Nephropathy in low income diabetics: the Mexico City diabetes study

RESUMO

Among the most serious complications associated with diabetes mellitus (DM) is nephropathy (DN). In Mexico, there is little information on the frequency and clinical characteristics of DN in the Mexican population. We present results of a population-based survey designed to estimate the prevalence of DN. The low income population consisted of 15,532 inhabitants. All 35- to 64-year-old males and non-pregnant women residing in the survey area were identified as eligible for the study (3505; 22.6 percent). A home interview was obtained in 2810 (80.2 percent). A physical exam with oral glucose tolerance test wasobtained in 2282 (81.2 percent of those interviewed). DM was diagnosed in 304 (crude rate 13.3 percent). Mean age for men and women with DM was 51.6 ñ 8.4 and 52.2 ñ 7.5, respectively. Duration of DM in men was 9.2 ñ 8.1 and in women, 7.3 ñ 6.7 years. Hypertension was diagnosed in 19.8 percent of men and 18.1 percent of women. Diabetic retinopathy of any level was found in 55.4 percent of men and 45.7 percent of women. Mean glycohemoglobin in men was 9.6 ñ 2.1 and in women 9.5 ñ 2.2 percent (normal 4 - 8 percent). At baseline, proteinuria (1+ or more, by dipstick) was found in 24.7 percent of men and 9.6 percent of women, microalbuminuria (MA) in 84.4 percent of men and 63.8 percent of women. Quantitative albuminuria was abnormally high in 54.7 percent of men and 40.3 percent or women. In the 203 diabetic studied with 24 h urine collection from creatinine clearance, normal renal function was found in 69.1 percent of men and 47.5 percent of women, reduced renal function was found in 26 percent of men and 50 percent of women, ranl insufficiency was diagnosed in 4.9 percent of men and 1.6 percent of women. One patient was on dialysis and in a subsequent follow up, we found that 2.3 percent of the patients had died of renal failure, six men (46 -63 years) and a woman of 62 years. We concluded that DN is a very serious threat to this population. The high case fatality rate associatd with this condition maintains a low prevalence. It is important to develop a program to diminish the frequency of this condition