Prevalence and risk factors of microalbuminuria in type 2 diabetes mellitus outpatients at University Sains Malaysia Hospital

Determinants of microalbuminuria among type 2 diabetes mellitus patients in Kuala Selangor district: A cross-sectional study

INTRODUCTION

Microalbuminuria presents significant health risks for the progression of endstage renal-failure (ESRF) among type 2 diabetes mellitus (T2DM) patients. This study aims to determine the proportion and associated factors of microalbuminuria among T2DM patients in Kuala Selangor district, Malaysia.

METHOD

A retrospective cross-sectional study was conducted from December 2020 to February 2021 using secondary data from the National Diabetic Registry (NDR), Malaysia, and reviewed patients' diabetic records for the year 2020. All T2DM patients aged >18 years who were registered with the NDR in 2020 and fulfilled the inclusion and exclusion criteria were included in the study. Descriptive statistics and multiple logistic regression analysis were performed. Data were analysed using SPSS version 26.0. A total of 343 samples were included in this study for the determination of the proportion of microalbuminuria and its associated factors.

RESULTS

Of 343 respondents, 34.4% had microalbuminuria. HbAlc >7.0% (AdjOR 2.19, 95% CI: 1.35, 3.55, p=0.001), HDL <1.04 mmol/L (AdjOR 2.44, 95% CI: 1.323, 4.52, p=0.004), dyslipidaemia (AdjOR 1.90, 95% CI: 1.03, 3.48, p=0.039), and peripheral neuropathy (AdjOR 3.01, 95% CI: 1.02, 8.93, p=0.047) were significantly associated with microalbuminuria. Conclusion: Microalbuminuria is a modifiable risk factor in preventing the progression of ESRF among T2DM patients. Therefore, identification of factors associated with microalbuminuria among this high-risk group is important to facilitate early screening and prompt treatment to prevent progression of diabetic kidney disease to ESRF.

Mechanistic Pathogenesis of Endothelial Dysfunction in Diabetic Nephropathy and Retinopathy

Diabetic nephropathy (DN) and diabetic retinopathy (DR) are microvascular complications of diabetes. Microvascular endothelial cells are thought to be the major targets of hyperglycemic injury. In diabetic microvasculature, the intracellular hyperglycemia causes damages to the vascular endothelium, via multiple pathophysiological process consist of inflammation, endothelial cell crosstalk with podocytes/pericytes and exosomes. In addition, DN and DR diseases development are involved in several critical regulators including the cell adhesion molecules (CAMs), the vascular endothelial growth factor (VEGF) family and the Notch signal. The present review attempts to gain a deeper understanding of the pathogenesis complexities underlying the endothelial dysfunction in diabetes diabetic and retinopathy, contributing to the development of new mechanistic therapeutic strategies against diabetes-induced microvascular endothelial dysfunction.

Study on the Risk Factors for Hyperuricaemia and Related Vascular Complications in Patients with Type 2 Diabetes Mellitus

Purpose

The study aimed to identify diseases that exhibit significant differences between hyperuricaemia (HUA) and non-hyperuricaemia (NHUA) groups and analyse the risk factors for HUA based on the related diseases in type 2 diabetes mellitus (T2DM).

Methods

A total of 3264 T2DM patients were investigated from 2013 to 2017 in the Jinyang and Sanlin communities by obtaining basic data from the electronic medical record system (EMRS). From September 2018 to July 2019, 3000 patients (264 patients were missing during follow-up) were investigated with questionnaires, physical examinations and biochemical index tests. After removing missing values, 2899 patients were divided into HUA and NHUA groups. The chi-square test was used to identify diseases with differences. Using Lasso analysis and logistic regression analysis, risk factors for HUA based on the related diseases were obtained. The C-index, receiver operating characteristic (ROC) curve and calibration plot were used to validate the discrimination and accuracy of the factors.

Results

The chi-square test showed that there were significant differences in coronary heart disease (CHD) and diabetic nephropathy (DN) between the HUA group and the NHUA group. Through Lasso regression, glycosylated haemoglobin A1c (HbA1c), triglyceride (TG), blood urea nitrogen (BUN) and serum creatinine (SCR) were screened in the CHD group. Body mass index (BMI), HbA1c, total cholesterol (TC), TG, BUN, SCR and urine microalbumin (UMA) were screened in the DN group. The P-value of all the variables was less than 0.05. Through the C-index, calibration, and ROC curve analyses, these risk factors had medium accuracy.

Conclusion

HUA was significantly related to CHD and DN. The level of UA was correlated with HbA1c, TG, BUN, and SCR based on CHD. The level of UA was associated with BMI, HbA1c, TC, TG, BUN, SCR, and UMA based on DN.

Nomogram for the prediction of diabetic nephropathy risk among patients with type 2 diabetes mellitus based on a questionnaire and biochemical indicators: a retrospective study

Purpose: Develop a diabetic nephropathy incidence risk nomogram in a Chinese population with type 2 diabetes mellitus.

Results: Predictors included systolic blood pressure, diastolic blood pressure, fasting blood glucose, glycosylated hemoglobin A1c, total triglycerides, serum creatinine, blood urea nitrogen and body mass index. The model displayed medium predictive power with a C-index of 0.744 and an area under curve of 0.744. Internal verification of C-index reached 0.737. The decision curve analysis showed the risk threshold was 20%. The value of net reclassification improvement and integrated discrimination improvement were 0.131, 0.05, and that the nomogram could be applied in clinical practice.

Conclusion: Diabetic nephropathy incidence risk nomogram incorporating 8 features is useful to predict diabetic nephropathy incidence risk in type 2 diabetes mellitus patients.

Methods: Questionnaires, physical examinations and biochemical tests were performed on 3489 T2DM patients in six communities in Shanghai. LASSO regression was used to optimize feature selection by running cyclic coordinate descent. Logistic regression analysis was applied to build a prediction model incorporating the selected features. The C-index, calibration plot, curve analysis, forest plot, net reclassification improvement, integrated discrimination improvement and internal validation were used to validate the discrimination, calibration and clinical usefulness of the model.

Risk factors for diabetic nephropathy complications in community patients with type 2 diabetes mellitus in Shanghai: Logistic regression and classification tree model analysis

BACKGROUND

The prevalence of type 2 diabetes mellitus (T2DM) in China was 11.6% in 2010. Chronic complications are the main diabetes-related cause of death and disability, accounting for more than 80% of the cost of diabetes treatment. Diabetic nephropathy (DN) is a common microvascular complication and is the second leading cause of end-stage renal failure in China.

OBJECTIVE

We aimed to analyse the DN status among community-based T2DM patients and to explore risk factors for T2DM with DN.

METHODS

This study was conducted in six communities of Shanghai. We administered a questionnaire, physical examination, and biochemical tests to 5078 patients with T2DM. Logistic regression and the classification tree model were used to analyse risk factors for T2DM with DN.

RESULTS

In total, 1937 patients were diagnosed with DN (prevalence 38.4%). The logistic regression model indicated that course of disease more than 15 years, body mass index (BMI) greater than 24 kg/m² , haemoglobin A1c (HbA1c) greater than 7.5%, fasting blood glucose (FBG) greater than 11.0 mmol/L, total cholesterol (TC), and high-density lipoprotein (HDL)-C control failure, hypertension, and diabetic retinopathy were risk factors for T2DM with DN (P < .05). The classification tree model identified seven risk factors (HbA1c, FBG, hypertension, postprandial blood glucose, BMI, triacylglycerol, and HDL), of which, HbA1c (cut-off point 7.45%), hypertension, and FBG showed the strongest association.

CONCLUSION

This suggests that screening for DN based on HbA1c, FBG, and hypertension should be more extensively promoted by the government on a community level, more attention should be focused on patients' health management, and that patients should be educated on self-management.

Validation of Malaysian Versions of Perceived Diabetes Self-Management Scale (PDSMS), Medication Understanding and Use Self-Efficacy Scale (MUSE) and 8-Morisky Medication Adherence Scale (MMAS-8) Using Partial Credit Rasch Model

INTRODUCTION

The Diabetes Mellitus (DM) is a common silent epidemic disease with frequent morbidity and mortality. The psychological and psychosocial health factors are negatively influencing the glycaemic control in diabetic patients. Therefore, various questionnaires were developed to address the psychological and psychosocial well-being of the diabetic patients. Most of these questionnaires were first developed in English and then translated into different languages to make them useful for the local communities.

AIM

The main aim of this study was to translate and validate the Malaysian versions of Perceived Diabetes Self-Management Scale (PDSMS), Medication Understanding and Use Self-Efficacy Scale (MUSE), and to revalidate 8-Morisky Medication Adherence Scale (MMAS-8) by Partial Credit Rasch Model (Modern Test Theory).

MATERIALS AND METHODS

Permission was obtained from respective authors to translate the English versions of PDSMS, MUSE and MMAS-8 into Malay language according to established standard international translation guidelines. In this cross-sectional study, 62 adult DM patients were recruited from Hospital Kuala Lumpur by purposive sampling method. The data were extracted from the self-administered questionnaires and entered manually in the Ministeps (Winsteps) software for Partial Credit Rasch Model. The item and person reliability, infit/outfit Z-Standard (ZSTD), infit/outfit Mean Square (MNSQ) and point measure correlation (PTMEA Corr) values were analysed for the reliability analyses and construct validation.

RESULTS

The Malay version of PDSMS, MUSE and MMAS-8 found to be valid and reliable instrument for the Malaysian diabetic adults. The instrument showed good overall reliability value of 0.76 and 0.93 for item and person reliability, respectively. The values of infit/outfit ZSTD, infit/outfit MNSQ, and PTMEA Corr were also within the stipulated range of the Rasch Model proving the valid item constructs of the questionnaire.

CONCLUSION

The translated Malay version of PDSMS, MUSE and MMAS-8 was found to be a highly reliable and valid questionnaire by Partial Credit Model. The Malay version was conceptually equivalent to original version, easy to understand and can be used for the Malaysian adult diabetic patients for future studies.

Impact of diabetes mellitus on the prognosis of patients with hepatocellular carcinoma after curative hepatectomy

BACKGROUND

The influence of diabetes mellitus (DM) on the prognosis of patients with hepatocellular carcinoma (HCC) remains controversial. Here we investigated the impact of DM on the prognosis of such patients after curative hepatectomy.

METHODS

A consecutive cohort of 505 patients with HCC (134 with DM, 371 without) underwent curative hepatectomy were retrospectively evaluated. Postoperative morbidity and mortality, overall survival (OS) and disease-free survival (DFS) were compared between patients with or without DM. Independent prognostic predictors were identified using the Cox proportional hazards model.

RESULTS

Patients with or without DM showed similar morbidity and 30- and 90- day mortality after curative hepatectomy (all P>0.05), as well as similar DFS at 1, 3, 5 years (P = 0.781). However, the group of patients with DM showed significantly lower OS at 1, 3, 5 years than the group without DM (P = 0.038). Similar results were obtained in the propensity-matched cohort. Cox multivariate analysis identified DM as an independent predictor of poor OS, but not of poor DFS. We repeat compared OS and DFS for DM and non-DM subgroups defined according to the presence or absence of hepatitis B virus infection and cirrhosis. Similar results were obtained in all subgroups except the non-cirrhotic subgroup which showed patients with and without DM had similar OS.

CONCLUSIONS

DM does not significantly affect the postoperative morbidity or mortality or the DFS of patients with HCC after curative hepatectomy. It is, however, associated with significantly lower OS, especially in patients with cirrhosis.