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Background: Type 2 diabetes contributes significantly to the burden of disease in South Africa. Proteinuria is a marker for chronic kidney and cardiovascular disease. All guidelines recommend testing for microalbuminuria because intervention at this stage can prevent or delay the onset of disease. Currently, none of the community health centres (CHCs) in Cape Town test for microalbuminuria, and there are concerns about its costs and feasibility. Objectives: The aim of this study was to assess the practicality, costs and consequences of introducing a screening test for microalbuminuria into primary care. Design: Chronic care teams were trained to screen and treat all patients with diabetes (n = 1 675) over a one-year period. The fidelity of screening, costs and consequences was evaluated. Setting and subjects: Patients with type 2 diabetes and chronic care teams at two community health centres in the Cape Town Metro district. Outcome measures: Data to evaluate screening were extracted from the records of 342 randomly selected patients. Data to evaluate treatment were taken from the records of all 140 patients diagnosed with microalbuminuria. Results: Of the patients with diabetes, 14.6% already had macroalbuminuria. Of the eligible patients, 69.9% completed the screening process which led to a diagnosis of microalbuminuria in another 11.7%. Of those who were positively diagnosed, the opportunity to initiate angiotensin-converting enzyme (ACE) inhibitors was missed in 20%, while 49.2% had ACE inhibitors initiated, or the dosage thereof increased. It would cost the health system an additional R1 463 to screen 100 patients and provide additional ACE inhibitor treatment for a year to the 12 that were diagnosed. Conclusion: The study demonstrated the feasibility of incorporating microalbuminuria testing into routine care. The costs involved were minimal, compared to the likely benefits of preventing end-stage renal failure and the costs of dialysis (estimated at R120 000 per year per patient). [ABSTRACT FROM AUTHOR]

It is important to decide if a patient with diabetes has good glycaemic control in order to guide treatment and to offer behaviour change counselling. Currently, determining random blood glucose (RBG) is usually carried out in primary care in the public sector to make this decision. This study investigates the validity of these decisions. Retrospective data from a district hospital setting were used to analyse the correlation between glycated haemoglobin (HbA1c) and RBG, the best predictive value of RBG, and its predictive properties. The best value of RBG to predict control (HbA1c = 7%) was 9.8 mmol/l. However, this threshold only gave a sensitivity of 77% and a specificity of 75%. Clinicians would be wrong 23% of the time when using RBG to determine glycaemic control. Attempts should be made to make HbA1c more available for clinical decision-making. Point-of-care testing for HbA1c should be considered. [ABSTRACT FROM AUTHOR]