Optimal age, duration of diabetes and frequency of screening for diabetic nephropathy in children and youths with type 1 Diabetes: A systematic review

This is the authors' abstract. We don't add key points for this paper.

Diabetic nephropathy (DN) is a major complication of type 1 diabetes (T1D) with lifelong health implications. This systematic review evaluated the optimal age, duration of diabetes, and frequency for DN screening in children and adolescents with T1D. A comprehensive literature search (1995-2024) across major databases identified 36 eligible studies, predominantly cross-sectional, encompassing 21,778 participants. Moderate albuminuria prevalence was 9.5 % overall, with most cases occurring after seven years of diabetes duration and in individuals older than 14 years, though rare cases were reported as early as 8.5 years and within two years of diagnosis. Severe albuminuria was less frequent (0.3-14.6 %), while end-stage kidney disease was rare, and no deaths were reported. Higher HbA1c levels (≥9%) were strongly associated with increased nephropathy risk, whereas limited data were available on blood pressure and other risk factors. No randomized trials or direct comparisons of screening strategies were identified, and heterogeneity in definitions and diagnostic methods limited evidence quality. Overall, findings support current international guidelines recommending screening from age 11 or puberty after 2-5 years of T1D duration, with intensified strategies potentially warranted for those with elevated HbA1 levels. High-quality, prospective studies are needed, especially in low- and middle-income countries.