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

(mean HbA1c: 7.3%) is associated with a significant reduction in renal events, including onset of or worsening of nephropathy [hazard ratio (HR) 0.79; P = 0.006], new-onset microalbuminuria (HR 0.91; P = 0.02), and, in particular, development of macro- albuminuria (HR 0.70; P <0.001). 13 There are several other predictors 14-18 of diabetic nephropathy including advanced age, longer duration of diabetes, body weight, smoking, diabetic ketoacidosis, mild to moderate nonproliferative diabetic retinopathy, proliferative diabetic retinopathy (the most prevalent predictor), proteinuria, hypertension, dyslipidaemia, physical inactivity etc. Both sexes are vulnerable to diabetic nephropathy, although there is an unexplained male preponderance of diabetic nephropathy. Ethnicity and family history also affect the risk of diabetic nephropathy. The burden of nephropathy will increase in future as the incidence of diabetes increases and the age of onset declines, although the effects may be lessened by the use of emerging therapies. 19 Therefore, we attempted to do a clinical study on relation of HbA1c and other risk factors with nephropathy. II. M aterial and M ethods This prospective observational study was carried out by involving 120 patients after taking the approval of the protocol review committee and institutional ethics committee. Type 1 diabetic patients are followed up regularly at least every 3 months. At each visit, HbA1C is measured; body weight and the average dose of total insulin required per day are measured. Height is documented once a year. Blood pressure is systematically measured at diagnosis, and recorded at least once a year. Eye examination, for the presence of diabetic retinopathy, is done by an ophthalmologist at the first visit to the center then followed up a yearly basis. Microalbuminuria is tested in each patient 5 years after the diagnosis of type 1 diabetes, as recommended by ADA 20 , and then yearly. Patients with type 1 diabetes, as defined by ADA 21 , admitted to the chronic care center were studied. Only patients admitted to the chronic care center within 12 months of diagnosis of type 1 diabetes mellitus were included, since structural renal abnormalities due to diabetes usually occurs afterward. 22 Patients were excluded from the study if the duration of diabetes was less than 5 years, since diabetic nephropathy is known to occur after at least 5 years of the disease. 20 Patients were also excluded from the study if they suffered from wolfram syndrome, or had thalassemia or other hemoglobinopathy. Two hundred and ten patients met the inclusion criteria, and 90 patients were excluded. The final sample size was 120 patients. The following information was obtained: age, gender, date of birth, date of onset of diabetes, date of admission to the center, family history for diabetes, results of microalbuminuria after 5 years of diagnosis, the dates and the results of HbA1C at each visit, BMI at baseline and blood pressure. Patients (micro- albuminureavs non-microalbuminurea) were selected based on a cutoff point of 24 h urine microalbumin of >30 mg/24 h on more than two occasions. Acceptable metabolic control was defined as having a mean HbA1C <8% and a poor metabolic control denoted a mean HbA1C P8%. Although the definition of poor vs acceptable metabolic control is not standardized, our definition was based on our assay methodology. Results were considered significant at the 5% critical level (p < 0.05). III. R esults The sample analyzed consisted of 120 type 1 diabetic patients, 67 females and 53 males, aged 10– 30 years were included in this study. 20 among 120 (16.67%) developed nephropathy after 5 years of onset of diabetes. As shown in Table 1, 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). BMI at first visit for those who developed nephropathy was not significantly different from the BMI at first visit for those who did not have evid ence of nephropathy (p = 0.41). There was no significant difference in the outcome between those with and without family history of diabetes. Hypertension was omitted, because of no variability, as patients were not hypertensive. Table 1: Main characteristics of the study population in relation to the development of diabetic nephropathy Parameter Nephropathy N = 20 No nephropathy N = 100 p- value Gender [n (%)]a Male 9 (45) 44 (44) 0.95 Female 11 (55) 56 (56) Age at onset (years) 11.95 ± 5.6 11.13 ± 4.10 0.48 4 Year 2022 Global Journal of Medical Research Volume XXII Issue IV Version I ( D ) F © 2022 Global Journals To Evaluate the Role of HbA1C as a Predictor for the Development of Diabetic Nephropathy in Type 1 Diabetic Patients