DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20151163

Effect of glycemic control on albumin excretion in urine in diabetics

Pankil K. Shah, Asutosh P. Chauhan

Abstract


Background: Diabetes Mellitus (DM) is commonest endocrine disorder worldwide. It is associated with variety of complications such as retinopathy, neuropathy and nephropathy. The severity of the complications depends on treatment strategies, duration of diabetes and glycemic control. Microalbuminuria (MA) is an earliest predictor of nephropathy in patients of diabetic nephropathy and Diabetic Nephropathy is most common cause for End Stage Renal Disease (ESRD) worldwide. It accounts for >40% of patients with ESRD.

Methods: The present study investigated effect of glycemic control on microalbuminuria. We studied 150 diabetic patients with duration of diabetes more than 3 years. Investigations like glycated hemoglobin (HbA1C) and fasting blood glucose were carried out to evaluate glycemic control and albumin in urine to evaluate early renal involvement.

Results: Out of 150 patients included in the study, 107 had poor glycemic control and 33 patients had good glycemic control. The HbA1C less than 7% is taken as cut off point for control of diabetes. The mean value of albumin in urine was  34.5 mg/L in the  group of  diabetics with good glycemic control and the same was 60.7  mg/L in the group of diabetics with poor glycemic control and this change was statistically significant (p<0.05).  

Conclusions: It is concluded that those patients with good glycemic control have decreased risk of developing microalbuminuria.

 


Keywords


Diabetes mellitus, HbA1C, Glycemic control, Microalbuminuria

Full Text:

PDF

References


Dennis L. Kasper, Eugene Brunwald, Anthony S. Fauci, Stephen N Hauser, Dan L. Longo, J. Larry Jemeson. Diabetes mellitus. In: Dennis L. Kasper, Eugene Brunwald, Anthony S. Fauci, Stephen N Hauser, Dan L. Longo, J. Larry Jemeson, eds. Harrison’s Principles of Internal Medicine. 16th ed. New York, NY: McGraw-Hill Professional; 2004: 2152-2180.

Burtis CA, Edward RA, David EB. Diabetes. In: Burtis CA, Edward RA, David EB, eds. Tietz Textbook of Clinical Chemistry and Metabolism. 4th ed. Philadelphia: Saunders; 2006: 546-853, 879.

NHS Centre for Reviews and Dissemination. Complications of diabetes: renal disease and promotion of self-management. Effect Health Care. 200;6(1);1-12.

Peter H. Initiation, progression and remission of diabetic nephropathy. Dan Med Bull. 2005;52:119-42.

Rozina Ghazali, One Loke Meng, Adlina bt. Bakar. Diabetic Nephropathy, July 2004. Malaysian Society of Nephrology. Available at: http://www.moh.gov.my/attachments/3938.pdf.

Salah RS, Ben H, Pajica P, Zeljkc M. Microalbuminuria and diabetes mellitus. Diabetologia Croatica. 2002;31(4):209-20.

Deferrari G, Repetto M, Calvi C, Ciabattoni M, Rossi C, Robaudo C. Diabetic nephropathy: from micro to macroalbuminuria. Nephrol Dial Transplant. 1998;13(8):11-5.

Satchell S, Tooke J. What is the mechanism of microalbuminuria in diabetes: a role for the glomerular endothelium? Diabetologia. 2008;51:714-25.

Brownlee M. Biochemistry and molecular cell biology of diabetic complications. Review article. Nature. 2001;414:813-20.

Helana W, Rhoda H, Yank B, Susan M, Jaime A, James R, et al. American college of endocrinology consensus statement on guidelines for glycemic control. ACE Guidelines for Glycemic Control. Endocr Pract. 2002;8(1):5-10.

Alwan C. Powers. Glycemic control. In: Dennis K, Eugene B, Anthony F, Stephen H, Dan L, Larry J, eds. Harrison’s Principles of Internal Medicine 16th ed. New York: McGraw Hill, Medical Publishing Division; 2005: 2152-2180.

Paola F, Marino B, Ilaria B, Pietro G, Enzo M, Michele M. Renal protection in diabetes: role of glycemic control. J Am Soc Nephrol. 2006;17:S86-9.

Josephine M, Mark E, Matthew D, Merlin C. Role of advanced glycation end products in diabetic nephropathy. J Am Soc Nephrol. 2003;14:S254-8.

Trinder P. Determination of glucose in blood using glucose oxidase with an alternative oxygen acceptor. Ann Clin Biochem. 1969;6:24-5.

David M, Thomas B, John L. Effect of aspirin on determinations of glycosylated haemoglobin. Clin Chem. 1983;29(3):466-9.

Anna-Majja Teppo. Immunoturbidimetry of albumin and immunoglobulin G in urine. Clin Chem. 1982;28(6):1359-61.

Nalini S, Linda H. Comparing glycemic control guideline in diabetes care. Diabetes. 2005;1(1):13-20.

Diabetes Complications and Control Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications of insulin dependent diabetes mellitus. N Engl J Med. 1993;329:977-86.

UKPDS Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. Lancet. 1998;352:837-53.