Diabetes Microalbuminuria Research Articles

Excreted albumin of diabetic microalbuminuria cases exhibits pseudo esterase activity: A new way to explore microalbuminuria, perhaps with more information

BackgroundMicroalbuminuria is associated with several clinical conditions of public health concern. Particularly in diabetic patients, there is routine microalbuminuria screening to understand whether the renal complication has progressed to the microalbuminuria stage or not. Therefore, microalbuminuria detection is a matter of considerable interest. For such detection, the clinical labs rely on immunochemical methods. Nevertheless, the immunochemical methods are believed to be less sensitive for the purpose. So, the need arises for continuous research in the field. We believe that pseudoesterase activity of the excreted albumin in microalbuminuria cases is a potential target. This aspect is investigated here and it is shown that the excreted albumin in diabetic microalbuminuria cases retains its pseudoesterase activity, unlike the overt albuminuria cases. MethodsThe cases of diabetic nephropathy and healthy controls were included in the study. The patients were divided into diabetic controls microalbuminuria, and overt albuminuria group considering the albumin to creatinine ratio (ACR). The urinary proteins of the cases were isolated by centrifugation. The obtained protein pellet was then checked for pseudoesterase activity by electrophoretic and fluorescence-based methods. The CD spectroscopy and LC-MS study was carried out to show the suitability of the substrate for the detection of albumin pseudoesterase activity. To further, understand the structure–function relation, molecular docking studies were carried out. ResultsFrom the CD and LC-MS study the suitability of the used substrate was confirmed. The electrophoretic and fluorescence study showed that the protein of the microalbuminuria group retained the pseudoesterase activity whereas the same is lost in the overt albuminuria group. The molecular docking studies indicated that a change in albumin structure may result in a change in its pseudoesterase activity. ConclusionThe urinary protein of diabetic microalbuminuria cases exhibits pseudoesterase activity. It distinguishes the excreted protein in the diabetic albuminuria group and the overt albuminuria group. This is the first study that showed the retention of pseudoesterase property in excreted albumin. Further, in this study a simple test is developed that distinguishes the excreted albumin in the microalbuminuria group and overt albuminuria group.

Management of the Diabetic Microalbuminuria with Ayurvedic intervention- A Case Report

Background: One of the most prevalent side effects of diabetes, diabetic nephropathy causes Hypoalbuminemia, chronic kidney damage and end-stage renal failure worldwide. This study was performed for the effectiveness of the Ayurvedic treatment in the patient presented with the complications of Diabetic Microalbuminuria with special reference of Kaphaja Shotha. A 67-year-old, male patient consulted to the Ayurveda hospital with generalized body swelling, difficulty in breathing on the rest, Fatigue for 2 years, following secondary prevention for two years. Design: Single Case report. Materials and Methods: In this prospective case study, conducted on a subject experiencing edema as a complication of diabetic nephropathy for two years, the individual was admitted to the Indoor Patient Department of Medicine. Over a period of three months, the subject was assessed every 15 days. The intervention involved the administration of oral medications including mainly Gokshuradi guggulu, Punarnavadi guggulu, Hingwastak Churna, Triphala Churna, Syrup Neeri KFT, and Gomutra Haritaki. The edema reduced progressively, and there was an alleviation of associated symptoms such as difficulty in breathing and fatigue. Additionally, the subject showed improvement in renal function parameters and reported an enhanced sense of well-being. Results: Laboratory investigation showed protein in urine and hypoalbuminemia with normal blood urea and S. Creatinine., which was corrected after treatment, increased serum albumin from 1.9 (g/dl) to 3.9(g/dl) and serum globulin from 1.7(g/dl) to 2.7 (g/dl). After 18 days, a significant improvement was noted in all the clinical features, blood investigations, Chest X ray of the patient and no any unwanted effects were noted during the study period. The case was managed without encountering any adverse effects, following the treatment regimen for Shotha. Keywords: Diabetic Microalbuminuria, Hypoalbuminemia, Kaphaja Shotha

Endostatin, soluble tumour necrosis factor receptor 1 and soluble tumour necrosis factor receptor 2 cannot predict new onset of microalbuminuria in patients with type 2 diabetes.

Inflammation and angiogenesis play an important role in the development of early diabetic kidney disease. We investigated the association of soluble Tumour Necrosis Factor Receptor 1 (sTNF-R1), sTNF-R2 and endostatin with new onset microalbuminuria in normoalbuminuric patients with diabetes mellitus type 2. We conducted a case control study to assess serum levels of sTNF-R1, sTNF-R2 and endostatin in 169 patients with new onset microalbuminuria and in 188 matched normoalbuminuric, diabetic controls. Baseline serum samples from participants of the ROADMAP (Randomized Olmesartan and Diabetes Microalbuminuria Prevention) and observational follow-up (ROADMAP-OFU) studies were used. Endostatin and sTNF-R1 but not sTNF-R2 were increased at baseline in patients with future microalbuminuria. In the multivariate analysis, each log2 increment in endostatin levels was associated with an increase of only 6% in the risk of development of microalbuminuria (adjusted HR (95% CI) 1.006 (1.001-1011). sTNF-R1 and sTNF-R2 levels were conversely associated with microalbuminuria, but the results did not reach statistical significance. The respective adjusted HRs (95% CI) were 1.305 (0.928-1.774) and 0.874 (0.711-1.074). sTNF-R1 and sTNF-R2 failed to predict the occurrence of microalbuminuria in normoalbuminuric patients with type 2 diabetes. Likewise, the utility of endostatin in predicting new onset proteinuria is limited.

Sympathetic skin response for early detection of type 2 diabetic peripheral neuropathy and nephropathy.

Diabetic peripheral neuropathy (DPN) and diabetic nephropathy (DN) are common complications of type 2 diabetes mellitus (T2DM). Although nerve conduction studies (NCS) and sympathetic skin response (SSR) can detect DPN, the more sensitive method for early diagnosis remains unclear. Furthermore, whether DPN can be used as a predictor for diabetic nephropathy needs clarification. We evaluated nerve conduction studies, sympathetic skin response, and the diabetic nephropathy indicator microalbuminuria (MAU) in 192 patients with type 2 diabetes mellitus and 50 healthy controls. Patients with type 2 diabetes mellitus showed a lower sensory nerve conduction velocity (SCV), sensory active nerve potential (SNAP), motor nerve conduction velocity (MCV), and compound motor action potential (CMAP) than the controls on NCS. Abnormal rates for nerve conduction studies and sympathetic skin response were 75.0% and 83.3%, respectively, in patients with type 2 diabetes mellitus. Interestingly, 54.2% of patients with normal nerve conduction studies had an abnormal sympathetic skin response. Moreover, we found a positive correlation between sympathetic skin response and microalbuminuria for the first time. The abnormal rate of microalbuminuria was 53.8%, lower than that of abnormal nerve conduction studies or sympathetic skin response patients. Sympathetic skin response is a more sensitive method than nerve conduction studies for the early diagnosis of diabetic peripheral neuropathy. Abnormal sympathetic skin response might serve as an indicator for early diabetic nephropathy. Additionally, diabetic peripheral neuropathy may occur earlier than diabetic nephropathy in the development of type 2 diabetes mellitus.

Eating Disorders in Adolescents with Type 1 Diabetes

Background Diabetes Mellitus is a chronic disease commonly associated with eating disorders especially in adolescents. Objectives to assess occurrence of eating disorders, and its nature, associated risk factors, comorbidities, and consequences in a cohort of adolescents with type 1 diabetes. Methods In this cross-sectional study, 138 patients were recruited to complete 3 questionnaires;Eating Attitude Test (EAT-26) and Eat Behavior questionnaire (ORTO-15) and Eating Disorder Examination Questionnaire version 6 (EDE-Q6) for assessment of any eating disorder (ED). Results Patients were categorized as having an ED according to predetermined cutoff value for each questionnaire. Of the 138 patients, 24 (17.4%) had risk for eating disorders by EAT-26 score, 53 (38.4%) have got Orthorexia nervosa by ORTO-15 and 45 (32.6%) were having a disordered eating behavior by EDE-Q6. Patients with risk of eating disorders had lower mean ORTO-15 score as compared to those without (p = 0.01), and higher mean Global EDE-Q6 (p < 0.001). A significant correlation was found between EAT-26 scores and both ORTO-15 and EDE-Q6 scores, (p < 0.05). As for risk factors, a positive correlation was found between EAT-26 scores and both age (p < 0.0001) and BMI (p < 0.0001). Also, ORTO-15 score correlated with duration of diabetes (p = 0.0418). Diabetic ketoacidosis, peripheral neuropathy and microalbuminuria occurred frequently in patients with any high score of the 3 questionnaires. Hypoglycemic episodes were reported more in those with high EAT-26 or global EDE-Q6 scores. Conclusion Subclinical eating disorders and abnormal eating behaviors are common in Egyptian adolescents with type I diabetes.

Clinical Characterization of Data-Driven Diabetes Clusters of Pediatric Type 2 Diabetes.

Pediatric Type 2 diabetes (T2D) is highly heterogeneous. Previous reports on adult-onset diabetes demonstrated the existence of diabetes clusters. Therefore, we set out to identify unique diabetes subgroups with distinct characteristics among youth with T2D using commonly available demographic, clinical, and biochemical data. We performed data-driven cluster analysis (K-prototypes clustering) to characterize diabetes subtypes in pediatrics using a dataset with 722 children and adolescents with autoantibody-negative T2D. The six variables included in our analysis were sex, race/ethnicity, age, BMI Z-score and hemoglobin A1c at the time of diagnosis, and non-HDL cholesterol within first year of diagnosis. We identified five distinct clusters of pediatric T2D, with different features, treatment regimens and risk of diabetes complications: Cluster 1 was characterized by higher A1c; Cluster 2, by higher non-HDL; Cluster 3, by lower age at diagnosis and lower A1c; Cluster 4, by lower BMI and higher A1c; and Cluster 5, by lower A1c and higher age. Youth in Cluster 1 had the highest rate of diabetic ketoacidosis (DKA) (p = 0.0001) and were most prescribed metformin (p = 0.06). Those in Cluster 2 were most prone to polycystic ovarian syndrome (p = 0.001). Younger individuals with lowest family history of diabetes were least frequently diagnosed with diabetic ketoacidosis (p = 0.001) and microalbuminuria (p = 0.06). Low-BMI individuals with higher A1c had the lowest prevalence of acanthosis nigricans (p = 0.0003) and hypertension (p = 0.03). Utilizing clinical measures gathered at the time of diabetes diagnosis can be used to identify subgroups of pediatric T2D with prognostic value. Consequently, this advancement contributes to the progression and wider implementation of precision medicine in diabetes management.

Microalbuminuria and Associated Factors in Diabetics at the CNHU-HKM of Cotonou

Diabetes mellitus is a disease of great frequency and is a major public health problem. Several complications can occur during the course of diabetes such as diabetic nephropathy, which starts with microalbuminuria in diabetic patients. This was a cross-sectional and analytical study which took place from 23 September to 23 December 2021 in the Endocrinology-Metabolism-Nutrition Department of the CNHU-HKM of Cotonou, Benin. We carried out an exhaustive census of the patients. Type 2 diabetic patients were included in the study, and 24-hour microalbumunuria, fundus examination and assessment of complications were performed. We identified 145 type 2 diabetic patients of whom 44 had positive microalbuminuria, i.e. a prevalence of 30.3%. There were 61 men and 84 women with a sex ratio of 0.72. The mean age was 59 years with extremes of 26 and 85 years. The complications identified in diabetics with positive microalbuminuria were Neuropathy (43.2%), Nephropathy (22.7%) and Retinopathy (20.5%). Factors associated with microalbuminuria in diabetics were: age, occupation, hypertension, diabetes imbalance, erectile dysfunction. Conclusion: Microalbuminuria is common in type 2 diabetes. It should be managed early to slow the progression of kidney disease to the end stage.

Comparison of Gambier Extract (Uncaria Gambier Robx) and Angiotensin Receptor Blocker on Proteinuria Reduction and Antioxidants - Enhancement in Nephrotic Rat Models.

Proteinuria is a significant clinical manifestation that causes edema in several diseases, including Nephrotic Syndrome (NS). Untreated proteinuria is strongly linked to the progression of kidney failure. One of the adjuvant therapies could be used to reduce proteinuria such as Angiotensin Receptor Blocker (ARB) including Losartan®. Gambier is a traditional medicinal plant widely known for its antioxidant effects. Catechin, a compound contained in Gambier Extract (GE), has been used to reduce microalbuminuria in diabetics. However, its application in NS has not been widely studied. This study compared the effects of GE and ARB in reducing proteinuria and increasing antioxidant activity levels, as well as reported histopathological findings in the nephrotic Wistar rat model. An experimental design study with a control group and a posttest was conducted. The experimental animals were divided into four groups: the control group (K1), the group with puromycin aminonucleoside (PAN) injection (K2), the group with PAN injection + GE (K3), and the group with PAN injection + Losartan® (K4). The standard GE used was Sarie Uncariae® by Toyo Brothers, PT while the ARB (Losartan®) was obtained from Novell, PT. Protein urine, the activity level of total superoxide dismutase (T-SOD), and malondialdehyde (MDA) were assessed using the colorimetric method. Renal histopathology was assessed based on Rollerman's criteria. Gambier extract significantly reduced proteinuria, as depicted by a decrease in protein/volume urine (p = 0.009), increased antioxidant activity, as illustrated by an elevation in T-SOD activity levels (p = 0.007), and tended to decrease MDA levels compared to Losartan®. Based on histopathological findings, GE tended to reduce the percentage of kidney damage in rats induced by puromycin. Gambier extract has been shown a higher antioxidant effect by increasing T-SOD activity levels, reducing proteinuria and also exhibiting a tendency to diminish kidney damage.

Disordered eating and behaviors among young Egyptians with type 1 diabetes: risk factors and comorbidities.

The study aimed to assess occurrence of eating disorders and its nature, associated risk factors, and comorbidities in a cohort of adolescents with type 1 diabetes (T1D). In this cross-sectional study, 138 patients were recruited to complete three questionnaires for assessment of eating disorder (ED); Eating Attitude Test (EAT-26) and Eat Behavior questionnaire (ORTO-15) and Eating Disorder Examination Questionnaire version 6 (EDE-Q6) to assess diabetes-related medical outcomes. Patients were categorized as having an ED according to predetermined cutoff value for each questionnaire. Of the 138 patients, 24 (17.4%) had risk for EDs by EAT-26 score, 53 (38.4%) have got orthorexia nervosa by ORTO-15 and 45 (32.6%) were having a disordered eating behavior by EDE-Q6. Patients with risk of EDs had lower mean ORTO-15 score (p=0.01), and higher mean Global EDE-Q6 (p<0.001). A positive correlation was found between EAT-26 scores and both age (p<0.0001) and body mass index (p<0.0001). ORTO-15 score was correlated with duration of diabetes (p=0.0418). Diabetic ketoacidosis, peripheral neuropathy, and microalbuminuria occurred frequently in patients with ED high score. Hypoglycemic episodes were reported more in those with high EAT-26 or Global EDE-Q6 scores. Subclinical EDs and abnormal eating behaviors are common in Egyptian adolescents with T1D.

Association of Estimated Time-in-Range Capillary Glucose Levels Versus HbA1c With Progression of Microvascular Complications in the Diabetes Control and Complications Trial.

Estimated time in range (eTIR) obtained from DCCT glucose profiles (pre- and postprandial and bedtime) was recently reported to be associated with microvascular outcomes and was recommended as a clinical trial outcome, but without consideration of HbA1c. The associations of eTIR with diabetic retinopathy and microalbuminuria were assessed without and with adjustment for HbA1c and baseline covariates. Adjusted for HbA1c and covariates, eTIR was marginally significantly associated with retinopathy in the full cohort (hazard ratio [HR] 1.12 per 10% lower eTIR [95% CI 1.0, 1.26], P = 0.042). Conversely, HbA1c was significantly associated with both outcomes (HR ≥1.19 per 0.5% higher HbA1c, P ≤ 0.0002) in five of six adjusted analyses. The association of eTIR with complications is largely explained by its correlation with HbA1c. HbA1c, not eTIR or continuous glucose monitoring TIR, remains the preferred outcome in clinical studies of type 1 diabetes complications.

Annual wellness visits are associated with increased use of preventive services in patients with diabetes living in the Diabetes Belt

ObjectiveTo examine whether Annual Wellness Visits (AWVs) were associated with increased use of preventive services in Medicare patients with diabetes living in the Diabetes Belt. MethodsWe used a case-control design where outcomes were utilization of preventive services recommended for patients with diabetes (foot exam, eye exam, A1c test, and microalbuminuria test) and the exposure was AWVs using data for Medicare patients with diabetes in 2014 – 2015 residing in the Diabetes Belt (N = 412,009). ResultsOnly 13.4% of patients in 2014 and 17.4% in 2015 used AWVs. Eye exams (61% vs 53%), foot exams (93% vs 79%), A1c tests (81% vs 71%), and microalbuminuria tests (45% vs 28%) were more common among patients who had an AWV in the preceding year compared with those who did not. These differences remained significant after adjusting for patient demographics, comorbidities, county level medical resources, and geographic factors. ConclusionsAWVs were significantly associated with increased preventive care use among patients with diabetes living in the Diabetes Belt. Low AWV utilization by patients with diabetes in and around the Diabetes Belt is concerning.

Prevalence of retinopathy in newly diagnosed type 2 diabetes mellitus patients and its association with microalbuminuria and HbA1c: A cross sectional study from Rajasthan

Background: Diabetes mellitus is a major public health problem with multiple medical complications. Microvascular complications of diabetes including diabetic retinopathy, depend on the duration and severity of hyperglycemia. There is a paucity of data about the relationship among diabetic retinopathy, microalbuminuria and HbA1c in newly diagnosed type 2 diabetes mellitus (T2DM) patients. The study was conducted on the prevalence of diabetic retinopathy and its association with microalbuminuria and HbA1c among newly diagnosed T2DM patients. Material and method: It was a hospital-based, cross-sectional study conducted at a tertiary care hospital in Rajasthan. After obtaining written informed consent, data were collected from 150 newly diagnosed T2DM patients. Data were analysed using SPSS 20.0. Categorical variables were presented as proportion and continuous variables were presented as mean (SD). Chi square test and one way ANOVA tests were used for bivariate analysis. Results: The mean (SD) age of patients was 50.43 (12.73) years. About 52.7% (n=79) patients were male. About 30% (n=45) of newly diagnosed T2DM patients had microalbuminuria. Thirty patients (20%) had diabetic retinopathy (DR). About 8% (n=12) participants had mild DR, 10.7% (n=16) had moderate to severe DR and 1.3 (n=2) % had proliferative DR. Microalbuminuria was found significantly associated with HbA1c (P&lt;0.01). Diabetic retinopathy and its severity were also found significantly associated with HbA1c (P&lt;0.01). Conclusion: In newly diagnosed T2DM patients, HbA1c and microalbuminuria are associated with the presence of retinopathy. If follow up studies support these results, periodic ophthalmologic monitoring may be beneficial for those newly diagnosed with T2DM.

399-P: Associations among Biomarkers of Inflammation, Tubular Injury, and Lipid Metabolism with Gestational Diabetes Mellitus (GDM) Status, Microalbuminuria, and Retinopathy in the MARIGOLD Study

Levels of hyperglycemia below those for diagnosis of diabetes are associated with microvascular injury, though the duration required to induce these complications remains poorly understood. This is especially relevant in patients with GDM due to its transient nature, which can nevertheless predispose to microvascular disease. Our aim was to assess whether mechanistic pathways associated with microvascular complications are upregulated in pregnant women with GDM or microvascular disease. In this analysis, urinary albumin excretion and biomarkers of inflammation, lipoprotein metabolism, and tubular injury were quantified in 355 women at 32-40 weeks of gestation, with and without GDM. Adjusted associations between all biomarkers and each outcome variable - GDM status, microalbuminuria, and retinopathy - were performed using logistic regression. Significant associations between GDM status and ApoA1, Il-6, IL-8, sTNFR I/II, NGAL, VEGF and vWF were observed (Figure 1A) . Increased CRP and sTNFR-II were associated with higher levels of albuminuria (Figure 1B) . CRP (Figure 1C) and previous GDM were associated with retinopathy. In conclusion, GDM and its relatively short-term exposure to hyperglycemia are associated with pathways involved in diabetes and microvascular complications. Disclosure H.Liu: None. B.R.Shah: None. V.S.Sridhar: None. L.Lovblom: None. D.Feig: Advisory Panel; Novo Nordisk, Research Support; Apotex. E.Herer: None. A.Kiss: None. L.Lipscombe: n/a. P.M.Yip: None. D.Cherney: Other Relationship; AbbVie Inc., AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Janssen Research &amp; Development, LLC, Lilly, Maze, BMS, CSL-Behring, Merck, Otsuka, Novartis and Novo-Nordisk , Mitsubishi Tanabe Pharma Corporation, Sanofi, Research Support; Boehringer Ingelheim-Lilly, Merck, Janssen, Sanofi, AstraZeneca and Novo-Nordisk.

Vitamin D Deficiency and Microalbuminuria in Patients with Diabetes Mellitus

Aim: As diabetes mellitus and its complications become more prevalent in the world, it is becoming an important public health problem. Previous studies have investigated vitamin D in the context of diabetes mellitus and its complications.. Microalbuminuria is important as the initial level of diabetic nephropathy. In this context, we aimed to investigate the level and deficiency of vitamin D in diabetic patients with microalbuminuria. Material and Methods: 52 type 1 (20.1%) and 206 (79.9%) type 2 diabetes patients who applied to the outpatient Endocrinology and Metabolic Diseases clinic between April 2019 and December 2020 were included in the study. Patients were classified according to microalbuminuria. Fasting glucose, HbA1c, duration of diabetes, and 25 (OH) Vitamin D levels and mean waist circumference were compared between the groups. Finally, the groups were compared according to diabetes type and microalbuminuria. Results: Urinary albumin/creatinine rates (UAC) in 159 (42.7%) diabetic patients were in normal range, and 65 (17.5%) diabetics had UAC between 30-300 mcg. 12 (3.2%) had UAC >300 mcg. 22 (5.9%) had chronic renal failure. Vitamin D deficiency was 61.6% and vitamin D insufficiency was 28.6% in all study groups. Median GFR was 98 (38-136) ml/dk and median 25 (OH) D level was 17.1 (5.0- 44.2)mg/dl. 25 (OH) Vitamin D levels and GFR were found to be significantly lower in the microalbuminuria group (p<0.01). 25 (OH) D levels were found to be low in both type 1 and type 2 diabetes patients with the complication of microalbuminuria, however only in type 1 diabetes patients low vitamin D this was found significant (p=0.01) Conclusion: 25 (OH) vitamin D deficiency and insufficiency were found to be more common in patients with diabetes. with microalbuminuria, which was more significant in type 1 diabetes patients The underlying mechanisms and potential therapeutic effect of vitamin D should be further investigated.

The relationship of renal resistive index and carotis intima media thickness in patients with diabetic microalbuminuria

ObjectivesDiabetes is a chronic disease with increasing morbidity and mortality. Microalbuminuria is seen in diabetic patients due to nephropathy. Patients with microalbuminuria are at high risk for atherosclerosis. It is thought that comparing the carotid artery, which is most frequently affected by atherosclerosis, by measuring and comparing the renal resistive index, may be beneficial for early diagnosis and treatment of diabetic complications. MethodsOur study included 108 patients with diabetic microalbuminuria. Carotid intima media thickness (CIMT) and renal resistive index (RRI) measured, who applied to Adana Numune Training and Research Hospital between January and November 2016. We aimed to evaluate the patients with normal-abnormal RRI and normal-abnormal CIMT. The patients' diabetes age, weight, height, fasting blood sugar, HbA1c, and creatinine parameters were compared. ResultsWe observed an increase in RRI in parallel with the increase in CIMT in diabetic microalbuminuric patients (p<0,001). There was also a positive correlation between the creatinine value and the RRI (p:0.021). The increase in creatinine was significantly associated with the increase in CIMT(p<0.001). However, we could not detect the similar correlation with body mass index (BMI) in terms of both RRI andCIMT. ConclusionRRI measurement can be performed together with CIMT measurement for early detection of atherosclerosis. Patients with microalbuminuria and prone to atherosclerosis that cannot be detected by measurement of CIMT can be detected by measurement of the RRI.

The natural history of emerging diabetic retinopathy and microalbuminuria from prepuberty to early adulthood in Type 1 diabetes: A 19-year prospective clinical follow-up study.

To evaluate the impact of long-term glycaemic control and glycaemic variability on microvascular complications in adolescents and young adults with childhood-onset Type 1 diabetes. Twenty-six participants took part in a prospective follow-up study. We used univariate generalised estimating equations (GEE) analysis with first-order autoregressive AR(1) covariance structure for repeated measurements to evaluate the relationship between emerging diabetic retinopathy (DR) and each single explanatory variable, namely age at developmental stages from late prepuberty until early adulthood, duration of diabetes and long-term HbA1c . Thereafter, the simultaneous effect of these three explanatory variables to DR was analysed in a multivariate model. Twenty-five participants developed DR by early adulthood after a median diabetes duration of 16.2years (range 6.3-24.0). No participants had DR during prepuberty. Each of the three variables was independently associated with emerging DR: age (OR 1.47, 95% CI to 1.25 to 1.74, p<0.001) stronger than diabetes duration (OR 1.42, 95% CI 1.23 to 1.63, p<0.001) and HbA1c (OR 1.02, 95% CI 1.001 to 1.05, p=0.041) in this population. In the multivariate analysis of these three explanatory variables, only age was associated with DR (adjusted OR 1.52, 95% CI 1.10 to 2.10, p=0.012). The emergence of DR during adolescence and early adulthood is not rare and increases with age in patients with deteriorating metabolic control during puberty and thereafter. This underpins the need to prevent deterioration of glycaemic control from taking place during puberty-seen again in this follow-up study-in children with diabetes.

Monocyte chemoattractant protein-1 predicts the development of diabetic nephropathy.

Diabetic nephropathy (DN) is a devastating complication of diabetes mellitus (DM). Therefore, screening strategies in order to prevent its development and/or retard its progression are of paramount importance. We investigated if monocyte chemoattractant protein-1 (MCP-1) was associated with new onset microalbuminuria-the earliest sign of the albuminuric phenotype of DN- in patients with type 2 DM and normoalbuminuria. We measured MCP-1 in serum and urine samples from patients of the Randomized Olmesartan And Diabetes Microalbuminuria Prevention (ROADMAP) study and its Observational Follow-up (OFU) cohort. A case control design was used with inclusion of 172 patients who developed microalbuminuria (MA) and of 188 well matched controls who remained normoalbuminuric. The median duration of follow-up for the ROADMAP cohorts was 6.5 years, whereas the mean time until occurrence of MA was 53.2 months. In the multivariate analysis, serum and urine MCP-1 remained significant predictors of new onset MA. The risk for MA increased continuously with increasing serum and urine MCP-1 levels but reached statistical significance only in the highest quartiles. The risk associations were stronger with serum MCP-1. MCP-1 is a marker and possibly a mediator of early diabetic nephropathy. Further prospective studies are necessary to test whether diabetic patients with elevated MCP-1 levels would benefit from specific therapeutic interventions.

Optimal glycaemic and blood pressure but not lipid targets are related to a lower prevalence of diabetic microvascular complications

BackgroundDiabetic microvascular complications are a major cause of morbidity and are related to glycaemic control and cardiovascular risk factors. AimsWe sought to determine the association of microvascular complications in relation to control of glycemia, blood pressure and lipids in T2DM patients attending secondary care in Qatar. MethodsThis is a cross-sectional study undertaken in patients with T2DM attending Qatar's National Diabetes Centres. Patients underwent assessment of glycemia, blood pressure and lipids and prevalence of diabetic peripheral neuropathy (DPN), retinopathy and microalbuminuria. ResultsWe included 1114 subjects aged 52.1 ± 11.3 years with a duration of diabetes 10.0 ± 7.6 years and had a prevalence of 25.8% for DPN, 34.3% for painful DPN, 36.8% for microalbuminuria and 25.1% for retinopathy. Patients who achieved an HbA1c ≤ 7.0% compared to >7% had a significantly lower prevalence of DPN (P < 0.01), painful DPN (P < 0.01), retinopathy (P < 0.01) and microalbuminuria (P < 0.007). Patients who achieved a systolic BP ≤ 140 mmHg compared to >140 mmHg had a significantly lower prevalence of DPN (P < 0.001), painful DPN (P < 0.001), retinopathy (P < 0.001) and microalbuminuria (P < 0.001). Patients who achieved an LDL ≤2.6 mmol/l compared to >2.6 mmol/l had a significantly higher prevalence of DPN (P < 0.03), but no difference in other outcomes. There was no difference in microvascular complications between those who achieved a HDL-C ≥ 1.02 mmol/l, and among those who achieved triglycerides ≤1.7 mmol/l. ConclusionsOptimal control of glycemia and blood pressure, but not lipids is associated with a lower prevalence of diabetic microvascular complications.

Relationship between diabetic retinopathy microalbuminuria and other modifiable risk factors

BackgroundDiabetic Retinopathy (DR) is an important microvascular complication of diabetes that can lead to irreversible blindness. Microalbuminuria is strongly associated with diabetic retinopathy and can be used as a reliable marker of diabetic retinopathy. AimTo assess the association between DR, microalbuminuria, and other modifiable risk factors in patients with type 2 diabetes. Methodology3090 patients with T2DM visiting North Delhi Diabetes Centre, New Delhi between July 2016 to October 2019 were evaluated for the clinical and biochemical parameters that included urinary albumin, HbA1C, lipid profiles, serum creatinine estimation and underwent biothesiometry. Results3090 patients (1350 females and 1740 males), with mean age of 52.7 ± 9.2 years and diabetes duration ranging from 1 to 19 years (mean 9.4 ± 6), duration of less than 5 years, 6–10 years and more than 10 years in 52%, 26% and in 22%, respectively. Duration of diabetes was strong predictor of retinopathy (p = 0.001). The HbA1c and BMI in patients with DR was significantly higher than in those without DR. 18.2% patients were diagnosed to have retinopathy. Peripheral neuropathy was observed in 24.2% and was positively associated with DR (p = 0.002). 33.9% and 4.5% patients had microalbuminuria macroalbuminuria, respectively and 9.7% patients had creatinine >1.3 mg/dL. There was significant positive relationship between different grades of retinopathy and albuminuria. ConclusionsOur study is a large real-world study that demonstrates that HbA1c, BMI, duration of diabetes, microalbuminuria and peripheral neuropathy are relatively, yet cohesively contributing factors towards varying grade of retinopathy.

The Association between Mean Platelet Volume and Albuminuria in Patients with Type 2 Diabetes Mellitus at King Abdul-Aziz Medical City, Jeddah 2020

Background: Diabetic patients are at greater risk for many complications. They also are considered to be in hypercoagulable state. Larger platelets are associated with a prothrombotic states because larger platelets are more active. Patients with type 2 diabetes mellitus are usually found to have an elevated MPV. Albuminuria is a very important predictor for both cardiovascular complications and diabetic nephropathy. We aimed in this study to find the association between MPV in diabetic patients and microalbuminuria, HbA1c level, duration of DM, body mass index (BMI), hypertension, stroke, and ischemic heart disease. Methods: A cross sectional quantitative study of diabetic patients. The data was collected retrospectively from the patients’ electronic files. It included 480 diabetic patients from June 2016 until December 2020. Sample size consisted of 480 patients and it included both male and female patients who are 18 years or older. The data that was collected included gender, duration of DM, HTN, IHD, history of stroke, MPV, albuminuria, BMI and HbA1c. Results: There was no statistically significant association between MPV and most of the designated variables including Gender, IHD, Stroke, HTN and Albuminuria. Furthermore, there was no association between MPV and albuminuria according to blood sugar level. It was also found that the higher the albuminuria the higher the MPV; the mean MPV increases in patients with increased albuminuria. Conclusions: MPV and albuminuria were positively correlated. MPV was higher in the controlled diabetes group. However, the association was not statistically significant.