However, our finding that three-quarters of DKD patients who have relatively ready access to healthcare via private insurance are also identified at stage 3 disease or later is particularly troubling, The American Diabetes Association recommends that all patients with diabetes undergo yearly measurement of serum creatinine (and urinary albumin-to-creatinine ratio) [12, 13] in an attempt detect CKD relatively early in the disease process. Here, ALB is linked to diabetic kidney disease.