Glycemic Status and Renal Function among Type 2 Diabetics

Introduction: Diabetic mellitus (DM) is a group of metabolic disorder characterized by chronic hyperglycemia due to derangement in carbohydrate, fat and protein metabolism that are associated with absolute or relative deficiencies in insulin secretion, insulin action or both1.According to WHO, diabetes affects more than 170 million people worldwide2, and affects more than 436,000 people in Nepal, and this number will rise to 1,328,000 by 20303. The prevalence of diabetic patients has increased from 19.04% in 2002 to 25.9% in 2009 in Nepal4.Diabetic patients are at an increased risk of developing specific complications including nephropathy, retinopathy neuropathy and atherosclerosis. Diabetic nephropathy occurs in approximately one third type 2 diabetes5. ? DM is the major cause of renal morbidity and mortality, and diabetic nephropathy is one of chronic kidney failure6, accounting for nearly 44 percent of new cases7. Even when diabetes is controlled, the disease can lead to chronic kidney disease (CKD) and kidney failure. Kidney failure is the final stage of chronic kidney disease. Nearly 24 million people in the United States have diabetes and nearly 180000 people are living with kidney failure as a result of diabetes8. The prevalence of nephropathy in India was less (8.9% in Vellore, 5.5% in Chennai) when compared with the prevalence of 22.3% in Asian Indians in the UK9. In chronic renal failure patients the

prevalence of diabetic nephropathy was 30.3% followed by chronic interstitial nephritis (23%) and chronic glomerulonephritis (17.7%) 10 .In diabetic nephropathy, a number of serum markers are known to be deranged 11 .Urea & creatinine are the parameters to diagnose functioning of the kidney.Changes in serum creatinine concentration more reliably reflect changes in GFR than do changes in serum urea concentrations.Creatinine is formed spontaneously at a constant rate from creatinine, and blood concentrations depend almost solely upon GFR.Urea formation is influenced by a number of factors such as liver function, protein intake and rate of protein catabolism 12 .Information on plasma biochemical profiles of diabetic population in mid and far western region of Nepal is scarce.The aim of our study was to measure the glycemic status and renal function among type 2 diabetic patients of mid and far western region of Nepal.

Material and Method:
It was a cross sectional study, consisted of 200 subjects (age and sex-matched) divided into two groups: diabetic subjects (n=100) and non-diabetic controls (n=100).This study was carried out in the central laboratory of biochemistry of the Nepalgunj medical college and Hospital, Nepalgunj, Banke, Nepal between the period 1 st February , 2012 to 31 st January , 2013 .Blood samples from subjects and controls were taken for investigation of fasting plasma glucose (FPG), blood urea, serum creatinine .Inclusion criteria-1) Patients who fulfill selection criteria were included in this study.2) Adult patients age between 30-65 years of either sex.3) Patients those are having history of diabetes up to five years Exclusion criteria-Patients with dehydration, muscle dystrophy, glomerulonephritis, pyelonephritis, hypertension, eclampsia preeclamsia urinary tract obstruction and congestive cardiac failure were excluded from the study.Fasting venous blood sample was collected from all participants (both subjects and controls) into sample containers using a 5mL syringe.Each blood samples was mixed gently and spun as quickly as possible at 3000 rpm for 5 min.Plasma was extracted into plain tubes and frozen at -4 0 C until required for further analysis. .Estimation of serum glucose was done by glucose oxidase and peroxidase method 13 .The diabetic status was defined as per the American Diabetes Association (ADA) 14 .Similarly serum urea was estimated by Berthelot's method 15 while creatinine was estimated by alkaline Jaffe's Picrate method 16 .These biochemical parameters were determined by using a fully automated clinical chemistry analyzer.The normal level of creatinine was considered 0.8 to 1. 4

Conclusion:
In our study higher blood urea level was found in type 2 DM as compared to non-diabetics.To monitor the diabetes patients, estimation of blood urea level along with blood sugar level could be important.Good control of blood glucose level is absolute requirement to prevent progressive renal impairment.As our sample size was small and duration of study was limited, another study with larger sample size and longer duration is also recommended.

Table 2 : Blood glucose, creatinine and urea concentration in male non-diabetic controls and type 2 diabetic subjects.
* By Using Student t test concentrations of creatinine and urea in both type 2 diabetic subjects and non-diabetic controls.Fasting blood glucose concentration, plasma creatinine and urea concentrations were observed to be significant-sensitive index of renal function.An increase in urea level is seen when there is damage to the kidney or the kidney is not functioning properly.Increment of blood urea level with the increment of blood sugar

Table 4 : Blood glucose, creatinine and urea concentration in male and female type 2 diabetic subjects. (NS-Non significant) Figure
This result is supported by various researchers who showed that sex wise variation occurs only in serum creatinine level but not in blood sugar level and urea level.High serum creatinine level was seen in males than females, which could be because of storage of creatinine as a waste product in muscle mass and the presence of high muscle mass in males 22 .Diabetic nephropathy, especially related to type 2 DM, has become the single most important cause of ESRD (end stage renal disease) worldwide.Management of traditional risk factors such as hyper tension, hyperlipidemia, and smoking to improve cardiovascular and renal outcomes continues to be important in patients with chronic kidney disease.
1: Compare of Blood glucose, creatinine and urea concentration in male and female type 2 diabetic subjects.