Clinical usefulness of measurement of urinary albumin excretion in diabetes mellitus.

Mortality in diabetes mellitus is related mainly to its renal and cardiovascular sequelae. Microalbuminuria identifies those at increased risk of both complications, possibly because microalbuminuria is a marker of generalised endothelial dysfunction. Screening for microalbuminuria is of proven benefit in insulin-dependent diabetes, as therapeutic strategies are available that are at least partially effective. Such benefits have not yet been demonstrated in non-insulin-dependent diabetes. Arguments are presented to suggest that microalbuminuria should be defined on the basis of three or more daytime or 24-h urine collections. This increases sensitivity compared to the use of overnight urine collections while specificity is maintained.