Screening and treatment of diabetic nephropathy by primary care physicians

OBJECTIVE: To describe the practices of Indiana primary care physicians rel ated to diabetic nephropathy screening and management, DESIGN: Cross-sectional, observational. SETTING: The state of Indiana. PARTICIPANTS: Active primary care physicians (defined as general internists , family practitioners, and general practitioners) in Indiana who provided care for diabetic patients at the time of the survey (n = 1,018) MEASUREMENTS AND MAIN RESULTS: Practice patterns relevant to microalbuminur ia and overt albuminuria screening and management were assessed along two d imensions: the percentage of patients to whom the practices were applied an d the frequency with which the practices were performed, Of 1,141 physician s who responded to the survey, 1,018 were eligible for analysis, Eighty-six percent of physicians reported screening more than half of their patients with type 1 diabetes for overt albuminuria, as did 82% of physicians for th eir patients with type 2 diabetes. Only 17%, of physicians indicated perfor ming microalbuminuria testing on more than half of their type 1 patients, A ngiotensin-converting enzyme inhibitor agents were used frequently to treat abnormal urinary albumin excretion when hypertension was present, but less often when hypertension was absent, Physician specialty, year of graduatio n from medical school, practice location, and familiarity with the results of the Diabetes Control and Complications Trial were significant predictors of screening and treatment practice patterns. CONCLUSIONS: Primary care physicians report practices that allow them to de tect overt albuminuria but not microalbuminuria. Angiotensin-converting enz yme inhibitors are frequently used by physicians who test for microalbuminu ria, but efforts to increase the detection of early renal damage are needed so that these agents and other therapeutic strategies may be employed at t he earliest opportunity.