Factors Related to the High Prevalence of Diabetic Kidney Disease in Ecuador-Update for Health Policy Makers

Abstract

Type 2 diabetes mellitus (T2DM) and diabetic kidney disease (DKD) are prevalent diseases in South America. Identification of factors associated to DKD is key to design appropriate regional health policies. We characterized DKD in 1663 adults (99% Confidence level, 1.4% margin of error) recruited from the general population of the Ecuadorian coast between 2014 and 2017 (46±14 years of age, 64% of them were women). Framed in our prospective, observational and cross-sectional study (NCT02237352) we evaluated demographic data, personal and family history, BMI, blood pressure (BP), plasma glucose (PG), HbA1c, creatinine (cr) and microalbuminuria (μAlb). T2DM was defined as peoples with clinical diagnosis of T2DM, being on insulin or oral hypoglycemic treatment, fasting PG ≥126 mg/dl, random glucose ≥200 mg/dl and HbA1c ≥6.5%. Subjects were deemed to have DKD when they presented μAlb ≥30 mg/gr-cr and/or estimated glomerular filtration rate ˂60 ml/min/1.73m2. Results: Our study shows that the prevalence of DKD in the Ecuadorian coast was 9.3% (95% CI, 8%-11%) with 19.5% of the persons not knowing their T2DM status. The factors significantly different comparing DKD vs. non-DKD subjects (P<0.05) were: Female 71.4% (CI 95%, 64% -78%) vs. 57.4% (95% CI, 61%-66%); age 58±9 vs. 45±14 years; BMI 29.5±4.9 vs. 27.7±5.3 Kg/m2; systolic BP 133.5±20.9 vs. 119.4±16.8 mmHg; diastolic BP 82.9±13.4 vs. 75.4±12 mmHg; PG 197.3±103.6 vs. 98.4±41.5 mg/dl; HbA1c 8.8±2.6 vs. 5.7±1.3%; personal history of gestational diabetes (GD) 7.3% (95% CI, 3%-14%) vs. 2.4% (95% CI, 2%-4%) and overweight newborn children (ONBC) 30.9% (95% CI, 23%-41%) vs. 14.7% (95% CI, 13%- 17%). Conclusion: Female gender, age, BMI, BP, PG, HbA1c, history of ONBC and GD all are factors linked to DKD in the Ecuadorian coast that should be considered to design meaningful health policies, to address the currently high prevalence of DKD. The amount of people unknowing their diagnosis of T2DM among folks with DKD suggests emphasizing the screening of T2DM. Disclosure M.E. Guadalupe: None. G.B. Alvarez Condo: None. F.E. Vera Lorenti: None. B.J. Pazmiño Gomez: None. E.I. Rodas Neira: None. D. Veron: None. A.G. Cercado: None. G.A. Villegas: None. A. Tufro: None. D. Veron: None.