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Micro-what? Important Information for Individuals with Diabetes
By Dr. Beth Ann Coonrod

Many individuals who have diabetes have learned about the laboratory test called hemoglobin A1c (sometimes referred to only as A1c), which reflects blood glucose levels over the previous two to three month period of time. There is another laboratory test about which people with diabetes should be just as aware: microalbuminuria.

What is microalbuminuria, and how is it detected?
Microalbuminuria ("my-crow al-byoo-min your-ee-uh") is a small but abnormal amount of protein in the urine, and it is usually the earliest detectable indication of diabetic kidney disease. Its presence also indicates an increased risk for cardiovascular (heart and blood vessel) disease.
Microalbuminuria is most commonly checked for using a sample of urine that is provided when a person goes to a laboratory. Sometimes, timed (for example, 24 hour) urine collections are used. It is not sufficient to use blood work alone to try to detect kidney problems early on. In most cases, by the time kidney disease would cause blood work to become abnormal, it would be more advanced than if sought by a urine test.
Both the American Association of Clinical Endocrinologists and the American Diabetes Association recommend that a person with diabetes be checked for microalbuminuria yearly.

How can the chance of developing microalbuminuria be reduced?
Optimal control of blood glucose, blood pressure, and lipids (cholesterol and triglycerides), and not smoking can help to reduce the chances of developing microalbuminuria. However, regardless of how well controlled these are, a person with diabetes should still get checked at least once per year.
If someone has microalbuminuria, what can be done to slow the progression to more advanced kidney disease?
The same factors that can help reduce the chances for developing microalbuminuria can help to delay the progression of kidney disease. The use of certain blood pressure medications, and reduction in dietary protein intake have also been shown to be helpful.

How can you know if you have had your yearly check for microalbuminuria?
If you have not had a urine test in the last year, then you know that you have not been checked for microalbuminuria. If you have had a urine test, you need to ask if it included a test for microalbuminuria, because it is not included as part of a routine urinalysis. It must be specifically ordered.

Dr. Beth Ann Coonrod is the Diabetes Disease Management Coordinator of the Diabetes Empowerment Program at the St. Clair Hospital Diabetes Center. For more information, call (412) 942-2151 or visit www.stclair.org.

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