The American Diabetes Association recommends screening diabetes patients yearly for the presence of urinary microalbumin. Once the microalbumin is detected and the patient is titrated to a maximum dose of ACE inhibitor or angiotensin receptor blocker (ARB), is there any reason (evidence-based or otherwise) to continue yearly screenings?
—Rebekah Bernard, MD, Ft. Myers, Fla.
Yes. Annual testing for microalbumin allows the clinician not only to monitor the progression of renal damage but also to improve treatment. This can go beyond maximizing the dose of ACE inhibitor or ARB. There is evidence that “dual blockade” of the renin-angiotensin system with ACE inhibitors and ARBs is well-tolerated and can provide an additional 11%-43% reduction in microalbuminuria compared with monotherapy using one agent or the other (Ann Pharmacother. 2004;38:1278-1282). Therapy for this form of diabetic kidney disease should also include lifestyle changes, aggressive glycemic control, and, given that microalbuminuria is an independent marker for heart disease, therapy for dyslipidemia.
—Susan Kashaf, MD, MPH (100-13)