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May 26, 2004

Complications

Question from Dallas, Texas, USA:

I have had diabetes for 26 years with pretty good control. My last glycohemoglobin showed an average glucose of 107 mg/dl [5.9 mmol/L]. I recently switched doctors and he is putting me on 20 mg of an ACE inhibitor because my last spot urine test showed a little bit of protein in my urine, according to the card he sent me in the mail. The day I went in, I was running a slight fever because of a sinus infection and not feeling too well. Could this have affected the spot exam? I always thought the 24 hr hour collection test should follow a spot test that was abnormal.

Answer:

The use of ACE inhibitors in individuals with diabetes is gaining acceptance in a preventive role in addition to treatment when there is protein in the urine. This is from previous studies, such as Progression of kidney disease, conducted by the Steno Diabetes Center in Denmark, and other studies done in Europe.

The spot urine test for microalbuminuria is quite sensitive and accurate. However, if you are somewhat skeptical, I would ask for a 24 hour urine with creatinine clearance to determine your kidney function. I would discuss this with your physician, if necessary face to face, to answer your doubts and questions.

Many of my patients are started on an ACE inhibitor, if there are no other problems, almost immediately upon diagnosis of diabetes mellitus. This is a preventive measure and protective in my opinion. But, I would discuss this with your doctor.

ABS