We have a different perspective about the utility of monitoring microalbuminuria than Dr Vincent (“Angiotensin blockade for diabetes: Monitor microalbuminuria?” J Fam Pract 2007; 56:145–146). We practice at a community health center with a diabetes program that is ADA-recognized for excellence in diabetes education and self-management. We have about 1200 diabetic patients in our practice, primarily Hispanic and indigent. With tight control, we have seen patients’ microalbuminuria decrease, sometimes to normal.
We find that an annual microalbumin result is an educational and motivational tool. Most patients know another diabetic who needs dialysis. When they see that maintaining blood glucose has improved this marker for kidney damage, they are overjoyed and thus motivated to continue to improve their self-management. Many of our patients participate in a quarterly group class, and the group actually cheers when a participant reaches a goal of a microalbumin less than 30.
Dr Vincent says his academic medical center charges $90 for a microalbumin test. We are able to purchase tests that give patients a result before they leave for $15.
Paula Lewis Devitt, RN, CDE
Sangre de Cristo Diabetes Self-Management Education
Program; Health Education and Community Outreach,
La Familia Medical Center, Santa Fe, NM
Neal Devitt, MD
La Familia Medical Center; Northern New Mexico Family
Practice Residency, Santa Fe; ndevitt@earthlink.net