Use of microalbuminuria testing in persons with type 2 diabetes - Are the right patients being tested?

OBJECTIVE our goal was to determine whether adult patients with type 2 diab etes who had gross proteinuria or were already taking angiotensin-blocking drugs were screened for microalbuminuria. STUDY DESIGN This was a retrospective cross-sectional study. POPULATION We included a total of 278 adult patients with type 2 diabetes s een during 1998 and 1999 at the family medicine practices of the Medical Un iversity of South Carolina. OUTCOMES MEASURED The outcomes were microalbuminuria testing during either 1998 or 1999 and the initiation of medication if the screening test result was positive. RESULTS We found that patients who could derive the greatest benefit from t esting (ie, those without preexisting proteinuria or who were not receiving an angiotensin-blocking drug) were no more likely to be screened for micro albuminuria than those with existing proteinuria (16% vs 18%, P=.84) or tho se who were already being treated with an angiotensin-converting enzyme inh ibitor or angiotensin receptor blocker (16% vs 16%, F-.83). Also, when the microalbuminuria test result was positive, only 40% of the patients were pl aced on angiotensin-blocking drugs. CONCLUSIONS Physician use of microalbuminuria screening does not follow est ablished guidelines. The test appears to be used for many patients, who mig ht not need to be screened, and it is not always used for patients who shou ld be screened. Consideration should be given to other strategies to preven t nephropathy in persons with type 2 diabetes.