In this article we discuss two case histories identifying common test result abnormalities in patients with diabetes that the primary healthcare professional has to deal with.
Case history 1: A positive test for microalbuminuria
Geoff, a 56-year-old with a six year history of type 2 diabetes, was seen in the practice diabetes clinic with the following results: HbA1C 71mmol/mol; cholesterol 4.1mmol/l, non-HDL cholesterol 2.4mmol/l; eGFR 62m/min/1.73m2; urinary albumin:creatinine ratio (ACR) 8.3mg/mmol (normal value < 3); weight 92kg, BMI 28.5 kg/m2; BP 149/88.
His repeat medication consisted of metformin 1g twice a day, atorvastatin 20mg once daily and losartan 50mg once daily. Geoff was a non-smoker who consumed 12 units of alcohol per week and he worked as a sales representative which involved him driving long distances. Bilateral background retinopathy had been picked up in routine retinal screening.
Discussion of results
While Geoff’s glomerular filtration rate remains above 60mL/min he has a raised ACR (in fact his second positive test), with microalbuminuria being a cardinal sign of diabetic nephropathy. Blood pressure is above target and this is of heightened significance given the finding of microalbuminuria.