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Micro-albuminuria 'under-diagnosed'

Half of all diabetes patients with

micro-albuminuria are not receiving the ACE inhibitor treatment they require, according to a new study.

The researchers warned the condition, an independent risk factor for cardiovascular and renal disease, was 'under-diagnosed' and not being identified or treated properly in patients with diabetes.

GP diabetes experts said the results were 'worrying' but added testing for and treating the condition would increase through the quality and outcomes framework.

The results showed only 53 per cent of patients with micro-albuminuria were on an ACE inhibitor or angiotensin 2 receptor antagonist (A2A).

Three points are available under the new contract's quality and outcomes framework if 70 per cent of patients with diabetes with proteinuria or micro-albuminuria are treated with ACE inhibitors or A2As.

Study co-author Dr John Wilding, reader in medicine and honorary consultant physician at University Hospital Aintree, said ACE inhibitors were used as frequently in patients with no signs of renal dysfunction as those with micro-albuminuria.

He warned communication problems between primary and secondary care needed to be addressed before the quality target could be met.

'We wanted to see if patients with early or established nephropathy were being treated as intensively as they might be and we found they were not,' he said.

'We screen for these patients but we weren't doing anything with that information. We do the test and write to the patient's GP and ask them to manage their blood pressure. The problem lies at the interface with primary and secondary care.'

The results, presented at the Diabetes UK annual conference in Birmingham earlier this month, also showed of the 200 patients with type 2 diabetes, 19 per cent had micro-

albuminuria, 71 per cent of whom had a blood pressure of more than 130/80.

Dr Eugene Hughes, committee member of Primary Care Diabetes Europe and a GP on the Isle of Wight, said the results were 'worrying' given that micro-albuminuria was an independent risk factor for cardio- and micro-vascular disease.

He said: 'Once GPs get to grips with the new contract, new referrals relating to micro-albuminuria will increase. Some pathology labs are already finding themselves flooded with micro-albuminuria tests.'

By Cato Pedder

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