Diabetes Care
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Diabetes Care 29:1733-1738, 2006
DOI: 10.2337/dc06-0260
© 2006 by the American Diabetes Association
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Clinical Care/Education/Nutrition
Original Article

Who Is Tested for Diabetic Kidney Disease and Who Initiates Treatment?

The Translating Research Into Action for Diabetes (TRIAD) study

Susan L. Johnson, MD, MS1, Edward F. Tierney, MPH2, Kingsley U. Onyemere, MD, MPH1, Chien-Wen Tseng, MD, MPH3, Monica M. Safford, MD4, Andrew J. Karter, PHD5, Assiamira Ferrara, MD, PHD5, O. Kenrick Duru, MD6, Arleen F. Brown, MD, PHD6, K.M. Venkat Narayan, MD, MSC, MBA, MRCP2, Theodore J. Thompson, MS2 and William H. Herman, MD, MPH1

1 Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan
2 Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
3 Pacific Health Research Institute, Honolulu, Hawaii
4 Department of Internal Medicine, Division of General Internal Medicine, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
5 Division of Research, Kaiser Permanente, Oakland, California
6 Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California

Address correspondence and reprint requests to William H. Herman, MD, MPH, University of Michigan Health System, 1500 East Medical Center Dr., 3920 Taubman Center, Ann Arbor, MI 48109-0354. E-mail: wherman{at}umich.edu

OBJECTIVE—We examined factors associated with screening for albuminuria and initiation of ACE inhibitor or angiotensin receptor blocker (ARB) treatment in diabetic patients.

RESEARCH DESIGN AND METHODS—We conducted surveys and medical record reviews for 5,378 patients participating in a study of diabetes care in managed care at baseline (2000–2001) and follow-up (2002–2003). Factors associated with testing for albuminuria were examined in cross-sectional analysis at baseline. Factors associated with initiating ACE inhibitor/ARB therapy were determined prospectively.

RESULTS—At baseline, 52% of patients not receiving ACE inhibitor/ARB therapy and without known diabetic kidney disease (DKD) were screened for albuminuria. Patients ≥65 years of age, those with higher HbA1c, those with cardiovascular disease (CVD), and those without hyperlipidemia were less likely to be screened. Of the patients with positive screening tests, 47% began ACE inhibitor/ARB therapy. Initiation of therapy was associated with positive screening test results, BMI ≥25 kg/m2, treatment with insulin or oral antidiabetic agents, peripheral neuropathy, systolic blood pressure ≥140 mmHg, and CVD. Of the patients receiving ACE inhibitor/ARB therapy or with known DKD, 63% were tested for albuminuria.

CONCLUSIONS—Screening for albuminuria was inadequate, especially in older patients or those with competing medical concerns. The value of screening could be increased if more patients with positive screening tests initiated ACE inhibitor/ARB therapy. The efficiency of screening could be improved by limiting screening to diabetic patients not receiving ACE inhibitor/ARB therapy and without known DKD.

Abbreviations: ARB, angiotensin receptor blocker • CVD, cardiovascular disease • DKD, diabetic kidney disease • ESRD, end-stage renal disease • SBP, systolic blood pressure • TRIAD, Translating Research Into Action for Diabetes


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Copyright © 2006 by the American Diabetes Association.