Prevalence and Risk Factors of Microalbuminuria among Type 2 Diabetes Mellitus: A Hospital-Based Study from; Warri; Nigeria

"Aims: The aim of this study was to determine the prevalence of microalbuminuria (MA) in patients with type 2 diabetes mellitus (T2DM) and to identify the associated risk factors. Settings and Design: The study was a prospective; descriptive; cross-sectional study carried out in the medical outpatient department of the Central Hospital; Warri from March to August 2014 after approval by the hospital's health and ethics committee. Materials and Methods: Two hundred T2DM aged 45-80 years were randomly selected for the study after obtaining their informed consent. Three-morning urine samples collected at 1-month interval were tested for MA using the ""MICRAL test"" strip. A fasting blood sample was also drawn after 10-12 h overnight fasting for plasma glucose; hemoglobin A1c (HbA1c); lipid profile; and serum creatinine investigations. MA was diagnosed if the urinary albumin excretion ratio was between 30 and 300 mg/24 h from two separate urine samples. Statistical Analysis Used: Data was analyzed using Statistical Package for Social Sciences version 16. Differences at P 0.05 were considered significant. Results: The prevalence of MA was 58. The mean age; duration of T2DM; systolic blood pressure; fasting blood glucose; HbA1c level; serum creatinine of type 2 diabetes with MA were significantly higher when compared to T2DM patients without MA while the mean diastolic blood pressure body mass index and age did not differ significantly between the two groups. Conclusions: The overall prevalence of the MA among type 2 diabetes visiting a medical outpatient clinic in Central Hospital; Warri were high and similar to that reported in other studies."

Is Screening for Microalbuminuria in Patients with Type 2 Diabetes Feasible in the Cape Town Public Sector Primary Care Context? A Cost and Consequence Study

Background: Type 2 diabetes contributes significantly to the burden of disease in South Africa. Proteinuria is a marker for chronic kidney and cardiovascular disease. All guidelines recommend testing for microalbuminuria because intervention at this stage can prevent or delay the onset of disease. Currently; none of the community health centres (CHCs) in Cape Town test for microalbuminuria; and there are concerns about its costs and feasibility. Objectives: The aim of this study was to assess the practicality; costs and consequences of introducing a screening test for microalbuminuria into primary care. Design: Chronic care teams were trained to screen and treat all patients with diabetes (n = 1 675) over a one-year period. The fidelity of screening; costs and consequences was evaluated. Setting and subjects: Patients with type 2 diabetes and chronic care teams at two community health centres in the Cape Town Metro district. Outcome measures: Data to evaluate screening were extracted from the records of 342 randomly selected patients. Data to evaluate treatment were taken from the records of all 140 patients diagnosed with microalbuminuria. Results: Of the patients with diabetes; 14.6 already had macroalbuminuria. Of the eligible patients; 69.9 completed the screening process which led to a diagnosis of microalbuminuria in another 11.7. Of those who were positively diagnosed; the opportunity to initiate angiotensin-converting enzyme (ACE) inhibitors was missed in 20; while 49.2 had ACE inhibitors initiated; or the dosage thereof increased. It would cost the health system an additional R1 463 to screen 100 patients and provide additional ACE inhibitor treatment for a year to the 12 that were diagnosed. Conclusion: The study demonstrated the feasibility of incorporating microalbuminuria testing into routine care. The costs involved were minimal; compared to the likely benefits of preventing end-stage renal failure and the costs of dialysis (estimated at R120 000 per year per patient)

Evaluation of Point-of-Care Tests for Detecting Microalbuminuria in Diabetic Patients

Background: Microalbuminuria; the presence of low levels of albumin in the urine; indicates renal damage and is recognised as a risk factor for the progression of renal and cardiovascular disease. Several international scientific bodies recommend microalbuminuria screening. Point-of-care testing (POCT) of microalbuminuria allows immediate identification of risk; and monitoring of treatment effects. In this study; two POCT instruments were evaluated as microalbuminuria screening methods. Method: Spot urine specimens from diabetic patients were analysed with the quantitative HemoCuer urine albumin analyser (n = 245); and the semiquantitative Clinitekr microalbumin urine dipstick (n = 204). These results were compared to the respective data for laboratory-determined albumin (nephelometry); creatinine (modified Jaffe) and albumin-to-creatinine ratio (ACR). Results: Linear regression analysis demonstrated a good correlation for the HemoCuer urine albumin with the laboratorydetermined albumin concentration (y = 0.8557x + 0.2487y; r = 0.97). The sensitivities for the HemoCuer and Clinitekr POCTsystems were 79.6and 83.8; and the pecificities 97.1and 93.8respectively. Positive and negative predictive values for the HemoCuer were 95.6and 85.8; and were 88.6and 91.0the Clinitekr. The repeatability of both instruments was excellent. Both instruments are easy to use; and more cost-effective than the laboratory methods for albumin and ACR. Conclusion: Both the HemoCuer and the Clinitekr microalbumin POCT systems for albuminuria are easy to use and inexpensive; and are adequately accurate as a screening method. Although the HemoCuer POCT system measures only urine albumin concentration; its sensitivity and specificity compared well with that of the Clinitekr POCT system; which determines the ACR

Incidence and evaluation of risk factors of microalbuminuria among diabetics and non-diabetics in Lagos; Nigeria

Contrary to African diabetic situation; clinical studies in developed countries have recognized microalbuminuria as a risk factor of renal dysfunction and pathogenic agent for deterioration of diabetes mellitus in diabetic and non-diabetic populations. This clinical understanding has enabled optimization of clinical practices that improve prognosis of diabetic management and reduce susceptibility to renal disease. This present study has investigated the incidence and risks of microalbuminuria in 115 diabetic patients aged 5 - 65 years with illness duration of 1 yr; 1 - 5 yr and 5 yr and 50 age and sex-matched non-diabetic subjects attending General Hospitals; Lagos; Nigeria. Blood pressures (SBP et DBP) and plasma levels of total cholesterol (TC); triglycerides (TAG); low-density lipoprotein (LDL-C) and high-density lipoprotein (HDL-C) as well as body mass index (BMI) were determined to establish associations with microalbuminuria. The incidence of microalbuminuria was found to be 22.2; 31.6and 59.1(P 0.05) among the diabetic groups; suggesting a linear relationship with the duration of diabetes in these patients. 26of non-diabetics had microalbuminuria of no significant disparity (P 0.05) when compared to diabetics of 1 yr-old duration. Multiple regression analyses indicate significant association (P 0.05) between SBP; DBP; TC; LDL-C and microalbuminuria in diabetic 5 yr. While all the atherogenic parameters except LDL-C associate strongly (P 0.05) with microalbuminuria in diabetics of 1 - 5 yr. The lipid atherogenic components minus TAG were found to relate strongly with microalbuminuria in diabetics of 1yr duration. Elevated BMI strongly predicts the risk of microalbuminuria in the non-diabetics examined

Incidence and Evaluation of Risk Factors of Microalbuminuria among Diabetics and Non-Diabetics in Lagos; Nigeria

Contrary to African diabetic situation; clinical studies in developed countries have recognized microalbuminuria as a risk factor of renal dysfunction and pathogenic agent for deterioration of diabetes mellitus in diabetic and non-diabetic populations. This clinical understanding has enabled optimization of clinical practices that improve prognosis of diabetic management and reduce susceptibility to renal disease. This present study has investigated the incidence and risks of microalbuminuria in 115 diabetic patients aged 5 - 65 years with illness duration of 1 yr; 1 - 5 yr and 5 yr and 50 age and sex-matched non-diabetic subjects attending General Hospitals; Lagos; Nigeria. Blood pressures (SBP et DBP) and plasma levels of total cholesterol (TC); triglycerides (TAG); low-density lipoprotein (LDL-C) and high-density lipoprotein (HDL-C) as well as body mass index (BMI) were determined to establish associations with microalbuminuria. The incidence of microalbuminuria was found to be 22.2; 31.6 and 59.1 (P 0.05) among the diabetic groups; suggesting a linear relationship with the duration of diabetes in these patients. 26 of non-diabetics had microalbuminuria of no significant disparity (P 0.05) when compared to diabetics of 1 yr-old duration. Multiple regression analyses indicate significant association (P 0.05) between SBP; DBP; TC; LDL-C and microalbuminuria in diabetic 5 yr. While all the atherogenic parameters except LDL-C associate strongly (P 0.05) with microalbuminuria in diabetics of 1 - 5 yr. The lipid atherogenic components minus TAG were found to relate strongly with microalbuminuria in diabetics of 1yr duration. Elevated BMI strongly predicts the risk of microalbuminuria in the non-diabetics examined

Prevalence de la microalbuminurie au sein d'une population diabetique au Benin

La microalbuminurie est une complication frequente du diabete insulinoprive. Elle n'est cependant pas rare dans le diabete de la maturite. Les auteurs notent que dans 30;45 pour cent des cas; cette anomalie est presente chez le diabetique beninois. Ils insistent sur la necessite de la recherche systematique et sur le role benefique d'une normoglycemie au long cour qui permet d'eviter sa survenue