Microalbuminuria testing in diabetes: is a dipstick as effective as laboratory tests?

The National Service Framework (NSF) for Diabetes (Department of Health, 2002) aims to improve care for people with diabetes. Primary care trusts need to demonstrate the provision of cost-effective and evidence based care. The National Institute for Clinical Excellence guidelines (NICE, 2002) recommend that microalbuminuria is tested annually in people with diabetes, either by a dipstick method or by a laboratory method. A mini systematic review was undertaken to establish whether a dipstick method of detecting microalbuminuria is as effective as a laboratory method. Four databases were searched and studies comparing dipstick and laboratory methods were included. A hand search was also included. The review was further limited to the Micral test II compared to a reference laboratory standard. Four studies met the inclusion criteria and it was concluded that the Micral test II has a high sensitivity but not very high specificity with lower positive predictive value; it was therefore found to be adequate as a screening tool but not as a diagnostic tool. Therefore the Micral II test is not as effective as a laboratory comparator.