P-451: Albuminuria in adolescents with type 1 diabetes independent of glycemic control: insights from early and long-duration disease

Introduction

Diabetic nephropathy in Type 1 Diabetes Mellitus (T1D) is classically linked to long disease duration, poor glycemic control, and hypertension. However, albuminuria may occur in well-controlled, normotensive patients.

Objectives

To describe two adolescents with T1D and persistent albuminuria despite good glycemic control and normal blood pressure, and their response to ACE inhibitor therapy.

Methods

We report a case series of two 15-year-old patients using continuous glucose monitoring and insulin pump therapy. Case 1 (diagnosed in 2023) had autoimmune thyroid disease (Graves’ disease); Case 2 (diagnosed in 2016) had autism spectrum disorder. Both were normotensive. Albuminuria was confirmed by repeated measurements of urinary albumin-to-creatinine ratio (UACR) and 24-hour albumin excretion. Secondary causes were excluded.

Results

Case 1 developed marked albuminuria within one year of diagnosis (1261 mg/L). Following initiation of ACE inhibitor therapy, albuminuria normalized with preserved renal function and HbA1c 6.1%.

Case 2 showed persistent albuminuria (UACR up to 293.7 mg/g; AER 703 mg/24h) despite HbA1c 6.3–7.0%. Following ACE inhibitor therapy, renal parameters stabilized.

Conclusions

Albuminuria may occur early or late in T1D despite good control and normal blood pressure. Early detection and ACE inhibitor therapy may improve or stabilize renal outcomes, supporting systematic screening in all pediatric patients.