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Use of glycated hemoglobin and microalbuminuria in the monitoring of diabetes mellitus.

Clinical testing to assess levels of disease control and progression among persons with type 1 and type 2 diabetes mellitus is widely recommended to clinicians to improve patients’ clinical outcomes. Two important foci of recommendations for the followup care of individuals with diabetes include monitoring of glycemic status by measurement of glycated hemoglobin (GHb) and screening for kidney disease with urine albumin to assess overall disease progression and to detect potential progression toward end-organ damage. According to the American Diabetes Association’s Clinical Practice Recommendations, monitoring of glycemic status is considered a cornerstone of diabetes care and affects how physicians and patients adjust medical therapy as well as behavioral therapy (e.g., diet and exercise). Screening for urine albumin among persons with diabetes is also widely recommended for the detection and treatment of incipient diabetic nephropathy and affects the physician’s implementation of therapy to slow progression of kidney disease. Despite widespread recommendations for screening of persons with diabetes for both glycemic control and urine albumin, there has not been a systematic assembly of the literature to assess the risk relation between tests assessing longterm glycemic control or tests assessing the presence of microalbuminuria with cardiovascular, peripheral vascular, renal, and neurological outcomes (all of which represent end-organ effects of long-term diabetes). The report from which this summary was developed was commissioned by the American Association of Clinical Chemistry; it systematically reviews the literature identifying the risk relation between testing for glycemic control or urine albumin and these important clinical outcomes.