Microalbuminuria screening in the UK: are we meeting European standards?
European guidelines recommend annual screening for microalbuminuria in patients with Type 1 (insulin-dependent) diabetes mellitus (IDDM) of greater than 5 years' duration and in those with Type 2 (non-insulin-dependent) diabetes mellitus (NIDDM) from diagnosis. To determine the current provision of screening for microalbuminuria we performed a postal survey of all diabetologists in the United Kingdom. Of 556 questionnaires sent, 326 (59%) were returned (246 adult, 57 paediatric, 3 adolescent clinics) and of these 306 (55%) were suitable for analysis. Screening programmes have been established by 210 (69%) diabetologists: 70 of these in the last 2 years. 46 more plan to screen patients with IDDM within 2 years. 155 (92%) of 169 adult programmes perform annual screening in IDDM, 74% according to European guidelines (39% in NIDDM). Other clinics use age, type of diabetes or criteria such as blood pressure to target screening. An albumin/creatinine ratio (52%) on an early morning urine (56%) or random (29%) urine sample is most commonly requested. Financial constraint was the principal reason given in 32 (33%) of 96 clinics that do not currently screen. Other reasons included implementation of other developments with a higher priority (24%) and doubts about the medical value of screening (46%). Assuming respondents are representative of current UK practice, we conclude that microalbuminuria screening is available to patients in many clinics, but is neither universal nor always performed according to European guidelines.
Gazis
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Department of Diabetes, Endocrinology, and Nutrition, University Hospital, Nottingham, UK.
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D000328:Adult; D000419:Albuminuria / Q000652:urine*; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000652:urine; D003928:Diabetic Nephropathies / Q000517:prevention & control*; D005069:Evaluation Studies as Topic; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000592:standards*; D011795:Surveys and Questionnaires; D013997:Time Factors; D006113:United Kingdom