PHYSICIANS PRACTICES IN SCREENING FOR THE DEVELOPMENT OF DIABETIC NEPHROPATHY AND THE USE OF GLYCOSYLATED HEMOGLOBIN LEVELS

OBJECTIVE - To compare outpatient screening of diabetic patients for n ephropathy and measurement of glycosylated hemoglobin (GHb) levels to published American Diabetes Association (ADA) guidelines. RESEARCH DES IGN AND METHODS - We reviewed charts from 157 diabetic patients follow ed for 27 months at the University of Washington's primary care clinic s. The number of screening urinalyses, 24-h urine measurements, and GH b measurements were obtained. From these values, the frequency of scre ening tests, normalized by patient-year, could be compared with the AD A guidelines. RESULTS - Forty-two percent of the patients received at least one urinalysis, and 5% had 24-h urine measurements. There were 0 .48 urinalyses and 0.05 24-h urine measurements per patient-year. Of 1 4 type I diabetes patients, 5 had a urinalysis and 1 received a 24-h u rine measurement. At least one GHb was measured for 85% of patients, a nd there were 1.66 GHb measurements per patient-year. Only 29% of pati ents received GHb concentrations as recommended by ADA guidelines. CON CLUSIONS - Diabetic patients at this institution are not screened for nephropathy and do not receive GHb measurements according to the ADA g uidelines. Because of recent advancements in the treatment of diabetic nephropathy and the results of the Diabetes Control and Complications Trial (DCCT), further efforts are needed for educating primary care p hysicians about standards of care for patients with diabetes.