Microalbuminuria Testing Research Articles

Dapagliflozin added to metformin reduces perirenal fat layer in type 2 diabetic patients with obesity

Sodium-glucose co-transporters type 2 inhibitors (SLGT2i) are highly effective in controlling type 2 diabetes, but reported beneficial cardiovascular effects suggest broader actions on insulin resistance. Weight loss may be initially explained by glycosuria-induced net caloric output and secondary volumetric reduction, but its maintenance could be due to loss of visceral fat mass. Structured ultrasound (US) imaging of abdominal adipose tissue (“eco-obesity”) is a recently described methodology used to measure 5 consecutive layers of abdominal fat, not assessable by DEXA or CT scan: superficial subcutaneous (SS), deep subcutaneous (DS), preperitoneal (PP), omental (Om) and right perirenal (RK). PP, Om and RK are predictors of metabolic syndrome (MS) with defined cut-off points. To assess the effect of SLGT2i on every fat depot we enrolled 29 patients with type 2 Diabetes (HbA1c 6.5–9%) and Obesity (IMC > 30 kg/m2) in an open-label, randomized, phase IV trial (EudraCT: 2019-000979-16): the Omendapa trial. Diabetes was diagnosed < 12 months before randomization and all patients were treatment naïve. 14 patients were treated with metformin alone (cohort A) and 15 were treated with metformin + dapaglifozin (cohort B). Anthropometric measures and laboratory tests for glucose, lipid profile, insulin, HOMA, leptin, ultrasensitive-CRP and microalbuminuria (MAL) were done at baseline, 3rd and 6th months. At 6th month, weight loss was −5.5 ± 5.2 kg (5.7% from initial weight) in cohort A and −8.4 ± 4.4 kg (8.6%) in cohort B. Abdominal circumference showed a −2.7 ± 3.1 cm and −5.4 ± 2.5 cm reduction, respectively (p = 0.011). Both Metformin alone (−19.4 ± 20.1 mm; −21.7%) or combined with Dapaglifozin (−20.5 ± 19.4 mm; −21.8%) induced significant Om fat reduction. 13.3% of cohort A patients and 21.4% of cohort’s B reached Om thickness below the cut-off for MS criteria. RK fat loss was significantly greater in cohort B group compared to cohort A, at both kidneys. Only in the Met + Dapa group, we observed correlations between Om fat with leptin/CRP/MAL and RK fat with HOMA-IR. US is a useful clinical tool to assess ectopic fat depots. Both Metformin and Dapaglifozin induce fat loss in layers involved with MS but combined treatment is particularly effective in perirenal fat layer reduction. Perirenal fat should be considered as a potential target for cardiovascular dapaglifozin beneficial effects.

Association Between Obesity, Hypertension and Target Organ Damage in Children

Background: The author analysed the association between obesity and hypertension as well as the association between the degree of hypertension and target organ damage. Methods: 61 children with suspected hypertension were evaluated. Ambulatory blood pressure monitoring was done in all of them. An echocardiogram and ophthalmologic examination were done in all children with confirmed hypertension and high-normal blood pressure and testing for microalbuminuria in most of them. The association between obesity and hypertension and between the degree of hypertension and target organ damage was tested using the chi-squared (χ2) and exact Fisher (if needed) statistical test. Results: Nine children with confirmed hypertension (50%), 13 children with high normal blood pressure (61.9%), and 10 children with normal blood pressure (45.5%) were obese. There was no statistically significant association between obesity and hypertension (p = 0.82). 66.7% of patients with hypertension and 38.1% of those with high-normal blood pressure had left ventricular hypertrophy (p = 0.14). 38.9% of patients with hypertension and 9.5% of those with high-normal blood pressure had hypertensive retinopathy (p = 0.34). 43.8% of patients with hypertension but 57.9% of those with high-normal blood pressure had microalbuminuria (p = 0.69). There was no statistically significant association between the degree of hypertension and left ventricular hypertrophy, hypertensive retinopathy, or microalbuminuria. Conclusion: The presented study did not prove a statistically significant association between obesity and hypertension or between the degree of hypertension and target organ damage.

Evaluation of the knowledge and practice of family physicians in the management of diabetes mellitus type 2 in Iran

BackgroundThe increasing prevalence and occurrence of type 2 diabetes has made it a widespread epidemic. Being the first line of care, family doctors can play an essential role in this field. The knowledge of these doctors about how to deal with the prevention, diagnosis, and correct treatment of patients is fundamental in reducing the burden of this disease in the community. In this study, we decided to evaluate the knowledge and practice of family doctors in Shiraz-Iran and its related factors in managing Diabetes.MethodThis analytical cross-sectional study was conducted among family doctors of two primary healthcare centers, Shahadai Wal-Fajr Health Center and the Enghlab Health Center in Shiraz, Iran, from March 2021 to August 2021. A researcher-designed diabetes questionnaire consisting of 21 items and a data collection form including demographic information and other related factors was used in this study. An interviewer asked the questions from participants at their workplace and completed the questionnaires. The data were analyzed by SPSS-20 software. A linear regression test was used to investigate the factors affecting the questionnaire score. A one-way ANOVA test was used to compare questionnaire scores among multiple groups.ResultsOn average, the participants obtained 62.5% of the total score. The average scores for each question in the screening, the diagnosis, and the treatment sections were 0.5 ± 0.28, 0.65 ± 0.2, and 0.66 ± 0.17, respectively. Physicians’ knowledge about the blood sugar threshold for diagnosing Diabetes was suboptimal, and 81.9, 47, 43 correctly mentioned the FBS, 2hrpp BS, and HbA1c threshold, respectively. Although 95% knew the first line medication but 33.6% prescribed 2nd or 3rd medication for DM treatment. Only 43% knew the goal of therapy. Sixty-three doctors (42%) have not registered any referrals for newly diagnosed uncomplicated diabetic patients, and 37.6% referred these new DM cases to an internist or endocrinologist at the first visit. Microvascular complication screening, such as testing for microalbuminuria and ophthalmologist consultation reported by 32. 89% and 8% of physicians, respectively. Years since graduation was the determining factor of the knowledge level of doctors in this study. Regarding the preferred education method, most participants selected the workshop method as the preferred training method. Virtual education was ranked as the second preferred educational method.ConclusionThe knowledge and practice of general family doctors were lower than the optimal level in diabetes screening, diagnosis, and treatment. In the treatment of patients, the knowledge of most of the physicians was appropriate in the early stages of treatment, such as determining the time to start the medication and the first line of treatment, but in the follow-up and more advanced treatment, the knowledge and performance of the doctors were less than expected. They prefer to refer patients to higher levels in the healthcare system. Recently graduated physicians had better knowledge and approach to DM management. Therefore, effective periodic training should be conducted as soon as possible to address this pitfall and improve the quality of care. Workshops and virtual education were the most preferred education methods from the participants’ points of view. So, it is suggested that these methods be used as the first training methods. Implementing the specialty training program for family medicine (which has been started in our country for a few years) is the best final solution. In addition, A clinical guideline should be designed for family physicians highlighting these physicians’ roles in the management of Diabetes.

Status of screening and preventive efforts against diabetic kidney disease between 2013 and 2018: analysis using an administrative database from Kyoto-city, Japan.

Japan has the second highest prevalence of dialysis use in the world. Approximately 40% of patients who begin dialysis have diabetic kidney disease (DKD). Local governments and medical facilities are required to provide preventive measures against worsening diabetes mellitus (DM). However, the percentage of patients with DM who receive such screening or interventions for DKD is unclear. This study aimed to reveal to what extent screening for DKD and preventive measures against worsening DKD are performed in patients with DM, using an administrative database in a municipality. This was a cross-sectional study that used the Kyoto-city's administrative medical and long-term care database. Patients with a diagnosis of DM and receiving antidiabetic medication between 2013 and 2018 were defined as patients with DM and included. Patients with DKD were defined as those diagnosed with diabetic nephropathy or those with chronic kidney disease. We described the characteristics of patients with DM, diabetic complications, and extent of DKD screenings and preventive efforts against worsening of DM by fiscal year. Across fiscal years, 25.8% to 27.5% of patient with DM had DKD. More than 3% of patients were on dialysis due DM in each fiscal year; approximately 15% started receiving dialysis that year. The percentage of patients who were regularly prescribed antidiabetic medication and received glycosylated hemoglobin testing ranged from 64.0% to 67.2% and from 30.6% to 36.5%, respectively. Urine microalbuminuria testing at least once a year occurred in 9.3% to 10.0%. The percentage of patients who received nutritional guidance ranged from 19.0% to 21.0%. Approximately 1% of patients received guidance for preventing DM from progressing to a disease that requires dialysis each fiscal year. This study from Japan, where a super-aging society has developed, using an administrative database in a municipality covering most of the elderly population clearly demonstrated an evidence-practice gap in efforts to prevent worsening of DKD. Strengthening cooperation between government and medical facilities and support for providing preventive measures against DKD are urgently needed.

Structural and dynamic properties of urinary human serum albumin fragments: a molecular dynamics study

A microalbuminuria level acts as a good index to screen and monitor diabetes and renal failure. However, the urinary albumin loss after sample preservation and storage is the major bottleneck to obtain the accurate microalbuminuria test. Such loss is due to the rapid albumin fragmentation by urinary proteases. Some fragments were suggested to be bioactive biomarkers of diabetes and renal disease, but no structural and dynamical properties of albumin fragments are available. Thus, in this work, the structural and dynamical properties of reported albumin fragments are revealed using molecular dynamics simulations. The properties of nine fragments (F1–F9) discovered recently were studied at the real pH conditions of urine samples (pH 4.5, 7 and 8). The complete loss of secondary structure is found in short fragments (F1–F6), while large-sized polypeptides (F7–F9) can somehow maintain their folds. Especially, F8 (subdomain IIIB) is the most stable fragment. The difference in histidine protonation states has no impact on the structural stability of albumin fragments. The ability of F8 (subdomain IIIB) to maintain its stability and folds suggests it as an alternative albumin biomarker in urine. An insight obtained here will become the fundamental importance for understanding clinical assays for albumin detection, sample stability and peptidomics analysis of urine. Communicated by Ramaswamy H. Sarma

Biological Effects of Zinc Oxide Nanoparticles on Biochemical Parameters in Diabetic Nephropathy

Diabetic nephropathy is the end stage renal disease that occurs as a result of diabetes. Cardiovascular and renal complications share common risk factors such as blood pressure, blood lipids, and glycemic control. Chronic kidney disease may predict cardiovascular disease in the general population. The impact of diabetes on renal impairment changes with increasing age. Serum markers of glomerular filtration rate and microalbuminuria identify renal impairment in different segments of the diabetic population, indicating that serum markers as well as microalbuminuria tests should be used in screening for nephropathy in diabetic people. The American Diabetes Association and the National Institutes of Health recommend Estimated glomerular filtration rate (eGFR) calculated from serum creatinine at least once a year in all people with diabetes for detection of kidney dysfunction. eGFR remains an independent and significant predictor after adjustment for conventional risk factors including age, sex, duration of diabetes, smoking, obesity, blood pressure, and glycemic and lipid control, as well as presence of diabetic retinopathy.

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.

915-P: Annual Wellness Visits and Preventive Care Utilization among Medicare Beneficiaries in the Diabetes Belt and Surrounding Areas

Objective: Medicare beneficiaries are eligible to receive free Annual Wellness Visits (AWVs) for assessing preventive care needs, identifying care resources, and scheduling visits. We previously reported that AWVs are associated with increased use of preventive care for patients with diabetes. In this study, our objective is to conduct a case-control study to examine whether AWVs are associated more strongly with preventive care use in the Diabetes Belt than in surrounding areas. Methods: We used a sample of ∼900,000 Medicare Fee-for-Service beneficiaries who lived in the Diabetes Belt and surrounding areas in 2014 - 2015. We identified patients who have used an annual foot exam, eye exam, A1c test, and microalbuminuria (MA) test and those who did not in 2015. We used the dates of service receipt and the last day of the year (12/31) as the event date for users and non-users, respectively. We looked one full year before the event date to identify any AWVs. We used propensity-score stratification to estimate log odds of 4 preventive care use of annual foot exam, eye exam, A1c test, and MA test. Results: For all four services, AWV users had significantly higher preventive care use compared to non-users. In 3 preventive services, AWVs were more strongly associated with preventive care use in the Belt than in the surrounding areas (foot exam, ORs = 2.38 vs 2.16, p &amp;lt; 0.001; A1c test, ORs = 1.44 vs. 1.36, p = 0.002; MA test, ORs = 1.70 vs. 1.44, p &amp;lt; 0.001; eye exam, ORs 1.22 vs. 1.19, p=0.063) . Discussion: AWVs appear to have stronger effects on preventive care use for patients with diabetes in the more healthcare resource-poor Diabetes Belt than in the surrounding areas. AWVs may help to reduce disparities in the use of recommended preventive care for patients with diabetes. Disclosure M.Sohn: None. T.L.Mcmurry: None. H.Kang: None. S.Kim: None. J.M.Lobo: n/a. Funding NIDDK R01DK113295

Relationship between amino acid ratios and decline in estimated glomerular filtration rate in diabetic and non-diabetic patients in South Africa.

BackgroundDiabetic kidney disease is a major complication resulting from type 1 and type 2 diabetes. Currently, the microalbuminuria test is used to monitor renal function; however, it does not detect albumin until progressive loss of renal function has occurred.ObjectiveThis study analysed the relationship between changes in amino acid ratios and estimated glomerular filtration rate (eGFR) decline in diabetic and non-diabetic patients.MethodsUrine samples were collected from participants between February 2019 to April 2019 and analysed from November 2020 to January 2021. Diabetic (glycated haemoglobin > 6.4%) and non-diabetic patients (glycated haemoglobin ≤ 6.4%) from Chris Hani Baragwanath Hospital, South Africa, were further categorised based on the degree of renal function predicted by the eGFRs. Amino acids were quantified using tandem mass spectrometry to determine the concentrations and ratios of tyrosine/phenylalanine, ornithine/arginine, arginine/citrulline and citrulline/ornithine at different stages of the chronic kidney disease.ResultsAmong diabetic patients, the tyrosine/phenylalanine ratio showed a statistically significant increase (p = 0.04) as the eGFR declined from stage 1 to stage 4; the ornithine/arginine ratio showed a strong negative correlation with eGFR. The citrulline/ornithine ratio differed between the diabetic and non-diabetic patients in stage 1 of chronic kidney disease.ConclusionAmino acid ratios (ornithine/arginine and tyrosine/phenylalanine) are affected by the progression of diabetes and can be correlated to renal function. The citrulline/ornithine ratios differ between the studied groups in stage 1 of the disease and may be utilised to predict the onset of chronic kidney disease.

313-OR: Disparities in Preventive Care Utilization among Patients with Diabetes in the Diabetes Belt and Surrounding Areas

Objective: Preventive care has been shown to reduce both the incidence and progression of diabetic complications. American Diabetes Association treatment guidelines recommend annual preventive care such as annual doctor visits and A1c tests. Our objective is to compare utilization rates of four annually recommended preventive services for persons with diabetes in the Diabetes Belt and those in the surrounding area. Methods: We used 2015 Medicare claims data to identify preventive service utilization using ICD9/10 and CPT/HCPCS codes. Diabetes Belt consists of 644 counties in the Appalachian region and southeastern part of US that had diabetes prevalence over 11% in 2008 compared to ~8.5% in the rest of the country. Surrounding counties include 118 counties that are adjacent but not contiguous to the Diabetes Belt counties. Results: Patients in the Belt had significantly lower utilization than those in surrounding counties for all four preventive services: foot exam, 81% vs. 88%; eye exam, 53% vs. 58%; microalbuminuria test, 31% vs. 34%; one or more A1c tests, 73% vs. 74%. After adjusting for age, sex, and race/ethnicity, patients in the Diabetes Belt had 38%, 18%, 16%, and 11% lower odds of using foot exams, microalbuminuria tests, eye exams, and A1c tests, respectively, compared to those in the surrounding counties (p for all comparisons &amp;lt; 0.001). Even after adjusting for socioeconomic, access-to-care factors, and service availability, patients in the Diabetes Belt had consistently lower rates of utilization for these four services than surrounding counties. Conclusion: Patients with diabetes in the Diabetes Belt are doubly jeopardized for diabetic complications because of higher prevalence diabetes and lower preventive care utilization than surrounding counties. Health policy makers may want to pay more attention to the Diabetes Belt in reducing the regional differences in the utilization of these services. Disclosure M. Sohn: None. H. Kang: None. T. L. Mcmurry: None. S. Kim: None. J. M. Lobo: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK113295)

145-OR: Annual Wellness Visits Are Associated with Increased Use of Diabetes Preventive Services in the Diabetes Belt and Surrounding Counties

Background: The Affordable Care Act created annual wellness visits (AWVs) for Medicare beneficiaries to have one yearly visit to primary care physicians and discuss preventive care for the upcoming year. We assessed whether AWVs were associated with increased use of these preventive services in Medicare patients with diabetes living in the Diabetes Belt and surrounding counties. Methods: We used claims files from a longitudinal sample of ∼1,000,000 Medicare patients with diabetes living in the diabetes belt or surrounding counties, covering years 2014-2015. The Diabetes Belt was identified by the CDC as 644 counties across Appalachian and southeastern counties in the US that had diabetes prevalence ≥ 11% in 2008. We used these data to examine associations between AWVs and preventive service use in the next year. We examined four preventive services recommended annually for patients with diabetes by the ADA, including A1c tests, foot exam, eye exam, and microalbuminuria (MA) tests. Results: Of all patients, only 19.6% used AWVs in 2015. Eye exams (61% vs. 56%), foot exams (92% vs. 83%), A1C tests (78% vs. 73%), and MA tests (42% vs. 31%) were more common among patients who had an AWV in the preceding year compared with those who did not. These differences remained after adjusting for patient demographics, comorbidities, county level medical resources, and geographic factors: eye exam (Odds Ratio 1.13, 95% CI 1.12-1.15); A1c Test (1.28, CI 1.26-1.31); Foot Exam (2.06, CI 2.01-2.11); MA Test (1.45, CI 1.42-1.47). Conclusions: This study shows that AWVs were significantly associated with increased recommended preventive care use among patients with diabetes living in and near the diabetes belt. The low rates of AWV utilization by patients with diabetes in and around the Diabetes Belt is concerning and should receive more policy attention. Disclosure T. L. Mcmurry: None. S. Kim: None. J. M. Lobo: None. H. Kang: None. M. Sohn: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK113295)

Impact of Longitudinal Virtual Primary Care on Diabetes Quality of Care.

BackgroundLack of healthcare access to due to physician shortages is a significant driver of telemedicine expansion in rural areas. Telemedicine is effective for management of chronic conditions such as diabetes but its effectiveness in primary care settings is unknown.ObjectiveTo evaluate differences in diabetes care before and after implementation of a longitudinal virtual primary care program.DesignPropensity score-matched cohort study utilizing difference-in-differences analysis.ParticipantsPatients with diabetes who received care at VA primary care clinics between January 2018 and December 2019 where the Virtual Integrated Multisite Patient Aligned Care Teams (V-IMPACT) program was implemented.ExposurePatient participation in at least one V-IMPACT visit while usual care patients did not participate in V-IMPACT.Main MeasuresThe primary outcome was change in hemoglobin A1C (HbA1C) and secondary outcomes included change in the proportion of patients meeting diabetes quality indicators: blood pressure control, statin use, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ACEi/ARB) use, and annual microalbuminuria testing.Key ResultsOur propensity-matched cohort included 9010 patients split evenly between those who participated in V-IMPACT and those who remained in usual in-person care. Among individuals with diabetes who participated in V-IMPACT, the change in mean HbA1C was − 0.055% (95% CI − 0.088 to − 0.022%) while those in usual care had a − 0.047% (95% CI − 0.080 to − 0.014%) change before and after program implementation. We observed a 5.1% (95% CI 2.4 to 7.7%) absolute increase in the proportion prescribed statins in the V-IMPACT group, a 5.3% (95% CI 2.5 to 8.2%) increase prescribed ACE/ARBs, and a 4.6% (95% 1.7 to 7.5%) increase in completed yearly microalbuminuria testing. V-IMPACT was not associated with a significant difference in the proportion with controlled blood pressure at < 140/90 or < 130/90 mmHg thresholds.ConclusionsQuality of diabetes care delivered by a longitudinal virtual primary care model was similar if not better than traditional in-person care.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-020-06547-x.

Relationship between microalbuminuria and metabolic parameters in a normotensive population with obesity

Aim: Today, the second-most common cause of preventable death after smoking is obesity. Microalbuminuria is defined as an albumin to creatinine ratio (ACR) of more than 30 mg per gram of creatinine. Obesity increases microalbuminuria by affecting the kidneys.Methods: This study was carried out by retrospectively examining the files of obese [Body mass index (BMI) ≥30 kg/m2)] individuals between the ages of 18 and 65 with spot microalbuminuria test in urine who admitted to the obesity outpatient clinic of a tertiary hospital between January 2013 and June 2015. Four hundred ninety subjects were included in the study. The physical parameters, blood and urine tests of the subjects included in the study at the time of first admission to the obesity clinic were examined.Results: Microalbuminuria was positive in 5.7 % of the participants. The glycated hemoglobin (HbA1c) and uric acid levels for subjects in the microalbuminuria-positive group were higher than in the levels of subjects in the microalbuminuria-negative group [5.6 (5.8-5.5) vs 5.5 (5.7-5.2); P=0.012 and 5.2 (6-4.5) vs 4.7 (5.5-4.2); P=0.038, respectively]. In microalbuminuria-negative group, 25-hydroxyvitamin D3 (25-OH D3) levels were higher than in the microalbuminuria-positive group [12 (18-7.1) vs 8.4 (12.9-6.9); P=0.032]. Urine albumin to creatinine ratio was positively associated with BMI, fasting insulin (FI), Homeostatic model assessment for insulin resistance (HOMA-IR), triglycerides (TG) and c-reactive protein (CRP).Conclusion: Obesity increases microalbuminuria by affecting the kidneys. Microalbuminuria is associated with insulin resistance, dyslipidemia and low 25-OH D3. Microalbuminuria must be checked in obese individuals. The prevalence of obesity should be reduced for a healthier life.

Poor recovery of cardiac function in myocardial infarction patients with metabolic syndrome and microalbuminuria.

This study aimed to investigate the impact of metabolic syndrome (MetS) with microalbuminuria on the improvement of cardiac function after acute myocardial infarction (AMI). Nondiabetic patients with acute ST segment elevation MI (STEMI) who underwent coronary revascularization from 2013 to 2017 were included. They were grouped according to history of MetS and microalbuminuria test results as follows: microalbuminuria/MetS group, normoalbuminuria/MetS group, microalbuminuria/no MetS group, and normoalbuminuria/no MetS group. Left ventricular ejection fraction (LVEF) and serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels at the 6‑month follow-up were measured and the predictive value of MetS with microalbuminuria on recovery of cardiac function was assessed by multivariable logistic regression modeling. Atotal of 530 STEMI patients were included (average age= 66.6years). Analysis of covariance showed that LVEF recovery in the normoalbuminuria/no MetS group was better than that of the normoalbuminuria/MetS, microalbuminuria/no MetS, and microalbuminuria/MetS groups (49.22% vs. 48.92% vs. 47.48% vs. 46.99%, respectively, p < 0.001) when acute phase LVEF was the covariable. The NT-proBNP level of the normoalbuminuria/no MetS group at the 6‑month follow-up was lower than that of the microalbuminuria/MetS group (p < 0.001). Further regression analysis revealed that there was a lower probability of complete cardiac function recovery after 6months in patients with microalbuminuria (odds ratio: 0.455) than in patients without microalbuminuria (95% CI: 0.316-0.655, p < 0.001). Although post-AMI cardiac function in MetS patients with microalbuminuria can be improved after revascularization, the improvement is not as good as that of patients without microalbuminuria, suggesting that clinical attention should be paid to this subgroup.

Microalbuminuria in Type 2 Diabetes Mellitus and Glycemic Control

Objective: To determine the frequency of microalbuminuria in Type 2 Diabetes Mellitus with good glycemic control. Introduction: Diabetes Mellitus is a chronic illness, frequently not diagnosed until complications appear. Microalbuminuria is a renal marker of generalized vascular endothelial damage and early atherosclerosis. Patients with microalbuminuria are at increased risk of microvascular and macrovascular complications of Diabetes Mellitus like myocardial infarction, stroke, and nephropathy. Poor glycemic control increases the risk of microalbuminuria. Methodology: A cross-sectional study is conducted at the Department of Medicine, Bolan Medical College/ Sandeman Provincial Hospital Quetta, Pakistan. The duration of the study is six months from September 2016 to March 2017. A total of 140 Type 2 DM patients with good glycemic control is included in this study. 63 (45%) were female, and 77 (55%) were male with a mean age of 44.47 ± 4.99 years. The mean duration of DM is found to be 4.21 ± 0.94 years. The mean HbA1c level was found to be 6.74 ± 0.17. 21 patients (15%) were found to have microalbuminuria. Conclusion: There is an association of microalbuminuria in diabetic patients with good glycemic control; however, the prevalence is low, but it is still positive. Uncontrolled DM is strongly associated with the prevalence of microalbuminuria. Screening for microalbuminuria and HbA1c test should be done both in new and already diagnosed type 2 diabetic patients as an early marker of renal dysfunction and glycemic control.

PREVALENCE OF MICROALBUMINURIA IN HYPERTENSIVE PATIENTS IN DARBHANGA MEDICAL COLLEGE LAHERIASARAI DARBHANGA AND HOSPITAL

Introduction: There are two mechanisms proposed for the greater urinary albumin excretion (UAE) in patients with essential hypertension: increased glomerular hydrostatic pressure or increased selectivity of the glomerular basement membrane. In hemodynamic mechanism regulation of the glomerular hydrostatic pressure is regulated by the relative vasoconstriction vasodilatation of the afferent and efferent glomerular arterioles. Hypertension is one of the major public health problems in the world. In India the prevalence of hypertension is about 25% in urban and 10-15% in rural, adult population as compared to west which is 30%. Essential hypertension is responsible for producing clinical proteinuria and a significant reduction in renal function in 5-15% of patients. Several studies have shown that proteinuria and microalbuminuria are independent predictors of cardiovascular morbidity and mortality in patients with hypertension. Some data suggest that reduction of albumin excretion rate reduces the risk of adverse renal and cardiovascular events (CVEs).&#x0D; Material and Methods: Patients, who had high blood pressure based on JNC 8 (Joint National Commission 8) criteria during three subsequent visits to the outpatient clinic and a creatinine clearance greater than 80 ml/min/1.73 m2, were included in the study. A total of 546 essential hypertensive patients whose BP was&gt; 140/90 mm Hg in nondiabetics and BP &gt;130/85 mm Hg in diabetic patients were included in the study. Blood pressure monitoring was done according to the WHO guidelines. Demographic data, age, sex, weight, associated cardiovascular disease, albuminuria, and clinical parameters were all recorded. All routine biochemical tests and microalbuminuria tests were performed by the laboratory. Blood and urine creatinine were measured using an autoanalyzer.&#x0D; Results: There were 322 (58.97%) male and 224 (41.02%) female included in the study. Left ventricular hypertrophy was observed in 267 (48.9%) of the patients, retinopathy was seen in 54 (9.89%) and microalbimunira was observed in 297(54.4%) of hypertensive patients. 129 (23.63%) were smokers. Statistical significance was observed renal parameters except serum uric acid levels.&#x0D; Conclusion: Prevalence of microalbuminuria in hypertensive patients warns that screening for microalbuminuria is essential for intervention and prevention of complications and renal diseases. Also it is necessary to screen the patients for early nephropathy to halt the disease progression.

Chasms in Achievement of Recommended Diabetes Care among Geographic Regions in Korea.

BackgroundAlthough effective care for type 2 diabetes (T2DM) is well known, considerable inadequate care has been still existed. Variations in achievement of the recommended quality indicators inT2DM care among small areas are not well known in Korea. This study examined the quality of care T2DM care and its geographical variations.MethodsWe used the national health insurance database and national health screening database. Seven quality indicators were used to evaluate continuity of care (medication possession ratio), process of care (hemoglobin A1c test, lipid profile, microalbuminuria test, and eye examination), and intermediate outcome (blood pressure control, and low-density lipoprotein control). Crude and age-standardized proportions were calculated for each 252 districts in Korea.ResultsAll quality indicators failed to achieve the recommended level. Only about 3% and 15% of the patients underwent eye examination and microalbuminuria test, respectively. Other indicators ranged from 48% to 68%. Wide variation in the quality existed among districts and indicators. Eye examination and microalbuminuria test varied the most showing tenfold (0.9%–9.2%) and fourfold (6.3%–28.9%) variation by districts, respectively. There were 32.4 and 42.7 percentage point gap between the best and the worst districts in hemoglobin A1c test and blood pressure control, respectively.ConclusionConsiderable proportion of T2DM patients were not adequately managed and quality of care varied substantially district to district. To improve the quality of diabetes care, it is necessary to identify the poor performance areas and establish a well-coordinated care system tailored to the need of the district.

Fasting glucose of patients from public health care in the southern region of São Paulo: correlation with glycated hemoglobin and lipid levels.

Fasting glucose is a test used for monitoring diabetes mellitus, as well as its screening and diagnosis. The objective of this study was to evaluate fasting glucose results and their correlation with glycated hemoglobin and lipids. Cross-sectional study, involving 77,581 patients, attended in 2014. The majority of the patients are women (65%). The age of the patients ranged from 18 to 115 years (mean of 53 ± 15.5). The agreement between fasting glucose and glycated hemoglobin was moderate (kappa = 0.416); however, it was substantial for the levels used for the diagnosis of diabetes (kappa = 0.689) and poor for pre-diabetes (kappa = 0.188). Fasting glucose ≥ 100 mg/dL was observed in 41.1% of the patients and 61.5% present glycated hemoglobin ≥ 5.7%. Lipid abnormalities are likeliest in patients with elevated fasting glucose. From those 14,241 individuals that had fasting glucose ≥ 126 mg/dL, the microalbuminuria test was performed in only 883 (6.2%) patients, with abnormal results in 201 (22.8%). The high frequency of fasting glucose with abnormal results may reflect the high proportion of exams performed by individuals with diagnosis of diabetes, to evaluate their glycemic control. The low frequency of requests for microalbuminuria tests in those with probable diagnosis of diabetes reflects the little attention paid for the screening of chronic complications of diabetes. It calls attention the high frequency of dyslipidemia in those individuals, highlighting the fact that this is a population with high cardiovascular risk.

Urinary Proteomics for the Early Diagnosis of Diabetic Nephropathy in Taiwanese Patients.

Diabetic nephropathy (DN) is a major complication in diabetic patients. Microalbuminuria testing is used to identify renal disease; however, its predictive value is questionable. We aimed to identify urinary biomarkers to early diagnosis nephropathy before identifiable alternations in kidney function or urine albumin excretion occurs. Proteomic approaches were used to identify potential urinary biomarkers and enzyme-linked immunosorbent assay was performed to verify the results. The data identified haptoglobin (HPT) and α-1-microglobulin/bikunin precursor (AMBP) as two biomarkers with the highest ability to distinguish between healthy individuals and patients with nephropathy, and between diabetic patients with and without DN. Further, the HPT-to-creatinine ratio (HCR) was evaluated as an independent predictor of early renal functional decline (ERFD) in a cohort with an average follow-up of 4.2 years. The area under the curve (AUC) value for ERFD prediction was significantly improved when the HCR biomarker was included in the model with albumin to creatinine ratio (ACR) and baseline characteristics (AUC values were 0.803 and 0.759 for HCR and ACR, respectively; p value was 0.0423 for difference between models). In conclusion, our results suggest that HCR represents an early indicator of nephropathy, and a marker related to ERFD among diabetic patients in Taiwan.

A18702 Microalbuminuria among newly diagnosed Sudanese patients with hypertension

Objectives: To assess microalbuminuria among newly diagnosed Sudanese patients with hypertension in Ibrahim Malik Teaching Hospital hospital from February to end of March 2017 Methods: It is a Descriptive cross sectional hospital based study, conducted in Ibrahim Malik Teaching hospital which is one of the major hospitals in Khartoum that provides medical services to a wide range of population. The study Covered 60 participants. Data were entered, prepared and analyzed using SPSS version 22.0 Results: The results found that the mean age of the participants was 50.4 ± 12.6 which is younger compared to other similar studies. 73.3% of the study participants had positive microalbuminuria which is higher compared to other similar studies. Only 27.0% of the participants found to have positive dipstick test for proteinuria which indicates low sensitivity of the test and the importance of microalbuminuria test for similar cases. Most the study participants were found to be in stage 2 and 3 hypertension. However, the study didn’t show significant relationship between the stage of hypertension and the level of microalbuminuria. 90% of patients found to have normal creatinine level. Conclusion: Microalbuminuria test should be part of routine follow up test for patients with newly diagnosed hypertension. Also, if they show persistent positive results after treatment of hypertension they should receive specific management such as angiotensin converting enzyme inhibitors or angiotnsin receptor blockers.