Assessment of serum magnesium and correlation with glycemic control and complication in type 2 diabetes mellitus – A cross-sectional study in a tertiary care hospital in eastern zone of India

Background: Diabetes mellitus (DM) is an expanding global health problem. Type 2 DM (T2DM) patients account about 90% of total DM patients. Magnesium is important for different physiological mechanism. Hypomagnesemia is common in T2DM patient. Magnitude of hypomagnesemia is related with glycemic control and is associated with complications of T2DM. Aims and Objectives: Our aim of the study was to assess the prevalence of hypomagnesemia in patients of T2DM patients and to find their correlation with glycemic control and complications of T2DM patients in rural population of eastern zone of India. Materials and Methods: The hospital-based cross-sectional study includes 99 male and female DM patients between 15 and 60 years age. Fasting blood sugar, postprandial blood sugar, HbA1c, serum total magnesium, and urine albumin creatinine ratio were measured. Data were entered into Microsoft Excel spreadsheet and then analyzed by SPSS (version 25.0; SPSS Inc.) and GraphPad Prism (version 5.0). P < 0.05 was considered statistically significant. Results: From our study, we observed that hypomagnesemia is common in T2DM patients. The magnitude of hypomagnesemia is correlated with glycemic control (P < 0.0001). Moreover, hypomagnesemia is associated with diabetic kidney diseases (P < 0.05). Conclusion: It can be concluded that serum magnesium should be monitored in all T2DM patients and should be managed appropriately because hypomagnesemia may induce complications in T2DM patients.

Self-Measured Blood Pressure and Target Organ Damage in Newly Detected Hypertension in South Gujarat, India

Introduction: Blood pressure transient spikes have been considered to be noise and only a hindrance to a proper assessment of typical blood pressure, which is defined as the actual underlying average blood pres-sure over a long period of time. The current study aimed to see if the highest Self measured Systolic blood Pressure could be utilized to forecast the occurrence of Target organ damage and evaluate the independent association between the maximum Self measured Systolic blood Pressure and Target organ damage in indi-viduals with untreated hypertension. Method: We evaluated the urine albumin/creatinine ratio (UACR) and carotid intima-media thickness (IMT) using ultrasonography in 462 hypertensive individuals who had never taken treatment for their hypertension. Residential blood pressure was recorded. Result: The maximal Self measured Systolic blood Pressure had considerably higher association coefficients with left ventricular mass index (LVMI) and carotid intima-media thickness than the mean Self measured Sys-tolic blood Pressure. Irrespective of the mean Self measured Blood pressure level, multivariate regression studies showed that the maximal Self measured Systolic blood Pressure was independently related with left ventricular mass index and carotid intima-media thickness. Conclusion: Transiently high blood pressure measurements recorded at Self measured shouldn't be dis-missed as noise but rather taken seriously as significant warning signs of hypertensive Target organ damage in the heart and arteries.

Additive antiproteinuric effect of pentoxifylline in patients with diabetic nephropathy under angiotensin receptor blockade: A short-term, randomized, and controlled trial

Background: The ever-increasing prevalence of diabetes has led to a higher incidence of progression into complications including nephropathy. Diabetic kidney disease (DKD) is a chronic condition that is managed with renin-angiotensin-aldosterone system blockers which retard its progression. Pentoxifylline as an add-on therapy has been tried for reducing DKD. Aims and Objectives: The aims of this study were to study the safety and efficacy of pentoxifylline added on to an angiotensin II receptor blocker (ARB) to reduce the progression of the disease condition in diabetic nephropathy (DN) patients over 1 year. Materials and Methods: It is a randomized open-label study conducted in the Department of Nephrology, of a tertiary care center for 1 year. Type 2 diabetes patients with DN who satisfied the eligibility criteria were randomized into pentoxifylline added on to ARB or ARB alone and followed up for urine albumin-creatinine ratio (ACR) and serum tumor necrosis factor (TNF)-alpha. Results: Twenty-six patients were recruited and completed the study. Urine ACR was significantly low in the pentoxifylline group compared to the ARB alone group (P = 0.021). Serum TNF-? was decreased in the pentoxifylline group in comparison to the ARB alone group (P = 0.06). Conclusion: Pentoxifylline caused significant lowering of urinary ACR and urine TNF-? for 4 months.

Association of serum chemerin level with early renal insufficiency in patients with type 2 diabetes / 中华内分泌代谢杂志

Objective:To assess the correlation between circulating chemerin and two indicators of renal function, estimated glomerular filtration rate (eGFR) and urine albumin creatinine ratio (UACR), in individuals with type 2 diabetes and to determine whether chemerin is an independent marker of early renal insufficiency.Methods:A total of 742 patients with type 2 diabetes were recruited into the cross-sectional community study. Basic information, anthropometric parameters, and biochemical parameters of these individuals were determined and collected, and serum chemerin level was measured using enzyme-linked immunosorbent assay.Results:Chemerin levels were significantly higher in the eGFR-impaired group compared with eGFR-normal group, and macroalbuminuria group compared to the normal or microalbuminuria groups. Spearman′ rank correlation analysis showed serum chemerin level was correlated with eGFR ( r=-0.25, P<0.001), UACR ( r=0.23, P<0.001) and some other biochemical indicators such as triglyceride. And univariate and multivariate logistic regression analyses revealed circulating chemerin was an independent risk factor for eGFR impairment or proteinuria after adjusting corresponding covariates. Receiver operating characteristic (ROC) curve analysis showed that the area under curve (AUC) of circulating chemerin for predicting early impaired eGFR in type 2 diabetes was 0.747, while the AUC of circulating chemerin for predicting macroalbuminuria in type 2 diabetes was 0.748. Conclusion:Circulating chemerin is associated with eGFR or UACR and may be a potential diagnostic marker for early renal insufficiency in type 2 diabetes.

Hypoadiponectinemia as a marker of increased cardiovascular risk in patients with non-alcoholic fatty liver disease: correlation with albumin/creatinine ratio

ABSTRACT Objective: We assessed plasma adiponectin and its correlation with carotid intima-media-thickness (CIMT), as a marker of atherosclerosis, and urine albumin/creatinine ratio (ACR) in patients with non-alcoholic fatty liver disease (NAFLD). Subjects and methods: The study included 100 Egyptian subjects (50 patients with NAFLD with no history of diabetes or hypertension and 50 age and sex-matched normal healthy control subjects). Urine albumin/creatinine ratio (ACR) was assessed in all participants and fasting plasma adiponectin was measured using ELISA technique. Ultrasonography was used to diagnose NAFLD. CIMT was assessed using high-resolution Doppler ultrasonography. Results: Mild albuminuria was detected in patients with NAFLD (mean urine ACR = 42 ± 30 mg/g). Plasma adiponectin was significantly lower and urine ACR and CIMT significantly higher in patients with NAFLD as compared with the control group (P < 0.001 for all). A significant negative correlation was found between plasma adiponectin and both urine ACR and CIMT in patients with NAFLD (P < 0.001 and < 0.05 respectively). A significant positive correlation was also found between CIMT and urine ACR in those patients (P < 0.05). Plasma adiponectin and urine ACR were independent determinants of CIMT in patients with NAFLD (P < 0.01 and < 0.05 respectively). Conclusion: Patients with NAFLD, without diabetes, have an increased risk of atherosclerosis and cardiovascular disease. Hypoadiponectinemia and low-grade albuminuria are important markers of that risk.

The relationship between heart rate variability and urine albumin/creatinine ratio in patients with type 2 diabetes / 中华内分泌代谢杂志

Objective:To explore the relationship between heart rate variability (HRV) and urine albumin/creatinine ratio (ACR) in patients with type 2 diabetes.Methods:A total of 1 543 patients with type 2 diabetes were selected from the Department of Endocrinology of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, and all the participants received 24-hour Holter monitoring and ACR measurement. HRV parameters include the standard deviation of all normal to normal intervals (SDNN), root mean square differences of successive RR intervals (rMSSD), the percent of adjacent RR intervals with a difference greater than 50 ms (PNN50), low frequency (LF), high frequency (HF), the ratio of LF to HF (LF/HF). Multivariate linear regression was used to analyze the relationship between HRV and ACR. Logistic regression was performed to further analyze the relationship between HRV and albuminuria while HRV parameter was divided into ≤25% (Q1) and ≥25% (Q2-Q4).Results:Multivariate linear regression results showed that the decrease of HRV parameters [ln(SDNN), ln(PNN50), ln(LF), ln(HF), ln(LF/HF)] was closely related to the increase of ln(ACR) (all P<0.05). Logistic regression analysis results showed that SDNN( OR=1.669, 95% CI 1.290-2.159), PNN50( OR=1.372, 95% CI 1.063-1.770), LF( OR=1.918, 95% CI 1.441-2.551), and LF/HF ( OR=1.623, 95% CI 1.220-2.183) were independent risk factors for albuminuria (all P<0.05); Furthermore, logistic regression analysis stratified by the median duration of diabetes (10 years) and cardiovascular disease found that in patients with diabetes≤10 years or without cardiovascular disease, the risk of albuminuria in the SDNN and LF Q1 group were higher than that in the Q2-Q4 group; while in patients with diabetes>10 years or with cardiovascular disease, the risk of albuminuria in the SDNN, PNN50, LF, and LF/HF Q1 group were higher than that in the Q2-Q4 group. Conclusion:The reduction of HRV parameters in patients with type 2 diabetes is closely related to the increase of ACR. With the progress of diabetes, more HRV parameters demonstrated predictive effect for risk of albuminuria.

Evaluation of the Association between Ischemia Modified Albumin (IMA), Glycemic and Lipid Status in Diabetic Nephropathy

Introduction:Hyperglycemia induced oxidative stress in Type 2 Diabetes Mellitus modifyvarious biomolecules to cause Diabetic Nephropathy (DN). IMA (Ischemia-Modified Albumin) is one such oxidative stress marker already examined in various clinical events but have not yet been evaluated in different stages of DN. Aim:To estimate and assess the relationship of IMA with glycemic status and lipid parameters in all stages of DN. Study Design: Cross-sectional study.Place and Duration of Study: Study was conducted at Department of Biochemistry,Kasturba Medical College Hospitals, Mangaluru conducted between 2014 and 2015 Materials andMethods:There were 60 type 2 diabeticcases and 30 healthy controls. Diabetic cases were further categorized into three equal groups on the basis of UACR (urine albumin-creatinine ratio), DN stage I having UACR less than 30 mg/g, DN stage II having UACR 30 to 300 mg/g, and DN stage III havingUACR ≥ 300 mg/g of creatinine. Using enzyme-linked immunosorbent assay serum IMA level was estimated whereas automated analyzers was used for serum creatinine, HbA1c, urine albumin and urine creatinine analysis.Results:Lowest level of IMA (109 ng/mL) measured in DN stage I, which was significantly different from those in DN stage II (154 ng/mL) and DN stage III (178 ng/mL). The significant positive correlation between IMA and fasting blood glucose, glycated hemoglobin were present in stage II and stage III DN. In this study significant positive correlation of serum IMA to serum total cholesterol, low density lipoprotein cholesterol and negative correlation with high density lipoprotein were revealed in all stage of DN. Conclusion:Current study postulates that early evaluation of serum IMA in diabetic patients with deranged lipid profile will provide an index of nephropathy development. This will help in prognosis and controlling complication in diabetes mellitus.

Moderately Increased Albuminuria; Marker of Chronic Complications in Nigerian Diabetes Mellitus Type 2 Patients; Makurdi Perspective.

Background: Diabetes mellitus (DM) and its complications are on the increase especially in the developing countries with significant negative economic consequences on individuals, families and health systems. Objective: We, therefore compared albumin/creatinine ratio, microalbuminuria, and HbA1c among subjects of varying degree of complications with controls to ascertain if they can serve as markers of diabetic chronic complications to enhance early detection of chronic complications amongst diabetes mellitus patients in developing countries. Methods: 109 type 2 DM subjects (47 males and 62 females) and 100 non-DM controls of the same age range (40-80 yrs) were recruited for this study. The chronic complications found were: nephropathy, retinopathy, coronary artery disease, cerebrovascular disease, peripheral vascular disease and diabetic foot. These were further classified into micro vascular complications (nephropathy and retinopathy) and macrovascular complications (Coronary Artery Disease, Cerebrovascular Disease, Peripheral Vascular Disease and diabetic foot).Out of these 109 DM subjects, 36 were without chronic complications, 37 have microvascular complications only and 36 have a combination of microvascular and macrovascular complications. HbA1c, Urine microalbumin and creatinine were analysed using standard methods. Results: The mean levels of HbA1c, Microalbuminuria and albumin-creatinine ratio were significantly higher in DM subjects when compared to the control (p<0.05). Microalbumin, albumincreatinine ratio, and HbA1c were significantly higher in DM subjects with chronic complications than those without complications (p<0.05). However, DM subjects with both macro and micro complications had significant higher level of urine microalbumin, albumin-creatinine ratio, and HbA1c than those with microvascular complications only (p<0.05). Subjects aged 40-45 years had significant (p<0.01) albumin/creatinine ratio than subjects aged 51-55yrs as well as those >60 years. The male subjects had a significant (p<0.01) albumin/creatinine ratio and microalbumin respectively on comparing to their female counterpart Conclusion: Albumin-creatinine ratio is a simple, and less cumbersome tool which could serve as a predictor of complications in type 2 diabetes mellitus.

Urinary Albumin Excretion Rate: Diagnostic and Prognostic Utility in Essential Hypertension.

Context : To evaluate the usefulness of urinary albumin excretion rate (UAER) i.e. Albumin/Creatinine Ratio (ACR) in diagnosis and prognosis of essential hypertension (EHT). Objectives : To find out the association of urinary albumin excretion rate with the pathophysiology of essential hypertension. Study Design : A cross-sectional analytical study. Materials & Methods : Urinary albumin excretion (UAE), urinary creatinine (UC) and UAER were analyzed and compared between hypertensive cases and age & sex matched normotensive controls of age group 30-65 years using unpaired two-tailed Student ‘t’ test. All statistical analyses were done with PASW (SPSS) v.18.0. Results : Systolic BP (SBP) and diastolic BP (DBP) of cases were found to be significantly higher (p < 0.001) than controls. Urine MAlb level (p < 0.001) and ACR (p < 0.001) in cases were significantly higher compared to controls. Correlation studies showed that SBP and DBP was significantly positively correlated with urine MAlb (SBP: r = 0.859, DBP: r = 0.733; p < 0.001) and ACR (SBP: r = 0.830, DBP: r = 0.739; p < 0.001). Sex-wise comparison in cases revealed that males had statistically non-significant (p > 0.05) lower levels of urine MAlb as compared to females but had significantly higher (p < 0.001) levels of urine creatinine and lower (p < 0.001) ACR compared to females. Conclusion: Urinary MAlb levels and ACR are seen to be increased in hypertensive subjects compared to normotensive subjects. ACR was significantly higher in female hypertensives than males which can be credited to the physiologically observed lower urine creatinine levels compared to males. Both Microalbuminuria and ACR can serve as specific and well-established marker of cardiovascular and renal damage in EHT.

Urine Albumin Creatinine Ratio is Associated with Carotid Atherosclerosis in a Community Based Cohort: Atherosclerosis Risk of Rural Area in Korean General Population Study

BACKGROUND: Albuminuria is a surrogate marker of endothelial dysfunction and a predictor of cardiovascular events. Data are limited with regard to the relationship between albuminuria and subclinical atherosclerosis in a community-based cohort. We determined the association between albuminuria measured by the urine albumin creatinine ratio (UACR) and carotid intima media thickness (CIMT) in a Korean rural population. METHODS: We enrolled 1,369 healthy subjects older than 40 years (857 males and 518 females) with normal renal function and measured the CIMT. We excluded subjects with overt proteinuria (> 300 mg/day) or with treatment of diabetes mellitus, hypertension, dyslipidemia, and any cardiovascular disease. The subjects were stratified into the quartile value of the UACR (lowest quartile: UACR 17.7). And we evaluate the relationship between UACR and CIMT by linear regression and logistic regression analysis. RESULTS: Increasing quartile of the UACR had a stepwise increase in body mass index, blood pressure, cholesterol profile [low density lipoprotein (LDL)-cholesterol and triglyceride], glucose, homeostratic model assessment of insulin resistance (HOMA-IR), and C-reactive protein (all p values < 0.001). Maximal CIMT from the 1st to the 4th quartile values of the UACR were 0.74 +/- 0.17, 0.77 +/- 0.18, 0.78 +/- 0.18, and 0.82 +/- 0.21 mm, respectively (p < 0.001). In a multivariate regression model adjusted for age, sex, systolic blood pressure, triglyceride, LDL-cholesterol, fasting blood sugar, waist circumference, adiponectin, HOMA-IR, high sensitive C-reactive protein, smoking, UACR showed a significant association with maximal CIMT (B = 0.014, R2 = 0.145, p = 0.002). CONCLUSION: Albuminuria measured by the UACR was significantly associated with both CIMT and traditional risk factors of atherosclerosis except for smoking in healthy Koreans.