Prevalence of nephropathy in type 1 diabetes in the Arab world: A systematic review and meta-analysis

Prevalence and Risk Factors of Diabetic Nephropathy Among Saudi Type-1 Diabetic Patients in Taif City, Saudi Arabia

Purpose

We investigated the prevalence and associated risk factors of DNP in T1DM patients in Taif city, Saudi Arabia, where the renal diseases are prevalent. The incidence of diabetic nephropathy (DNP) is increasing in Saudi Arabia, and the country is also ranked 4th in terms of the number of diagnosed type-1 diabetes (T1DM) patients.

Patients and Methods

The retrospective cohort study was conducted with type-1 diabetes patients registered at King Abdulaziz Specialist Hospital in Taif, Saudi Arabia. A total of 198 patients (aged > 18 years), had T1DM for more than 5 years with documented albuminuria; albumin-creatinine ratio (ACR) ≥30 mg/g creatinine in two of three urine samples or estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, were included in the study. Patients' demographic and laboratory data were collected from medical records. A regression analysis model was used to identify risk factors for DNP. Statistical significance was set at P < 0.05.

Results

The overall prevalence of DNP was 23.7% in our study group, with 8% having low eGFR alone, 20.71% having positive ACR and 6.22% having both positive ACR and low eGFR. A statistically significant correlation between DNP and risk factors was found for uncontrolled and longer duration of T1DM, elevated ACR, and hypertension (P < 0.05). No statistical significance was found for age, sex, or body mass index (BMI).

Conclusion

The prevalence of DNP in T1DM patients in Taif city was higher (23.7%) than the pooled average prevalence in Saudi Arabia (20.59%). Patients' education regarding glycemic and blood pressure control could reduce the burden.

Structural characterization and conformational dynamics of alpha-1 antitrypsin pathogenic variants causing alpha-1-antitrypsin deficiency

Background: Alpha-1 antitrypsin deficiency (A1ATD) is a progressive lung disease caused by inherited pathogenic variants in the SERPINA1 gene. However, their actual role in maintenance of structural and functional characteristics of the corresponding α-1 anti-trypsin (A1AT) protein is not well characterized. Methods: The A1ATD causative SERPINA1 missense variants were initially collected from variant databases, and they were filtered based on their pathogenicity potential. Then, the tertiary protein models were constructed and the impact of individual variants on secondary structure, stability, protein-protein interactions, and molecular dynamic (MD) features of the A1AT protein was studied using diverse computational methods. Results: We identified that A1ATD linked SERPINA1 missense variants like F76S, S77F, L278P, E288V, G216C, and H358R are highly deleterious as per the consensual prediction scores of SIFT, PolyPhen, FATHMM, M-CAP and REVEL computational methods. All these variants were predicted to alter free energy dynamics and destabilize the A1AT protein. These variants were seen to cause minor structural drifts at residue level (RMSD = <2Å) of the protein. Interestingly, S77F and L278P variants subtly alter the size of secondary structural elements like beta pleated sheets and loops. The residue level fluctuations at 100 ns simulation confirm the highly damaging structural consequences of all the six missense variants on the conformation dynamics of the A1AT protein. Moreover, these variants were also predicted to cause functional deformities by negatively impacting the binding energy of A1AT protein with NE ligand molecule. Conclusion: This study adds a new computational biology dimension to interpret the genotype-protein phenotype relationship between SERPINA1 pathogenic variants with its structural plasticity and functional behavior with NE ligand molecule contributing to the Alpha-1-antitrypsin deficiency. Our results support that A1ATD complications correlates with the conformational flexibility and its propensity of A1AT protein polymerization when misfolded.

Prevalence of diabetic nephropathy in the diabetes mellitus population: A protocol for systematic review and meta-analysis

BACKGROUND

Diabetic nephropathy (DN) is the leading cause of end-stage renal disease worldwide, placing enormous pressure on healthcare systems and creating a heavy socioeconomic burden. It is urgent to comprehensively study the epidemiological characteristics of DN in diabetic patients and to analyze the related factors to its incidence in order to implement effective prevention and control measures.

METHODS AND ANALYSIS

Computer-aided searches of the MEDLINE, EMBASE, Web of Science, PsycINFO, and CINAHL databases will be performed for prospective cohort studies reporting the prevalence of DN in diabetic populations. Studies will be pooled using a generalized linear mixed model, and a single proportion of included studies will be calculated to derive the overall incidence of DN in the diabetic population, and to analyze the effect of different factors on the incidence of DN. Publication bias will be assessed using a funnel plot combined with Begg test. Sensitivity analyses will be performed using the separation method, the exclusion of low-quality studies, and the trim and fill method.

RESULTS

The primary outcome will be the prevalence of DN in the diabetic population; secondary outcomes will be the influence of factors such as age, gender, region, ethnicity, duration of diabetes, type of diabetes, baseline body mass index, baseline glycated hemoglobin level, baseline blood pressure, quality of included studies, and follow-up time on the prevalence of DN in diabetic patients.

CONCLUSION

Through this systematic review and meta-analysis, the study will more comprehensively obtain the prevalence of DN in diabetic populations worldwide, and gain a deeper understanding of the differences in the prevalence of DN in diabetic populations with different characteristics, so as to provide evidence for the management of diabetes and the prevention of DN.

Therapeutic application of nutraceuticals in diabetic nephropathy: Current evidence and future implications

Diabetes mellitus (DM) is a common metabolic disease which may cause several complications, such as diabetic nephropathy (DN). The routine medical treatments used for DM are not effective enough and have many undesirable side effects. Moreover, the global increased prevalence of DM makes researchers try to explore potential complementary or alternative treatments. Nutraceuticals, as natural products with pharmaceutical agents, have a wide range of therapeutic properties in various pathologic conditions such as DN. However, the exact underlying mechanisms have not been fully understood. The purpose of this review is to summarize recent findings on the effect of nutraceuticals on DN.