Survey Finds Most PCPs Do Not Use uACR to Assess Cardiovascular Risk in Type 2 Diabetes

A national survey of 600 primary care physicians (PCPs) examined perceptions and use of urine albumin-to-creatinine ratio (UACR) testing in patients with type 2 diabetes. Results showed that while most clinicians reported familiarity with the test and acknowledged ordering it, the survey revealed a significant gap between testing and clinical action.

According to Holly Kramer, MD, MPH, a professor of public health sciences and medicine at Loyola University Chicago who specializes in nephrology, the majority of participants did not view uACR as a tool for assessing cardiovascular risk, despite strong evidence linking elevated UACR to adverse cardiovascular outcomes. She contrasts this with how clinicians routinely use blood pressure and cholesterol measurements to estimate future risk of heart failure, myocardial infarction, and cardiovascular mortality.

In a recent interview with Patient Care Online, Kramer highlights that a uACR above 30 mg/g is associated with a 5-fold increased risk of heart failure, a 4r-fold increased risk of cardiovascular mortality, and a 3-fold increased risk of myocardial infarction in patients with type 2 diabetes. Despite this, only about 30% of clinicians reported acting on abnormal uACR results, leaving roughly 70% untreated from a risk-reduction standpoint. The survey findings illustrate that while annual testing is commonly recognized as a guideline recommendation, the broader significance of the result is often overlooked, according to Kramer. For PCPs, the findings raise important questions about how test results are interpreted, communicated, and integrated into cardiovascular and renal risk management.