Evaluation of Microalbuminuria and Glycosylated Hemoglobin in the Assessment of Diabetes Control in Children with Type 1 Diabetes Mellitus Hospitalized with Diabetic Ketoacidosis

Abstract

Background: Microalbuminuria is thought to be an early predictor of impending diabetic nephropathy, while glycosylated hemoglobin (HbA1c) is a biochemical marker of long-term glycemic control in children with type 1 diabetes mellitus (T1DM). Objectives: The study aimed to evaluate the prevalence of microalbuminuria and its association with HbA1c on admission and duration of diabetes. Also, changes in HbA1c level on admission and three months after admission were studied to assess diabetes control in children with T1DM. Methods: This prospective study was conducted among 38 children (< 18 years) diagnosed with TIDM presenting with clinical signs, symptoms, and biochemical parameters of DKA. The presence of microalbuminuria, HbA1c level, and the number of past episodes of DKA were recorded. HbA1c level was again estimated after three months. The resultant data was tabulated and analyzed statistically (P < 0.05). Results: Microalbuminuria and poor HbA1c control were observed in 18% and 60% of the sample population, respectively. A significant association was found between HbA1c > 9% (P = 0.032) and the duration of diabetes > 4 years (P = 0.032) and microalbuminuria. Significant improvement in glycemic control was noted from the time of admission to three months after admission (9.76 ± 2.77 vs. 7.75 ± 1.28; P = 0.00012). A significant difference was observed between past DKA episodes according to HbA1c control (P < 0.001). Conclusions: Microalbuminuria assessment is needed in T1DM children, especially those with HbA1c > 9% and duration of diabetes > four years, to evaluate diabetic nephropathy. Good glycemic control can be achieved with effective insulin therapy accompanied by appropriate counseling and regular follow-up.