Evaluation Of Evidence Based Practice Guidelines for Identification of Microalbuminuria in Children with Type 1 Diabetes

Terri Lipman, PhD, CRNP, FAAN, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA, Kathy Montgomery, MSN, CRNP, Division of Endocrinology, Children's Hospital of Philadelphia, Phila, PA, USA, and Jorge Baluarte, MD, Division of Nephrology, Childrens Hospital of Philadelphia, Philadelphia, PA, USA.

Nephropathy is a significant long-term complication of diabetes. The earliest evidence of nephropathy is the appearance of microalbuminuria (MA) in the urine.

The purpose of this study was to evaluate the use of an evidenced based clinical practice guideline (CPG) in identifying pediatric patients with MA.

All children are screened annually for MA using a random spot urine specimen. An algorithm was created to facilitate the tracking and follow up of patients with an elevated random spot MA result ( > 30 mg/g). Data were collected on all children with Type 1 diabetes and a urine MA ³ 30 mg/g for one year. Charts were reviewed to determine documentation of lab result, follow-up plan, follow-up result of subsequent tests and the final disposition.

Of 776 children with Type 1 diabetes evaluated during the study period, 141 (18 %) had an elevated spot MA screen. Of those 141 children, 42 (30%) had no follow-up plan documented. A first morning void was ordered on 99 children (70%). Repeat values were documented on only 23 of these 99 children (23%). Of the 23 repeat values that were recorded, 12 had persistent MA (52%).

Eighteen percent of children with Type 1 diabetes in our population demonstrated MA in a random spot urine specimen.

Of the elevated random spot urine tests that were repeated using a first morning void, half of them remained elevated and half converted to normal.

Adherence to a clinical practice guideline was documented in only 16% of children who received MA screening.

Adherence to the CPG on MA as measured by documentation was poor. More education, revisions to our outpatient clinic record and ongoing monitoring is needed.