Microalbumin—Why You Should Test
The urinary microalbumin (MA) test is an immunoassay that is at least 30-fold more sensitive than standard urine protein assays. It is the earliest available indicator for the development of diabetic complications. These may include diabetic nephropathy, cardiovascular disease and hypertension.

The urine protein test will detect any protein, even bacterial proteins, and some other chemical substances. The MA test only detects human serum albumin, the primary protein present in pathological proteinuria. This markedly improved specificity can help insurance companies eliminate adverse underwriting actions based on contaminated urine specimens from otherwise healthy applicants.

Facts

• Persistently elevated MA, not elevated total urine protein, defines diabetic nephropathy.
• Diabetic complications may be determined by elevated MA 5 to 10 years earlier than total urine protein. For this reason, the American Diabetes Association recommends regular MA testing in Type 1 and Type 2 diabetics.
• Type 2 diabetics with elevated MA have a 4- to 5-fold increased risk of both CVD occurrence and CVD mortality when compared to Type 2 diabetics with normal MA measurements. Increased CVD mortality is the primary mortality risk for both Type 1 and Type 2 diabetes.
• Insurance urine specimens are not sterile. They may be contaminated with seminal fluid, mucous or other bodily fluids, which may cause an elevated total urine protein result. If the urine preservative tablet is not left in the specimen, bacteria can grow in urine and produce bacterial proteins, which will also result in an elevated total urine protein. None of these contaminates will cause an elevated MA test result.
• MA testing can eliminate the need to collect additional urine specimens or delay issuing policies on applicants whose elevated total urine protein was only due to such contami - nates. This can reduce testing costs, eliminate unnecessary delays, and improve policy issue rates. About 20 to 30% of all applicants with elevated urine protein results will have normal MA results and can be underwritten without the need for adverse action.

Recommended Testing Guidelines
To take advantage of the superior sensitivity of the MA test, order MA testing on applicants who are known to be diabetic or who have one or more of the following indicators for glucose intolerance: an elevated serum glucose, an elevated serum fructosamine, an elevated blood hemoglobin A1c (glycated hemoglobin), or detectable urine glucose. To take advantage of the improved specificity of the MA test, order MA testing on applicants with elevated total urine protein or elevated urine protein to urine creatinine ratios that would have resulted in either adverse action being taken or additional urine specimens being collected.