No abstract

A substantial proportion of metabolic abnormalities in GDM women are not detected with a monitoring program that measures only fasting ketonuria and postprandial CBG after main meals.

The presence of microalbuminuria is associated with an increased risk for developing nephropathy and cardiovascular diseases in both type 1 and type 2 diabetes (1-3). A proper pharmacological treatment can reduce urinary albumin excretion rate (AER) and prevent clinical nephropathy. Consequently, the screening for microalbuminuria should be an essential tool of the care for diabetic patients.Controversy still exists regarding the type of urine specimen to be used to evaluate microalbuminuria. AER determined in timed urine collections (24 h or overnight) is the most direct measure of urinary albumin excretion (4,5). However, due to the demand of the protocol and frequent imperfect patient adherence, the AER is not practical for epidemiological studies or clinical settings. For these reasons, the measurement of the albumin-tocreatinine ratio (ACR) in a random spot urine has became a widely accepted clinical tool for assessing urinary albumin excretion (6 -8). Recently, several semiquantitative office tests for detecting abnormal albuminuria have been developed (9).The aim of our study was to identify the easiest and most cost-effective screening program for microalbuminuria in an outpatient clinic. We evaluated specificity, sensitivity, and positive (PPV) and negative (NPV) predictive values of measurement of microalbuminuria by using ACR or by an immunological semiquantitative test in a first-morning spot urine sample in comparison with AER measured in three timed overnight urine collections.Urinary albumin concentration was determined by using an immunological semiquantitative test (Micral-test; Roche Diagnostics, Mannheim, Germany) and the ACR by using DCA 2000 Analyzer (Bayer, Mü nchen, Germany) in a firstmorning urine specimen of 1,712 type 2 diabetic patients consecutively admitted to our outpatient clinic. AER was then measured using three timed overnight urine collections that were performed at home a month after the screening evaluation. Albuminuria was detected by immunoturbidimetric method (Image; Beckman). Sensitivity, specificity, PPV, and NPV were calculated to determine the diagnostic properties of Micral and ACR. The AER, calculated as the median of three timed overnight urine collections, was used as the reference indicator. Microalbuminuria was defined as Micral-test Ն20 mg/l or ACR Ͼ2.8 g/mol for women and Ͼ1.9 g/mol for men (10) or AER between 20 and 200 g/min. Patients with urinary tract infections, acetonuria, hematuria, or leucocituria (n ϭ 56) were excluded from the study.In the remaining 1,656 patients eligible for evaluation, the median of AER revealed that 1,273 patients were normoalbuminuric (76.8%), 338 microalbuminuric (20.4%) and 45 macroalbuminuric (2.7%). These figures are similar to those already found in an Italian population (11). Macroalbuminuric patients were excluded from the subsequent analysis.Of the remaining 1,611 patients, 516 patients were classified as microalbuminuric by using Micral-test (194 falsepositive test results and 16 false-negative tests compared with the AE...