title: Use of microalbuminuria testing in persons with type 2 diabetes: are the right patients being tested?
abstract: OBJECTIVE
  Our goal was to determine whether adult patients with type 2 diabetes who had gross proteinuria or were already taking angiotensin-blocking drugs were screened for microalbuminuria.
  
  
  METHODS
  This was a retrospective cross-sectional study.
  
  
  METHODS
  We included a total of 278 adult patients with type 2 diabetes seen during 1998 and 1999 at the family medicine practices of the Medical University of South Carolina.
  
  
  METHODS
  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 testing (ie, those without preexisting proteinuria or who were not receiving an angiotensin-blocking drug) were no more likely to be screened for microalbuminuria than those with existing proteinuria (16% vs 18%, P=.84) or those who were already being treated with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (16% vs 16%, P=.83). Also, when the microalbuminuria test result was positive, only 40% of the patients were placed on angiotensin-blocking drugs.
  
  
  CONCLUSIONS
  Physician use of microalbuminuria screening does not follow established guidelines. The test appears to be used for many patients who might not need to be screened, and it is not always used for patients who should be screened. Consideration should be given to other strategies to prevent nephropathy in persons with type 2 diabetes.
authors.affiliation: Medical University of South Carolina, Department of Family Medicine, PO Box 250192, 295 Calhoun Street, Charleston, SC 29403, USA. huestowj@musc.edu
authors.forename: W J
authors.initials: WJ
authors.lastname: Hueston
authors.forename: S
authors.initials: S
authors.lastname: Scibelli
authors.forename: A G
authors.initials: AG
authors.lastname: Mainous
mesh_terms: D000419:Albuminuria / Q000175:diagnosis* / Q000209:etiology* / Q000652:urine; D000465:Algorithms; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D003663:Decision Trees; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003928:Diabetic Nephropathies / Q000150:complications*; D005194:Family Practice / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000592:standards / Q000706:statistics & numerical data*; D008875:Middle Aged; D020380:Needs Assessment; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013022:South Carolina; D016896:Treatment Outcome
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors