Annual screening for albuminuria may not be necessary in all patients with type 1 diabetes

Patients with type 1 diabetes may benefit from a personalized approach to albuminuria screening rather than annual testing, according to a recent study.

Researchers used data from the Diabetes Control and Complications Trial to evaluate screening for albuminuria based on individualized risk factors in patients with type 1 diabetes. Urinary albumin excretion measurements were used to create piecewise-exponential incidence models that assumed six-month constant hazards. Individualized screening schedules were developed based on the likelihood of onset of moderately or severely elevated albuminuria, defined as a confirmed albumin excretion rate (AER) of at least 30 mg/24 h or at least 300 mg/24 h, respectively, as well as risk factors. Time with undetected albuminuria and number of tests with individualized versus annual screening were compared. The results were published Nov. 2 by Diabetes Care.

Data from 1,343 trial participants were included. The patients' median age was 28 years, duration of diabetes was four years, AER was 10 mg/24 h, and HbA1c level was 8.5%. At three years, there was a 3.2% cumulative incidence of albuminuria following normoalbuminuria (AER <30 mg/24 h) at any time during the study, and this was strongly associated with higher HbA1c levels and AER. Personalized screening in two years for those with a current AER of 10 mg/24 h or less and an HbA1c level of 8% or less (low risk), in six months for those with an AER of 21 to 30 mg/24 h or an HbA1c level of 9% or greater (high risk), and in one year for all other participants (average risk) was associated with a 34.9% reduction in time with undetected albuminuria and a 20.4% reduction in testing frequency versus annual screening. Lesser reductions were seen when risk was stratified by HbA1c level or AER alone.

The researchers acknowledged that a controlled trial would provide the strongest evidence of the benefits of a personalized screening approach and said that it might be difficult to screen higher-risk patients more frequently, among other limitations. They concluded that in patients with type 1 diabetes and normoalbuminuria, a personalized screening schedule for albuminuria onset based on HbA1c level and urinary albumin may decrease the number of tests required (and associated costs) for screening and lead to more timely identification of kidney disease. “The findings of these analyses provide strong justification for a personalized screening schedule as an alternative to the current practice of routine annual screening for elevated albuminuria in all people with [type 1 diabetes],” the authors wrote.