ABSTRACT
Background: Diabetes mellitus is the commonest endocrine disease in Nigeria. Nephropathy is one of the complications of type 2 diabetes mellitus that could lead to end stage renal disease. Persistent microalbuminuria is a predictor of high risk of developing diabetic nephropathy. Early detection of kidney disease and intervention will prevent progression to end stage renal disease. Objective: To determine the association between albumin creatinine ratio and eGFR in type 2 diabetic patients, their usefulness as early predictors of diabetic nephropathy and progression of disease. Materials and Methods: This was a cross sectional study conducted in the State Specialist Hospital, Benin City, Edo State, Nigeria. Forty six type 2 diabetes mellitus patients, both male and female within the age range of 30 – 85 years were recruited for the study, after meeting the inclusion criteria. Twenty age and gender matched healthy subjects were selected as controls. Fasting plasma glucose, glycated haemoglobin, C-Reactive protein, serum creatinine were assayed. Urine albumin was estimated and albumin creatinine ratio determined, eGFR was estimated according to the Modification of Diet in Renal Disease (MDRD) formula. Results: There was a significant difference between means of glycated haemoglobin, C – Reactive protein, Albumin creatinine ratio, eGFR of subjects which was (8.3±2.1%, 17.9±1.3 mg/l, 247.7±22.2 mg/g, 88±5.9 ml/min) respectively and that of controls which was (4.5±1.1%, 10.2±2 mg/l, 22.7±5.1 mg/g, 93.1±2.3 ml/min) p<0.05. ACR showed a strong and linear negative correlation with eGFR (r=-.682, p<0.05). A higher percentage of patients (64.7%) with e-GFR<60 ml/min had microalbuminuria, compared with (57.7%) with microalbuminuria in the subjects with eGFR>60 ml/min. Albuminuria worsened with increased duration of disease, as 55.6% of patients with diabetes mellitus of 5 years and above had macro albuminuria compared with 25% of patients with disease less than 5 years. Decline in eGFR increased with increasing duration of disease, 55.6% with disease duration of 5 years and above had eGFR<60 ml/min, compared with 45.5% in those with disease less than 5 years. Conclusion: Albumin creatinine ratio and eGFR had a significant and linear negative correlation in this study. Therefore, they could be useful as predictors of early kidney disease in type 2 diabetes mellitus in this local government area. Increase in severity of albuminuria, coupled with higher prevalence of decline in eGFR with increasing duration of disease may be suggestive of their usefulness as predictors of disease progression.
ABSTRACT
Diabetes is the commonest endocrine metabolic disorder in Nigeria. Aim: The aim was to assess the level of glycaemic control in type 2 diabetics in Oredo and Egor local government areas in Benin metropolis, with a view of planning improved diabetes care. Study and Design: This is a cross sectional study. Place and Duration of the Study: The study was carried out in the department of medicine Central Hospital Benin (Secondary Health center), department of Medicine University of Benin teaching Hospital (Tertiary Health center) and department of chemical pathology, University of Benin teaching hospital Benin City Nigeria between October 2012 and June 2013. Methodology: Fasting Blood sample of 126 type 2 diabetics (38.1% males and 61.9% females from the secondary health centre and 781 type 2 diabetics (47.1% male and 58.3% females ) from the tertiary health centre was assayed for plasma glucose and Glycated haemoglobin. Body mass index was calculated from measured height and weight and blood pressure measurements taken with mercury sphygmomanometer. Results: Mean fasting plasma glucose and mean glycated haemoglobin was 142.2±7.2mg/dl, 8.3±2.1% and 145.8±5.4mg/dL,8.3±2.6% for patients in the secondary and tertiary health centres respectively. 20.6% of the patients in the secondary health centre and 40.5% of those in the tertiary health centre had glycated haemoglobin values < 7% as recommended by the American Diabetes Association (ADA). 25.3% and 20.6% of the patients in the secondary and tertiary health centres respectively, met the blood pressure target recommended by ADA. Conclusion: Most diabetics in Egor and Oredo Local Government Areas, Benin City, south-south Nigeria still have suboptimal glycaemic control, are hypertensive and have chronic complications of the disease. Improved Health care delivery, and subsidization of health care is recommended.