected albuminuria and testing frequency.
Main Results:
- Personalized screening reduced time with undetected albuminuria by 34.9% and testing frequency by 20.4% compared to annual screening.
- Low-risk individuals (AER ≤10 mg/24 h, HbA1c ≤8%) were screened every 2 years.
- High-risk individuals (AER 21-30 mg/24 h or HbA1c ≥9%) were screened every 6 months; others annually.
Conclusions:
- A personalized screening schedule offers a substantial improvement over annual testing for T1D kidney disease.
- This individualized approach effectively reduces both delayed detection of kidney disease and the number of urine tests performed.
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