Computer-based assessment of surveillance and therapy for microalbuminuria in diabetes mellitus

R. H. Noth, D. Radel, F. Beza, Arthur L Swislocki

Research output: Contribution to journalArticle

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Abstract

Clinical data widely publicized in the past 2 years strongly support early intervention in diabetic kidney disease with intensive glucose control and ACE inhibitors. In the VANCHCS, relevant information, with local testing results, was distributed, reinforced by conferences and memos. To assess the impact on physician ordering of quantitative 24-hr urine albumin (UAE) or protein (UPR) and treatment with ACE inhibitors, all VANCHCS patients receiving pharmacotherapy in the past 3 years for diabetes were identified in the VA computer database and matching data retrieved for analysis by laptop computer. Almost all patients were older {63±11yrs) males with NIDDM. 7/92-6/93 7/93-6/94 7/94-6/95 # patients with diabetes treated 2556 2754 2939 # tested with UAE or UPR 628 (25%) 683 (25%) 695 (24%) # visit(s) to endocrinologist ≥1 849 (33%) 1000 (36%)* 1187 (39%)*2 # tested by endocrinologists 447 (53%) 470 (47%)* 503 (42%)2 # tested by non-endocrinologists 181(11%)1 213 (12%)1 192(11%)1 # tested with HbA1c 1763 (69%) 1999 (73%)* 2312 (79%)*2 # microalbuminuria (30≤UAE<300mg/d) 119/554 (21%) 183/624 (29%)* 203/654 (31%)2 # Rx with ACE (UAE<15mg/d) 55/174 (32%) 78/201 (38%) 77/203 (38%) # Rx with ACE (microalbuminuria) 73 (61%)1 122 (67%)1 149 (73%)1 2 P<0.05 by chi-square compared to previous yr (*), 2 years previously (2), or group above (1) Patients with microalbuminuria had the same HbAlc as those with UAE<15. Conclusions: Physicians treat with ACE inhibitors for documented microalbuminuria, but tend not to make the extra effort to do quantitative UAE testing, leaving half the patients at risk undetected and untreated. Selective intensification of glucose control is not being achieved. Usual educational efforts have been ineffective. Specialists are about 4x more likely to test for UAE. Efforts here are now being made to simplify testing and expand input of non-physician providers to this process.

Original languageEnglish (US)
JournalJournal of Investigative Medicine
Volume44
Issue number1
StatePublished - 1996

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Medical problems
Angiotensin-Converting Enzyme Inhibitors
Diabetes Mellitus
Testing
Drug therapy
Glucose
Laptop computers
Albumins
Proteins
Physicians
Therapeutics
Diabetic Nephropathies
Type 2 Diabetes Mellitus
Urine
Databases
Drug Therapy
Endocrinologists

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)

Cite this

Computer-based assessment of surveillance and therapy for microalbuminuria in diabetes mellitus. / Noth, R. H.; Radel, D.; Beza, F.; Swislocki, Arthur L.

In: Journal of Investigative Medicine, Vol. 44, No. 1, 1996.

Research output: Contribution to journalArticle

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abstract = "Clinical data widely publicized in the past 2 years strongly support early intervention in diabetic kidney disease with intensive glucose control and ACE inhibitors. In the VANCHCS, relevant information, with local testing results, was distributed, reinforced by conferences and memos. To assess the impact on physician ordering of quantitative 24-hr urine albumin (UAE) or protein (UPR) and treatment with ACE inhibitors, all VANCHCS patients receiving pharmacotherapy in the past 3 years for diabetes were identified in the VA computer database and matching data retrieved for analysis by laptop computer. Almost all patients were older {63±11yrs) males with NIDDM. 7/92-6/93 7/93-6/94 7/94-6/95 # patients with diabetes treated 2556 2754 2939 # tested with UAE or UPR 628 (25{\%}) 683 (25{\%}) 695 (24{\%}) # visit(s) to endocrinologist ≥1 849 (33{\%}) 1000 (36{\%})* 1187 (39{\%})*2 # tested by endocrinologists 447 (53{\%}) 470 (47{\%})* 503 (42{\%})2 # tested by non-endocrinologists 181(11{\%})1 213 (12{\%})1 192(11{\%})1 # tested with HbA1c 1763 (69{\%}) 1999 (73{\%})* 2312 (79{\%})*2 # microalbuminuria (30≤UAE<300mg/d) 119/554 (21{\%}) 183/624 (29{\%})* 203/654 (31{\%})2 # Rx with ACE (UAE<15mg/d) 55/174 (32{\%}) 78/201 (38{\%}) 77/203 (38{\%}) # Rx with ACE (microalbuminuria) 73 (61{\%})1 122 (67{\%})1 149 (73{\%})1 2 P<0.05 by chi-square compared to previous yr (*), 2 years previously (2), or group above (1) Patients with microalbuminuria had the same HbAlc as those with UAE<15. Conclusions: Physicians treat with ACE inhibitors for documented microalbuminuria, but tend not to make the extra effort to do quantitative UAE testing, leaving half the patients at risk undetected and untreated. Selective intensification of glucose control is not being achieved. Usual educational efforts have been ineffective. Specialists are about 4x more likely to test for UAE. Efforts here are now being made to simplify testing and expand input of non-physician providers to this process.",
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N2 - Clinical data widely publicized in the past 2 years strongly support early intervention in diabetic kidney disease with intensive glucose control and ACE inhibitors. In the VANCHCS, relevant information, with local testing results, was distributed, reinforced by conferences and memos. To assess the impact on physician ordering of quantitative 24-hr urine albumin (UAE) or protein (UPR) and treatment with ACE inhibitors, all VANCHCS patients receiving pharmacotherapy in the past 3 years for diabetes were identified in the VA computer database and matching data retrieved for analysis by laptop computer. Almost all patients were older {63±11yrs) males with NIDDM. 7/92-6/93 7/93-6/94 7/94-6/95 # patients with diabetes treated 2556 2754 2939 # tested with UAE or UPR 628 (25%) 683 (25%) 695 (24%) # visit(s) to endocrinologist ≥1 849 (33%) 1000 (36%)* 1187 (39%)*2 # tested by endocrinologists 447 (53%) 470 (47%)* 503 (42%)2 # tested by non-endocrinologists 181(11%)1 213 (12%)1 192(11%)1 # tested with HbA1c 1763 (69%) 1999 (73%)* 2312 (79%)*2 # microalbuminuria (30≤UAE<300mg/d) 119/554 (21%) 183/624 (29%)* 203/654 (31%)2 # Rx with ACE (UAE<15mg/d) 55/174 (32%) 78/201 (38%) 77/203 (38%) # Rx with ACE (microalbuminuria) 73 (61%)1 122 (67%)1 149 (73%)1 2 P<0.05 by chi-square compared to previous yr (*), 2 years previously (2), or group above (1) Patients with microalbuminuria had the same HbAlc as those with UAE<15. Conclusions: Physicians treat with ACE inhibitors for documented microalbuminuria, but tend not to make the extra effort to do quantitative UAE testing, leaving half the patients at risk undetected and untreated. Selective intensification of glucose control is not being achieved. Usual educational efforts have been ineffective. Specialists are about 4x more likely to test for UAE. Efforts here are now being made to simplify testing and expand input of non-physician providers to this process.

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