Urine test may predict Diabetes

Dr Jitendra Singh
It has been repeatedly emphasised in these columns that the treatment of Diabetes should begin before diabetes appears and the treatment of diabetic complications should begin before the complications appear. Such an approach can help avoid damage to vital organs like kidneys, heart and eyes thus ensuring a complication-free normal quality of life for a person with Diabetes.
Presence of sugar in a routine Urine test is noticed only when the Blood Sugar values have crossed certain levels, probably beyond 180 mg/dl or so. But, what is lesser known is that there is also another marker in urine in the form of Albumin.
While Sugar in routine Urine test appears much later in Diabetes, albumin in urine or microalbuminuria can be present even in early stages of Glucose Intolerance long before the manifestation of overt Diabetes. The detection of albumin in urine of any individual, therefore, calls for screening to rule out underlying Diabetes or Pre-Diabetes.
Microalbuminuria or small quantities of albumin in the urine occur in early stages of kidney involvement in Diabetes Mellitus. In addition, microalbuminuria is now also recognised as a marker of impending or possible future involvement of heart. In fact, many a victim of nephropathy or diabetic affliction of kidney fail to reach the end-stage kidney disease because before that they succumb to a fatal heart attack.
An increased risk for albuminuria or albumin in urine is evident among persons with Impaired Fasting Glucose and newly diagonised Diabetes suggesting that the development of albuminuria commences early in the onset of Diabetes. Data published from credible sources reveals that even before the onset of Diabetes, microalbuminuria is found to be present in persons with Impaired Fasting Glucose and Impaired Glucose Tolerance to the extent of nearly 9% and 10% respectively. It is this latter group of population which can be effectively targetted and saved from going ahead to develop Diabetes and its consequent complications.
Early and aggressive control of Blood Sugar and Blood Pressure in presence of Diabetes has been found to have a beneficial effect on albuminuria. This is turn can help reduce the burden of kidney disease as also heart related complications.
Increased urine albumin excretion is not unique to adults with Diabetes Mellitus alone but may also be seen in a substantial proporation of adults without Diabetes Mellitus. If detected in time, such individuals can be helped through medicinal as well as non-medicinal intervention under the advice of preferably a Diabetologist or a physician.
At the same time, it must be emphasised that screening tests for chronic kidney disease in Diabetics should ideally also include estimation of glomerular filtration rate in addition to urine albumin excretion in order to maximize the sensitivity of screening tests. Be that as it is, to put it in a single sentence, albuminin urine may forwarn about Diabetes.


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