Individualized Frequency of Urinary Albumin Screening in Type 1 Diabetes

Screening recommendations for kidney disease include annual testing for albuminuria following 5 years duration of type 1 diabetes. Bruce A. Perkins, MD, MPH, and colleagues sought to identify a simple, risk factor–based screening schedule to optimize early detection and testing frequency. Results were reported online in Diabetes Care [doi.org/10.2337/dc22-1420].

The researchers created piecewise-exponential incidence models assuming 6-month constant hazards using urinary albumin excretion measurements from 1343 participants in the Diabetes Control and Complications Trial. Individualized screening schedules were identified using the likelihood of the onset of moderately or severely elevated albuminuria (confirmed albumin excretion rate [AER] ≥30 or ≥300 mg/24 hours, respectively). Time with undetected albuminuria and number of tests were compared with annual screening.

The 3-year cumulative incidence of elevated albuminuria following normoalbuminuria at any time during the study was 3.2%, which was strongly associated with higher glycated hemoglobin (HbA1c) and AER. There was an association between personalized screening in 2 years for individuals with current AER ≤10 mg/24 hours and HbA1c ≤8% (low risk [0.6% 3-year cumulative incidence]), in 6 months for those with AER 21-30 mg/24 hours or HbA1c ≥9% (high risk [8.9% cumulative incidence]), and in 1 year for all others (average risk [2.4% 3-year cumulative incidence]) and a 34.9% reduction in time with undetected albuminuria and a 20.4% reduction in testing frequency, compared with annual screening. When stratified by categories of HbA1c or AER alone, the reductions were of lesser magnitude.

“A personalized alternative to annual screening in type 1 diabetes can substantially reduce both the time with undetected kidney disease and the frequency of urine testing,” the researchers said.