Risk factors associated with the development of overt nephropathy in type 2 diabetes patients: A 12 years observational study.

Background & objectives: Diabetic nephropathy (DN) is the leading cause of chronic kidney disease and end-stage renal disease in developing countries. Early detection and risk reduction measures can prevent DN. The aim of the study was to determine the risk factors for the development of proteinuria over a period of 12 years of follow up in normoalbuminuric type 2 diabetes patients attending a specialized centre. Methods: Of the 2630 type 2 diabetes subjects newly registered in 1996, 152 (M:F;92:60) normoalbuminuric subjects had baseline and subsequent measurements of anthropometric, haemodynamic and biochemical details spanning 12 years. The subjects were divided into 2 groups based on the renal status during follow up visits. Group 1 (non-progressors) had persistent normoalbuminuria and group 2 (progressors) had persistent proteinuria. Presence of other diabetic complications during follow up and details on antidiabetic and antihypertensive agents were noted. Results: During median follow up of 11 years in subjects with normal renal function at baseline, 44.1 per cent developed proteinuria at follow up. Glucose levels, HbA1c, systolic blood pressure (SBP), triglycerides, and urea levels were significantly higher at baseline among progressors than non-progressors. Progressors had a longer duration of diabetes and significant fall in estimated glomerular filtration rate (eGFR) levels at follow up. In Cox's regression analysis, baseline age, duration of diabetes, baseline HbA1c and mean values of HbA1c, triglycerides, SBP and presence of retinopathy showed significant association with the development of macroalbuminuria. Interpretation & conclusions: Type 2 diabetes patients with uncontrolled diabetes and increase in blood pressure are at high risk of developing nephropathy. Age, long duration of diabetes, elevated BP, poor glycaemic control and presence of retinopathy were significantly associated with the progression of diabetic nephropathy.

Efficacy of Glycated Albumin (GA) in Comparison with Glycated Haemoglobin (HbA1c) in Type 2 Diabetic Subject in India.

The study was planned to determine the efficacy of GA in comparison with HbA1c among type2 diabetic subjects. A total of 94 type 2 diabetic (group2) subjects were selected for this prospective study and were compared with 50 non diabetic controls (group1). The subjects were reviewed for a period of 3months. Anthropometric, blood pressure, plasma glucose, GA and HbA1c measurements were done at baseline, 1st and final follow up visits for all the subjects.GA levels strongly correlated with HbA1c% both in control and study group. The mean GA and HbA1c values were significantly lower at the baseline and during follow up visits in controls than in study subjects (p<0.001). GA, HbA1c and the ratio decreased significantly within 4weeks, but GA showed a significantly larger decrease than HbA1c. There was no significant difference in the GA% after 3months. GA may be a useful marker for assessing short term glycemic changes in type2 diabetes.