Johnson JA, Yeun JY
Screening for incipient diabetic nephropathy in the era of
primary care
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1359 1996
The progression of diabetic nephropathy in type I diabetics can be slowed
by treatment with angiotensin converting enzyme inhibitors (CEI). Data
from Ravid et al (Ann Int Med 15:18(8):577, 1993) suggests that enalapril
can also slow the progression of diabetic nephropathy in normotensive type
II diabetics with microalbuminuria. The authors screened pharmacy records
from January to March, 1996 to investigate whether diabetics > 5 years
were being screened for microalbuminuria.
Out of 1121 records 101 patients were identified as taking insulin or
oral hypoglycemics. Screening for microalbuminuria was highest in
endocrine clinic (50% patients), 17 - 19% in adult primary care or internal
medicine clinics and lowest in non-primary care medical clinics (0%).
Three patients had microalbuminuria (two with hypertension) but only one
was
treated with a CEI. The authors concluded that adherence to the ADA
guidelines for screening for microalbuminuria in diabetics is low
especially in primary care providers and that treatment of hypertensives
with CEI is poor.
Comment: Controversy still exists regarding the screening and
treatment of type II diabetics in contrast to Type I patients. Screening
for microalbuminuria is not as useful as in type I patients but once
hypertension and overt proteinuria develops the course of nephropathy is
similar in both type I and II patients. Despite the grouping of both types
of diabetics in this study, the authors remind us to educate our colleagues
about the need to screen diabetics for microalbuminuria and treat with CEI
as primary antihypertensive therapy.
(Harold Bregman, M.D., Lutheran General Hospital, Park Ridge, IL)
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Am Soc Nephrol
Proteinuria/Hematuria :
Diabetes