Microalbuminuria screening for patients having type 2 diabetes mellitus: Who wants to participate?

Background and objectives: "Difficult-to-recruit'' patients are sometimes l ess compliant with their care, are more reluctant to seek medical attention and less likely to survive than their "easy-to-recruit" counterparts. They also tend to be excluded from clinical trials. The aim of this paper was t o evaluate whether such differences extend to patients' willingness to be s creened for diabetic nephropathy in a family practice setting. Design: A cr oss-sectional study. Setting: A Canadian university family practice unit. P atients: Two hundred and forty-seven patients with type 2 (adult-onset) dia betes mellitus as identified by computer searches of patient records of app roximately 12 000 patients in the family practice unit. Intervention: A cro ss-sectional secondary preventive screening program obtained urine samples from all patients with type 2 diabetes mellitus, regardless of patients' wi llingness to participate. Main outcome measure: The prevalence of micro- an d macroalbuminuria. Results: Of the 247 patients identified, 186 (75%) easy -to-recruit enrollees agreed to participate in screening and 61 (25%) diffi cult-to-recruit non-enrollees initially declined to be screened. The non-en rollees were subsequently evaluated by their own family physicians as part of routine clinical care and the results were captured for analysis. Overal l rates of albuminuria were similar in the easy- and difficult-to-recruit g roups (31% versus 38%, p = 0.151). The main predictors of albuminuria were female sex (odds ratio [OR] = 2.1, p = 0.021), duration of diabetes in year s (OR = 1.05, p = 0.023), current use of angiotensin-converting enzyme inhi bitor (OR = 2.26, p = 0.008) and number of diabetic complications (OR = 1.4 5, p = 0.028). Conclusions: There is little difference in the prevalence of albuminuria related to patients' willingness to participate in a screening program. Therefore, there are no disproportionate gains for family practic e researchers who aggressively seek difficult-to-recruit patients in this s etting. In contrast, primary care doctors should make every effort to ensur e optimal care to diabetic patients regardless of a patient's initial hesit ancy.