Cardiovascular disease (CVD) is the major cause of morbidity and mortality in diabetes. To determine the proportion of patients who met the5 were hypertension, hyperglycemia, increased low-density lipoprotein (LDL) cholesterol, low levels of high-density lipoprotein (HDL) cholesterol, and smoking. While tight control of blood glucose in both type 1 and type 2

Background/Aims: Microalbuminuria is a marker of abnormal vascular response and a predictor of cardiovascular morbidity and mortality. We evaluated a new quantitative office-based method to assess urinary albumin excretion (UAE) and compared it to other established methods. Methods: Spot urine samples from 165 patients were analyzed at a single study site using the HemoCue system, Clinitek Microalbumin, and Chemstrip Micral test, as well as at a central laboratory, where UAE and creatinine levels were measured. The central laboratory UAE values were used as reference. We evaluated the validity of the HemoCue results and compared them to the respective data for the laboratory albumin-to-creatinine ratio (ACR). Additionally, we assessed, diagnostic sensitivity, specificity, and positive and negative predictive values of all four methods, as well as the reproducibility of the HemoCue measurements. Results: Linear regression analysis demonstrated a good correlation for the HemoCue system (y = 0.9978x – 1.0217, R² = 0.904) and ACR (y = 0.0815x + 0.3373, R² = 0.784). Sensitivity and specificity for microalbuminuria diagnosis were 92 and 98% for HemoCue, 73 and 96% for ACR, 100 and 81% for Clinitek Microalbumin, and 70 and 83% for Chemstrip Micral dipstick, respectively. The correlation coefficient of duplicate HemoCue measurements was r = 0.98 (p < 0.001). Conclusions: The HemoCue system for microalbuminuria detection was as accurate and precise as laboratory ACR estimations. Its diagnostic performance was much better than that of widely used dipstick methods.

Achievement of recommended levels of blood pressure as prescribed by guidelines (i.e., systolic blood pressure of < 130 mmHg in people with nephropathy secondary to type 2 diabetes) generally requires three or more different antihypertensive agents that have complementary modes of action. This systolic goal blood pressure, recommended by generally all international guideline committees, was derived from largely observational studies demonstrating a greater reduction of cardiovascular risk and preservation of kidney function at these levels. Commonly used antihypertensive combinations include angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers, which have compelling indications for use in people with kidney disease and/or diabetes, combined with a diuretic, generally a thiazide-type agent. If additional therapy is required, either a beta-blocker or a calcium antagonist may be added to this antihypertensive "cocktail." Beta-blockers are particularly effective in people with a high sympathetic drive (i.e., high pulse rates) to lower blood pressure and reduce cardiovascular risk. Moreover, in recent studies, their benefits on kidney function, both by reducing macroalbuminuria and slowing the decline of kidney function, make them good agents to add in the appropriate clinical setting. With all these potential benefits of achieving blood pressure goals, it is unfortunate that only 11% of people being treated for hypertension with diabetic kidney disease achieve the blood pressure goal of < 130 mmHg, likely contributing to the climbing incidence of people starting dialysis. Physicians need to work harder and educate patients on the importance of achieving these lower blood pressure guidelines.