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RE: [IP] 24 hour urine tests and other urine tests

FYI: the following information is from the ADA web site, Clinical Practice 
Recommendations. After initial evaluation for microalbumin and routine urine 
test, annual visits should include:

<<In the absence of previously demonstrated microalbuminuria, an annual test 
for the presence of microalbumin is necessary. Screening for microalbuminuria 
in individuals with type 1 diabetes should begin with puberty and after 5 
years' duration of the disease. Because of the difficulty in precise dating 
of the onset of type 2 diabetes, such screening should begin at the time of 
diagnosis. Screening for microalbuminuria can be performed by three methods:

Measurement of the albumin-to-creatinine ratio in a random, spot collection

24-h collection with creatinine, allowing the simultaneous measurement of 
creatinine clearance

Timed (e.g., 4-h or overnight) collection

The first method is often found to be the easiest in an office setting and 
generally provides accurate information. First-void or other morning 
collections are preferred because of the known diurnal variation in albumin 
excretion, but if this timing cannot be used, uniformity of timing for 
different collections in the same individual should be employed.

The role of annual urine protein dipstick testing and microalbuminuria 
assessment is less clear after diagnosis of microalbuminuria and institution 
of ACE inhibitor therapy and blood pressure control. Many experts recommend 
continued surveillance both to assess response to therapy and progression of 
disease. In addition to assessment of urinary albumin excretion, assessment 
of renal function is important in patients with diabetic kidney disease.>>

I hope this is useful information.  There was a study a few years ago that 
reviewed medical management practices based on ADA guidelines. Many physician 
practices failed to do microalbumin screening tests to evaluate the need for 
24 hour urine testing.  From comments by members of this list, not much has 
changed. Sad.
Barbara B.

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