Global Journal of Medical Research, F: Diseases, Volume 22 Issue 4

To Evaluate the Role of HbA1C as a Predictor for the Development of Diabetic Nephropathy in Type 1 Diabetic Patients Dr. Sushant Duddala α , Arghadip Das σ , Shaibesh M Shrestha ρ , Dr. Snigdha Shanti Cheela Ѡ , Dr. Himani J Suthar ¥ , Dr. Vinodh Boopalraj § & Irshan Ali Mohammed χ Abstract- Aim: The aim of this study to evaluate the role of HbA1C as a predictor for the development of diabetic nephropathy in type 1 diabetic patients. Methods: This prospective observational study was carried out by involving 120 patients. The ‘‘fluctuations” in HbA1C over time was assessed. HbA1C fluctuation was defined as an increase in HbA1C of more than 2% between two consecutive measurements, or an increase of more than 1% at 2 points in time. Results: There was no association between gender and the development of diabetic nephropathy (p = 0.95). There were no significant group differences in the ‘‘age at onset of diabetes” or ‘‘time period from the onset of diabetes till admission to the chronic care center” (p = 0.48 and p = 0.81, respectively). The association between fluctuations in HbA1C and diabetic nephropathy is shown in Table 1. Among those who developed nephropathy, 10 of 20(60%) had fluctuations in HbA1C; compared to those who do not develop nephropathy 54 of 100 (54%) had fluctuations in HbA1C (p = 0.05). The mean HbA1C per individual was 8.65 ± 1.3 in the whole sample. As shown in Table 1, mean HbA1C was 9.5 ± 1.7% among those who developed nephropathy compared to a mean of 8.6 ± 1.2% for those who did not develop nephropathy, and was statistically significant between the two groups (p = 0.004). Conclusion: We concluded that the T1D patients who have a similar mean HbA1C may progressively behave differently in terms of developing nephropathy, depending on the fluctuations in HbA1C. Keywords: type 1 diabetic, diabetic nephropathy, glycosylated hemoglobin (HbA1C). Corresponding Author α : MBBS, Prathima Institute of Medical Sciences, Telangana, India. Author σ : Medical Student, Nilratan Sircar Medical College, Kolkata, West Bengal, India. Author ρ : MD, DipIBLM, Medical school : Saint Louis University, US. e-mail: shresthashaibesh@gmail.com Author Ѡ : MBBS, Prathima Institute of Medical Sciences, Telangana, India. Author ¥ : MBBS, G.M.E.R.S Medical College and Hospital, Gandhinagar, Gujarat, India. Author § : MD, Physician in General Medicine, Pediatric Medicine, Yerevan StateMedical University, Armenia. Author χ : BLDE University, Shri B.M Patel Medical College and Research Center, Vijayapur, Karnataka, India. I. I ntroduction he proportion of patients with end-stage renal disease (ESRD) caused by diabetes has progressively increased during the last few decades and diabetic nephropathy (DN) is the leading cause of end stage renal disease (ESRD) in the world. Diabetic nephropathy is defined by persistent albuminuria, declining glomerular filtration rate (GFR) and progressive rise in blood pressure. Approximately 40-50% of patients with type 1 diabetes and 20-30% of patients with type 2 diabetes develop diabetic nephropathy. 1 Based on studies in type 1 diabetes, it had been generally considered that once overt diabetic nephropathy, manifesting as persistent proteinuria, is present, it was only possible to slow, but not halt, the progression toward ESRD. 2-4 This led investigators during the early 1980s to search for early predictors of diabetic nephropathy. Most investigators now agree that diabetic nephropathy result from the interaction of multiple metabolic, genetic and other factors of which chronic hyperglycemia is one of the most significant factor in both the initiation and progression of the disease. 5 Different randomized controlled trials and observational studies have strongly suggest that hyperglycaemia or closely associated factors of poor glycaemic control, like HbA1c is a good predictor of diabetic nephropathy 5-9 , and is highly correlated with fasting blood glucose (FBG) and does not require measurement in the fasting state. 10 One study showed that increasing HbA1c categories had a higher prevalence of chronic kidney disease (CKD) and micro or macro-albuminuria. In the multivariable models, HbA1c categories above 7.0% were significantly associated with increased prevalence of diabetic nephropathy compared with the lowest category. 11 Another study demonstrated that HbA1c >6.5% predicts a future risk of kidney disease. Above the threshold point with the increasing of HbA1c levels the risk of kidney diseases also increases sequentially. 12 It indicates that HbA1c may be used as a useful marker for nephropathy along with other risk factors. The ADVANCE trial documented that (in subjects with type 2 diabetes mellitus) strict glycaemic control (mean HbA1c: 6.5%) in comparison with standard control T 3 Year 2022 Global Journal of Medical Research Volume XXII Issue IV Version I ( D ) F © 2022 Global Journals