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Comorbidities and complications:when, how and who to screen and when to treat? Microalbuminuria in adolescents with Type 1 diabetes

M Loredana Marcovecchio & David B Dunger

Progressive increases in albumin excretion and microalbuminuria can be detected in young people with childhood-onset Type 1 diabetes during puberty. Risk factors for microalbuminuria during puberty include hyperglycemia, diabetes duration, female gender, high blood pressure and lipid levels, changes in sex hormones, reduced IGF-I levels, together with other, as yet unidentified, genetic and environmental factors. Annual screening for microalbuminuria during puberty is recommended for the early detection of this marker of later diabetes complications. When microalbuminuria is detected, the first treatment strategy is to improve glycemic control, a known modifiable risk factor, whereas the efficacy and safety of additional interventions, such as angiotensin-converting enzyme inhibitors or statins, is not yet established, and are currently being evaluated.