Consequential of Hemoglobin E Disorder on Renal Complication of Diabetic Patients in Surin Hospital, Thailand

Abstract

Background: Decreased erythrocyte life-span is associated with artificial low hemoglobinA1c (HbA1c) in hemoglobin E diabetes. This research aims to study the renal complication in hemoglobin E disorder diabetic patients in Surin hospital. Methods: This case control cohort study was conducted from 2009 to 2018.Patient’s clinical information, fasting plasma glucose (FPG), and HbA1c levels were collected and divided into two groups, homozygous group (HbEE) and negative dichlorophenol-indolephenolgroup (control group). Subjects were confirmed diabetics who already had been treated either with insulin, oral hypoglycemic drugs or a physician-prescribed diet. Target of diabetic control follow standard treatment, not try to intensive control. The endpoint was that of new diabetes nephropathy, defined as the development of macroalbuminuria (urine albumin > 300 microgram/milligram) and rate of decline of estimated glomerular filtration rate (eGFR) per year. The hypothesis was that the cumulative average duration of disease was equal; the renal complication between two groups was not different. Results: From 2009 to 2018, 132 diabetic patients with hemoglobin E disorder and 493 diabetic patients with negative DCIP were included in the study. There were no significant differences in regard to age, duration of disease, systolic blood pressure (SBP), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) among the groups. The hematocrit (Hct.), diastolic blood pressure (DBP), hemoglobin A1c (HbA1c), cholesterol (CHO), triglyceride (TG), serum creatinine (Cr) was significantly lower in HbEE group. The eGFR and FPG was significant high in HbEE group. When compared with controls, risk difference of macroalbuminuria was 4.2% lower prevalent in diabetic patients with hemoglobin E homozygous (P=0.008). The rate of decline in eGFR were significant much slower in HbEE group 0.64 ml/min/year and 0.71 ml/min/ year in control group (P<0.001), after adjusted confounding factors. Conclusions: With long term cohort study, hemoglobin E disorder diabetic patients have less effect on renal complication when the mean fasting plasma glucose level was higher and lower HbA1c than negative DCIP group. Diabetic patients with hemoglobin E disorder should be monitored using HbA1c level as an indicator for long-term glycemic control.