Optimal Frequency of Urinary Albumin Screening in Type 1 Diabetes

Bruce A. Perkins; Ionut Bebu; Ian H. de Boer; Mark Molitch; Bernard Zinman; John Bantle; Gayle M. Lorenzi; David M. Nathan; John M. Lachin

doi:10.2337/dc22-1420

Optimal Frequency of Urinary Albumin Screening in Type 1 Diabetes

Bruce A. Perkins, Ionut Bebu, Ian H. de Boer, Mark Molitch, Bernard Zinman, John Bantle, Gayle M. Lorenzi, David M. Nathan, John M. Lachin

Medicine - Endocrine and Diabetes Division

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

OBJECTIVE: Kidney disease screening recommendations include annual urine testing for albuminuria after 5 years' duration of type 1 diabetes. We aimed to determine a simple, risk factor-based screening schedule that optimizes early detection and testing frequency.

RESEARCH DESIGN AND METHODS: Urinary albumin excretion measurements from 1,343 participants in the Diabetes Control and Complications Trial and its long-term follow-up were used to create piecewise-exponential incidence models assuming 6-month constant hazards. Likelihood of the onset of moderately or severely elevated albuminuria (confirmed albumin excretion rate AER ≥30 or ≥300 mg/24 h, respectively) and its risk factors were used to identify individualized screening schedules. Time with undetected albuminuria and number of tests were compared with annual screening.

RESULTS: 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. Personalized screening in 2 years for those with current AER ≤10 mg/24 h and HbA1c ≤8% (low risk [0.6% three-year cumulative incidence]), in 6 months for those with AER 21-30 mg/24 h or HbA1c ≥9% (high risk [8.9% three-year cumulative incidence]), and in 1 year for all others (average risk [2.4% three-year cumulative incidence]) was associated with 34.9% reduction in time with undetected albuminuria and 20.4% reduction in testing frequency as compared with annual screening. Stratification by categories of HbA1c or AER alone was associated with reductions of lesser magnitude.

CONCLUSIONS: 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.

ARTICLE HIGHLIGHTS: Kidney disease screening recommendations include annual urine testing for albuminuria after 5 years' duration of type 1 diabetes. We investigated simple screening schedules that optimize early detection and testing frequency. Personalized screening in 2 years for those with current AER ≤10 mg/24 h and HbA1c ≤8%, in 6 months for those with AER 21-30 mg/24 h or HbA1c ≥9%, and in 1 year for all others yielded 34.9% reduction in time with undetected albuminuria and 20.4% fewer evaluations compared with annual screening. 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.

Original language	English (US)
Pages (from-to)	2943-2949
Number of pages	7
Journal	Diabetes care
Volume	45
Issue number	12
DOIs	https://doi.org/10.2337/dc22-1420
State	Published - Dec 2022

Bibliographical note

Funding Information:
Funding. DCCT/EDIC has been supported by cooperative agreement grants (1982–1993, 2012–2022) and contracts (1982–2012) with the Division of Diabetes, Endocrinology, and Metabolic Diseases of the National Institute of Diabetes and Digestive and Kidney Diseases (current grant nos. U01 DK094176 and U01 DK094157) and by the National Eye Institute, the National Institute of Neurological Disorders and Stroke, the General Clinical Research Centers program (1993–2007), and Clinical Translational Science Center program (2006–present), Bethesda, MD. Industry contributors have provided free or discounted supplies or equipment to support participants’ adherence to the study: Abbott Diabetes Care (Alameda, CA), Animas (Westchester, PA), Bayer Diabetes Care (North America Headquarters, Tarrytown, NY), Becton Dickinson (Franklin Lakes, NJ), Eli Lilly (Indianapolis, IN), Extend Nutrition (St. Louis, MO), Insulet Corporation (Bedford, MA), LifeScan (Milpitas, CA), Medtronic Diabetes (Minneapolis, MN), Nipro Diagnostics (Ft. Lauderdale, FL), Nova Diabetes Care (Billerica, MA), OMRON (Shelton, CT), Perrigo Diabetes Care (Alle-gan, MI), Roche Diabetes Care (Indianapolis, IN), and Sanofi (Bridgewater, NJ).

Publisher Copyright:
© 2022 by the American Diabetes Association.

Keywords

Humans
Albumins
Albuminuria/complications
Diabetes Mellitus, Type 1/complications
Diabetic Nephropathies/epidemiology
Glycated Hemoglobin/analysis
Incidence

PubMed: MeSH publication types

Clinical Trial
Journal Article
Research Support, N.I.H., Extramural

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.2337/dc22-1420

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@article{4ffd316f6e6f445e967952f52419dd96,

title = "Optimal Frequency of Urinary Albumin Screening in Type 1 Diabetes",

abstract = "OBJECTIVE: Kidney disease screening recommendations include annual urine testing for albuminuria after 5 years' duration of type 1 diabetes. We aimed to determine a simple, risk factor-based screening schedule that optimizes early detection and testing frequency.RESEARCH DESIGN AND METHODS: Urinary albumin excretion measurements from 1,343 participants in the Diabetes Control and Complications Trial and its long-term follow-up were used to create piecewise-exponential incidence models assuming 6-month constant hazards. Likelihood of the onset of moderately or severely elevated albuminuria (confirmed albumin excretion rate AER ≥30 or ≥300 mg/24 h, respectively) and its risk factors were used to identify individualized screening schedules. Time with undetected albuminuria and number of tests were compared with annual screening.RESULTS: 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. Personalized screening in 2 years for those with current AER ≤10 mg/24 h and HbA1c ≤8% (low risk [0.6% three-year cumulative incidence]), in 6 months for those with AER 21-30 mg/24 h or HbA1c ≥9% (high risk [8.9% three-year cumulative incidence]), and in 1 year for all others (average risk [2.4% three-year cumulative incidence]) was associated with 34.9% reduction in time with undetected albuminuria and 20.4% reduction in testing frequency as compared with annual screening. Stratification by categories of HbA1c or AER alone was associated with reductions of lesser magnitude.CONCLUSIONS: 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.ARTICLE HIGHLIGHTS: Kidney disease screening recommendations include annual urine testing for albuminuria after 5 years' duration of type 1 diabetes. We investigated simple screening schedules that optimize early detection and testing frequency. Personalized screening in 2 years for those with current AER ≤10 mg/24 h and HbA1c ≤8%, in 6 months for those with AER 21-30 mg/24 h or HbA1c ≥9%, and in 1 year for all others yielded 34.9% reduction in time with undetected albuminuria and 20.4% fewer evaluations compared with annual screening. 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.",

keywords = "Humans, Albumins, Albuminuria/complications, Diabetes Mellitus, Type 1/complications, Diabetic Nephropathies/epidemiology, Glycated Hemoglobin/analysis, Incidence",

author = "Perkins, {Bruce A.} and Ionut Bebu and {de Boer}, {Ian H.} and Mark Molitch and Bernard Zinman and John Bantle and Lorenzi, {Gayle M.} and Nathan, {David M.} and Lachin, {John M.}",

note = "Funding Information: Funding. DCCT/EDIC has been supported by cooperative agreement grants (1982–1993, 2012–2022) and contracts (1982–2012) with the Division of Diabetes, Endocrinology, and Metabolic Diseases of the National Institute of Diabetes and Digestive and Kidney Diseases (current grant nos. U01 DK094176 and U01 DK094157) and by the National Eye Institute, the National Institute of Neurological Disorders and Stroke, the General Clinical Research Centers program (1993–2007), and Clinical Translational Science Center program (2006–present), Bethesda, MD. Industry contributors have provided free or discounted supplies or equipment to support participants{\textquoteright} adherence to the study: Abbott Diabetes Care (Alameda, CA), Animas (Westchester, PA), Bayer Diabetes Care (North America Headquarters, Tarrytown, NY), Becton Dickinson (Franklin Lakes, NJ), Eli Lilly (Indianapolis, IN), Extend Nutrition (St. Louis, MO), Insulet Corporation (Bedford, MA), LifeScan (Milpitas, CA), Medtronic Diabetes (Minneapolis, MN), Nipro Diagnostics (Ft. Lauderdale, FL), Nova Diabetes Care (Billerica, MA), OMRON (Shelton, CT), Perrigo Diabetes Care (Alle-gan, MI), Roche Diabetes Care (Indianapolis, IN), and Sanofi (Bridgewater, NJ). Publisher Copyright: {\textcopyright} 2022 by the American Diabetes Association.",

year = "2022",

month = dec,

doi = "10.2337/dc22-1420",

language = "English (US)",

volume = "45",

pages = "2943--2949",

journal = "Diabetes care",

issn = "0149-5992",

publisher = "American Diabetes Association Inc.",

number = "12",

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TY - JOUR

T1 - Optimal Frequency of Urinary Albumin Screening in Type 1 Diabetes

AU - Perkins, Bruce A.

AU - Bebu, Ionut

AU - de Boer, Ian H.

AU - Molitch, Mark

AU - Zinman, Bernard

AU - Bantle, John

AU - Lorenzi, Gayle M.

AU - Nathan, David M.

AU - Lachin, John M.

N1 - Funding Information: Funding. DCCT/EDIC has been supported by cooperative agreement grants (1982–1993, 2012–2022) and contracts (1982–2012) with the Division of Diabetes, Endocrinology, and Metabolic Diseases of the National Institute of Diabetes and Digestive and Kidney Diseases (current grant nos. U01 DK094176 and U01 DK094157) and by the National Eye Institute, the National Institute of Neurological Disorders and Stroke, the General Clinical Research Centers program (1993–2007), and Clinical Translational Science Center program (2006–present), Bethesda, MD. Industry contributors have provided free or discounted supplies or equipment to support participants’ adherence to the study: Abbott Diabetes Care (Alameda, CA), Animas (Westchester, PA), Bayer Diabetes Care (North America Headquarters, Tarrytown, NY), Becton Dickinson (Franklin Lakes, NJ), Eli Lilly (Indianapolis, IN), Extend Nutrition (St. Louis, MO), Insulet Corporation (Bedford, MA), LifeScan (Milpitas, CA), Medtronic Diabetes (Minneapolis, MN), Nipro Diagnostics (Ft. Lauderdale, FL), Nova Diabetes Care (Billerica, MA), OMRON (Shelton, CT), Perrigo Diabetes Care (Alle-gan, MI), Roche Diabetes Care (Indianapolis, IN), and Sanofi (Bridgewater, NJ). Publisher Copyright: © 2022 by the American Diabetes Association.

PY - 2022/12

Y1 - 2022/12

N2 - OBJECTIVE: Kidney disease screening recommendations include annual urine testing for albuminuria after 5 years' duration of type 1 diabetes. We aimed to determine a simple, risk factor-based screening schedule that optimizes early detection and testing frequency.RESEARCH DESIGN AND METHODS: Urinary albumin excretion measurements from 1,343 participants in the Diabetes Control and Complications Trial and its long-term follow-up were used to create piecewise-exponential incidence models assuming 6-month constant hazards. Likelihood of the onset of moderately or severely elevated albuminuria (confirmed albumin excretion rate AER ≥30 or ≥300 mg/24 h, respectively) and its risk factors were used to identify individualized screening schedules. Time with undetected albuminuria and number of tests were compared with annual screening.RESULTS: 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. Personalized screening in 2 years for those with current AER ≤10 mg/24 h and HbA1c ≤8% (low risk [0.6% three-year cumulative incidence]), in 6 months for those with AER 21-30 mg/24 h or HbA1c ≥9% (high risk [8.9% three-year cumulative incidence]), and in 1 year for all others (average risk [2.4% three-year cumulative incidence]) was associated with 34.9% reduction in time with undetected albuminuria and 20.4% reduction in testing frequency as compared with annual screening. Stratification by categories of HbA1c or AER alone was associated with reductions of lesser magnitude.CONCLUSIONS: 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.ARTICLE HIGHLIGHTS: Kidney disease screening recommendations include annual urine testing for albuminuria after 5 years' duration of type 1 diabetes. We investigated simple screening schedules that optimize early detection and testing frequency. Personalized screening in 2 years for those with current AER ≤10 mg/24 h and HbA1c ≤8%, in 6 months for those with AER 21-30 mg/24 h or HbA1c ≥9%, and in 1 year for all others yielded 34.9% reduction in time with undetected albuminuria and 20.4% fewer evaluations compared with annual screening. 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.

AB - OBJECTIVE: Kidney disease screening recommendations include annual urine testing for albuminuria after 5 years' duration of type 1 diabetes. We aimed to determine a simple, risk factor-based screening schedule that optimizes early detection and testing frequency.RESEARCH DESIGN AND METHODS: Urinary albumin excretion measurements from 1,343 participants in the Diabetes Control and Complications Trial and its long-term follow-up were used to create piecewise-exponential incidence models assuming 6-month constant hazards. Likelihood of the onset of moderately or severely elevated albuminuria (confirmed albumin excretion rate AER ≥30 or ≥300 mg/24 h, respectively) and its risk factors were used to identify individualized screening schedules. Time with undetected albuminuria and number of tests were compared with annual screening.RESULTS: 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. Personalized screening in 2 years for those with current AER ≤10 mg/24 h and HbA1c ≤8% (low risk [0.6% three-year cumulative incidence]), in 6 months for those with AER 21-30 mg/24 h or HbA1c ≥9% (high risk [8.9% three-year cumulative incidence]), and in 1 year for all others (average risk [2.4% three-year cumulative incidence]) was associated with 34.9% reduction in time with undetected albuminuria and 20.4% reduction in testing frequency as compared with annual screening. Stratification by categories of HbA1c or AER alone was associated with reductions of lesser magnitude.CONCLUSIONS: 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.ARTICLE HIGHLIGHTS: Kidney disease screening recommendations include annual urine testing for albuminuria after 5 years' duration of type 1 diabetes. We investigated simple screening schedules that optimize early detection and testing frequency. Personalized screening in 2 years for those with current AER ≤10 mg/24 h and HbA1c ≤8%, in 6 months for those with AER 21-30 mg/24 h or HbA1c ≥9%, and in 1 year for all others yielded 34.9% reduction in time with undetected albuminuria and 20.4% fewer evaluations compared with annual screening. 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.

KW - Humans

KW - Albumins

KW - Albuminuria/complications

KW - Diabetes Mellitus, Type 1/complications

KW - Diabetic Nephropathies/epidemiology

KW - Glycated Hemoglobin/analysis

KW - Incidence

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JO - Diabetes care

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Optimal Frequency of Urinary Albumin Screening in Type 1 Diabetes

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

UN SDGs

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