The prognostic significance of urinary albumin in Polynesians with non-insulin-dependent diabetes

Polynesian (59 Maori and 30 Pacific Island) patients were identified from two diabetes clinic registers and followed for a mean of 4.8 years, in order to determine the prognostic significance of urinary albumin excretion. Events were defined as death or entry onto a renal replacement programme. Fourteen events occurred during the period of follow-up. Urinary albumin/creatinine ratio was treated as a continuous variable in a proportional hazards analysis. A 10-fold increase in albumin/creatinine ratio was associated with a 5-fold increase in the risk of an event (95% C.I. = 2.05-12.09). In conclusion, elevated urinary albumin/creatinine predicted mortality and renal morbidity in Maori and Pacific Island patients with non-insulin-dependent diabetes.

Assessment of Micral-Test microalbuminuria test strip in the laboratory and in diabetic outpatients

We have evaluated a semi-quantitative dry immunochemical screening method (Micral-Test) for the detection of low concentrations of albumin in urine. The stability of Micral-Test strips on storage was good, especially with regard to temperature, light and humidity. Changes in urine osmolality (urea and creatinine concentration), pH and sodium and potassium concentration did not have a significant analytical effect on the Micral-Test measurement; extremes of temperature altered the rate of colour development. The depth of dipping the strip into the sample and the timing of reading colour development were critical. We measured the albumin concentration in 184 urine samples from diabetic outpatients by the Micral-Test and by our in-house immunoturbidimetric method; a Micral-Test result of 20 mg/L had a sensitivity of 91% and specificity of 97% to predict a discriminating urine albumin concentration greater than 30 mg/L by the in house method. The Micral-Test is suitable for use by non-laboratory personnel and is capable of producing analytically acceptable results for use in diabetes clinics and by general practitioners.

Random urine albumin:creatinine ratio measurements as a screening test for diabetic microalbuminuria--a five year follow up

Serial random urine samples have been collected from 167 insulin treated diabetic patients attending the Waikato diabetes clinic from 1984 to 1989 and albumin/creatinine ratios measured as a screening test for diabetic microalbuminuria. The group ranged in age from 12 to 50 years and comprised 79 males and 88 females. Where the initial test was normal (less than 2.5), as found in 117 patients, 86.7% of all tests over the five year period (1032) remained normal. Of 50 patients with an initial elevated value, 39% of a total of 575 values taken over the five year period were subsequently normal.

CONCLUSION

a random urine albumin measurement taken at yearly intervals is an adequate screening programme for patients with an initial normal value.

Urine albumin creatinine ratio and clinical correlates in a diabetic population

The urine albumin/creatinine ratio was measured in random urine samples in a range of diabetic subjects as a guide to urinary albumin excretion rate in diabetic patients. In 74 control subjects the 95th percentile for the albumin/creatinine ratio was 1.3. In 39 diabetic patients the random urine albumin/creatinine ratio correlated highly with the 24 hour urine albumin excretion (r = 0.9371, p less than 0.001). In 337 insulin treated diabetic subjects 55% of the female and 39% of the male values exceeded 1.3. In 98 noninsulin treated diabetic subjects 67% of female and 62% of male values exceeded 1.3. Selecting albumin/creatinine ratios between 2.5 to 26.8 corresponding to albumin excretion rates between 20 mg and 250 mg/day, 26.1% of the insulin treated group were in this microalbuminuric range, and 8.7% had overt albuminuria. Higher figures were seen in the noninsulin treated group. Within these two large diabetic groups significant associations (p less than 0.005) were seen with glycaemia, blood pressure, body mass index, retinopathy and duration of diabetes. We believe that measurement of albumin/creatinine ratios on random urine samples offers a simple and convenient way of monitoring albumin excretion in large numbers of diabetic patients.

Laboratory assessment of a commercial kit for measuring fructosamine in serum

We have evaluated the laboratory performance and clinical usefulness of the Roche fructosamine kit. As used with an Abbott ABA 100 bichromatic analyzer, the kit response varied linearly with fructosamine concentration to 5.0 mmol/L (deoxymorpholinofructose equivalents). Interbatch precision was 4.1% and 3.6% for respective fructosamine concentrations of 3.2 and 5.0 mmol/L; intrabatch precision was 3.2% and 3.0% (fructosamine = 3.0 and 4.0 mmol/L). In 55 nondiabetic subjects all fructosamine values were less than 3.0 mmol/L, 95% were less than 2.7 mmol/L. For both fructosamine and glycated hemoglobin (Hb A1c) the 95th percentile of the reference range corresponded to approximately the 10th percentile of values observed in 108 diabetic subjects. In the latter subjects fructosamine concentrations correlated somewhat (r = 0.6504) with the Hb A1c value and for eight diabetic subjects indicated a similar degree of diabetic control over a 10-week period. From assessments of sensitivity and specificity for predicting abnormal glucose tolerance in 145 subjects, we conclude that this assay of serum fructosamine reflects diabetic control about as well as Hb A1c estimation, but neither can replace the glucose tolerance test for the diagnosis of diabetes.

Laboratory assessment of a commercial kit for measuring fructosamine in serum

We have evaluated the laboratory performance and clinical usefulness of the Roche fructosamine kit. As used with an Abbott ABA 100 bichromatic analyzer, the kit response varied linearly with fructosamine concentration to 5.0 mmol/L (deoxymorpholinofructose equivalents). Interbatch precision was 4.1% and 3.6% for respective fructosamine concentrations of 3.2 and 5.0 mmol/L; intrabatch precision was 3.2% and 3.0% (fructosamine = 3.0 and 4.0 mmol/L). In 55 nondiabetic subjects all fructosamine values were less than 3.0 mmol/L, 95% were less than 2.7 mmol/L. For both fructosamine and glycated hemoglobin (Hb A1c) the 95th percentile of the reference range corresponded to approximately the 10th percentile of values observed in 108 diabetic subjects. In the latter subjects fructosamine concentrations correlated somewhat (r = 0.6504) with the Hb A1c value and for eight diabetic subjects indicated a similar degree of diabetic control over a 10-week period. From assessments of sensitivity and specificity for predicting abnormal glucose tolerance in 145 subjects, we conclude that this assay of serum fructosamine reflects diabetic control about as well as Hb A1c estimation, but neither can replace the glucose tolerance test for the diagnosis of diabetes.

Multiple dose insulin regimen using the NovoPen: initial experience and approximate dose requirements

We present our initial experience with a multiple dose per day insulin regimen using the newly developed multidose NovoPen insulin injector. Fourteen insulin dependent diabetic patients were studied, 6 with excellent control and 8 with poor control on twice a day conventional insulin injection regimens. Total insulin dosage per day remained the same on the new compared to the old regimen; 0.71 (SD) 0.22 versus 0.73 (0.23) units/kg per day. Mean blood glucose control as evidenced by HbA1% values did not alter significantly in the well controlled group, but improved significantly in the poorly controlled group. Frequency of hypoglycaemia appeared to be reduced on the multiple dose regimen in particular in two of the subjects with excellent blood glucose control. The NovoPen proved to be reliable and convenient and was well accepted by all but one subject.

Dehydroepiandrosterone sulphate concentrations in asthmatic patients: pilot study

Dehydroepiandrosterone sulphate (DHEA-SO4) values were measured as a guide to adrenal function in 72 asthmatic patients admitted to the Waikato Hospital with severe bronchospasm. In a reference sample 700 micrograms/l was taken as the lower limit of the reference range for DHEA-SO4 concentrations. All DHEA-SO4 values in 20 patients with known primary or secondary adrenal insufficiency were less than this value. In the asthmatic group, 10 of 14 DHEA-SO4 values were low in patients taking oral steroid therapy, eight of 23 values in patients taking inhaled steroids, and six of 29 values in patients on no known steroid therapy. Five of six patients who had been on oral steroids within a month of admission also had low values. In total 40% of all values were less than 700 micrograms/l. These data provide inferential evidence of possible adrenal suppression in a substantial number of patients requiring hospital admission for treatment of severe bronchospasm.

Clinical importance of the reversible fraction of haemoglobin A1c in Type 2 (non-insulin-dependent) diabetes

Two studies demonstrating the clinical relevance of the labile fraction of haemoglobin A1c are presented. Haemolysates, dialysed at 37 degrees C against 0.9% NaCl, showed an average decrease of haemoglobin A1c value of 7.0% of total glycosylated haemoglobin, post-dialysis. There was a close correlation between the pre- and post-dialysis haemoglobin A1c values (r = 0.9644). In four Type 2 (non-insulin-dependent) diabetic subjects, blood glucose and pre- and post-dialysis haemoglobin A1c values were determined at weekly intervals over an 18-week period, including 6 weeks when oral hypoglycaemic therapy was withheld. During this time, pre- and post-dialysis haemoglobin A1c values responded synchronously to changes in blood glucose concentration. The mean coefficient of variation of the pre- and post-dialysis haemoglobin A1c values did not differ significantly over the 18-week period. It is concluded that the routine elimination of the labile fraction of haemoglobin A1c is not necessary to assess control in Type 2 diabetes.

Glycosylated haemoglobin: an overview of a series of clinical studies

A series of studies on the clinical relevance of chromatographically determined glycosylated haemoglobins is presented. Both whole blood samples and haemolysates were stable at 5 degrees C for up to two weeks. Prolonged storage required temperatures less than -80 degrees C. Haemoglobin (Hb) AIc percent values in non-diabetic subjects ranged from 4.0 to 6.0 percent (mean +/- 2 SD). HbAIc percent values proved to be as stable in diabetic as non-diabetic subjects on repetitive sampling over a three month period. A dissociable component was not observed in any of 78 samples. HbAIc percent values of carbohydrate intolerant subjects (n = 18) were not distinguishable from those in non-diabetic subjects. A close correlation was observed between HbAIc percent and the mean of multiple capillary glucose samples in 37 insulin dependent diabetic subjects. In clinical practice HbAic percent proved to be a stable objective measure of blood glucose concentrations in diabetic patients--the major present need is for a simple reliable technique of measurement.

Serum creatinine concentration in children: normal values for sex and age

This paper presents the normal serum creatinine values in a population of 639 male and 631 female young people aged between one year and 20 years. In addition, preliminary data are presented which indicate the serum creatinine of male and female infants aged between one day and 14 days.