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About this publication
The Norwegian Knowledge Centre for the Health Services was inquired by Kjell Maartmann-Moe to evaluate the effect of testing patients with diabetes mellitus for microalbuminuria. Based on this request we consulted the most recent and relevant guidelines for management of diabetic patients, including the Norwegian National Guidelines published in 2009, and the English Guidelines from NICE updated in 2008.
According to these guidelines, there seems to be a universal recommendation for diabetic patients to attend a regular control involving blood pressure (hypertension) control and testing for microalbuminuria.
We performed an overall search within relevant databases for systematic reviews on the effect of testing for microalbuminuria regarding mortality, morbidity, adverse effects and cost analyses. We found no systematic review that explicitly provided an answer to whether there is a positive health effect associated with testing for microalbuminuria compared to no testing. However, we found one HTA report from 2005 that revealed that diabetic patients with microalbuminuria had an increased risk of mortality and/or morbidity compared to patients with no raise in urinary albumin levels. Nevertheless, this report concluded that there was insufficient evidence to state that a universal screening would provide a positive effect on health outcomes. In addition, we found several systematic reports on diagnostic test accuracy for microalbuminuria and/or albuminuria. However, these reports did not provide any clear cut answers to questions relating to an overall health effect of microalbuminuria testing. Finally, with regard to cost effectiveness we found no analyses based on satisfactory/high quality evidence.
Based on the above findings, we concluded that the recommendation for universal testing of all diabetic patients for microalbuminuria is based on a consensus of an anticipated positive effect. We did not find it likely that substantial new evidence has been provided to alter this conclusion. We therefore decided not to perform a systematic search for primary studies on this topic. We would however emphasize that a lack of high level evidence per se does not implicate that the recommendation of testing all diabetes patients is wrong. This report provides a brief summary on the issue and explains the background for our conclusion.