Merlin C Thomas1. 1. Danielle Alberti Memorial Centre for Diabetic Complications, Baker Medical Research Institute, P.O. Box 6492, Melbourne, Victoria 8008, Australia. Merlin.Thomas@baker.edu.au
Abstract
BACKGROUND: While CKD is a common finding in patients with type 2 diabetes, the clinical response to its identification is often problematic. This study aims to determine the frequency of albuminuria in patients with type 2 diabetes in the primary care setting and examine the factors which influence its management. METHODS: Expressions of interest were invited from all registered GPs across Australia, from whom 500 investigators were randomly selected. Investigators were requested to document the clinical characteristics of 10-15 consecutively presenting patients with type 2 diabetes. Results from the most recent urinalysis were classified according to guidelines, then systematically compared to classifications provided by GPs themselves and their management strategies. RESULTS: One in three patients had an elevated urinary albumin excretion (UAE, 34.6%, 95% CI, 33.3-35.9%) on their most recent urinalysis. The presence of microalbuminuria or proteinuria, as identified by the GP, was not associated with a perceived increase in cardiovascular risk. In addition, the use of aspirin and the prescribing of agents to block the RAS were not significantly linked to UAE. Similarly, the perceived adequacy of blood pressure control was not significantly different whether or not microalbuminuria or proteinuria was identified to be present. CONCLUSION: An elevated UAE is a common finding in general practice. However, it fails to significantly influence their clinical care. Additional education to ensure appropriate case recognition and management of kidney disease is needed, focusing on the significance of albuminuria to the care of patients with type 2 diabetes.
BACKGROUND: While CKD is a common finding in patients with type 2 diabetes, the clinical response to its identification is often problematic. This study aims to determine the frequency of albuminuria in patients with type 2 diabetes in the primary care setting and examine the factors which influence its management. METHODS: Expressions of interest were invited from all registered GPs across Australia, from whom 500 investigators were randomly selected. Investigators were requested to document the clinical characteristics of 10-15 consecutively presenting patients with type 2 diabetes. Results from the most recent urinalysis were classified according to guidelines, then systematically compared to classifications provided by GPs themselves and their management strategies. RESULTS: One in three patients had an elevated urinary albumin excretion (UAE, 34.6%, 95% CI, 33.3-35.9%) on their most recent urinalysis. The presence of microalbuminuria or proteinuria, as identified by the GP, was not associated with a perceived increase in cardiovascular risk. In addition, the use of aspirin and the prescribing of agents to block the RAS were not significantly linked to UAE. Similarly, the perceived adequacy of blood pressure control was not significantly different whether or not microalbuminuria or proteinuria was identified to be present. CONCLUSION: An elevated UAE is a common finding in general practice. However, it fails to significantly influence their clinical care. Additional education to ensure appropriate case recognition and management of kidney disease is needed, focusing on the significance of albuminuria to the care of patients with type 2 diabetes.
Authors: Maartje C J Slagman; Femke Waanders; Marc H Hemmelder; Arend-Jan Woittiez; Wilbert M T Janssen; Hiddo J Lambers Heerspink; Gerjan Navis; Gozewijn D Laverman Journal: BMJ Date: 2011-07-26