Prevalence of Diabetic Nephropathy and associated risk factors among type 2 diabetes mellitus patients in Ramallah, Palestine

Diabetes-Related Microvascular Complications in Primary Health Care Settings in the West Bank, Palestine

BACKGROUND

Worldwide, retinopathy, nephropathy, and neuropathy are the major diabetes-related microvascular complications. In Palestine, a low-middle-income country, diabetes is the fourth reason for death. However, a few studies examined diabetes microvascular consequences and its management. Therefore, we carried out a national study that aims to investigate the factors associated with diabetes-related microvascular complications among individuals seeking care in primary healthcare settings of the West Bank of Palestine.

METHOD

Using a cluster systematic sampling technique, 882 participants with diabetes patients were chosen for a cross-sectional study from primary healthcare facilities operated by the Ministry of Health (PMoH), the United Nations Relief and Works Agency (UNRWA), and the Palestinian Medical Relief Society (PMRS). Data about patients related to diabetes-related complications, medication use, and other diseases were extracted from patients' medical records. In addition, an interview face-to-face questionnaire was used to collect information about patients' sociodemographic variables, medical history, smoking habits, duration of the disease, presence of concurrent conditions previous referrals, and hospital admissions, as well as their level of knowledge regarding diabetes, complications, and treatments.

RESULTS

Approximately 34.4% of persons with diabetes patients in Palestine encounter at least one microvascular complication associated with diabetes. The most prevalent diabetes-related microvascular complication was retinopathy (17.3%), 23.4% of participants had more than one microvascular complication, and 29% of male patients had erectile dysfunction. A higher probability of having any microvascular complications was associated with older age (over 60 years). Participants with diabetes patients with fundoscopy or ophthalmology reports, according to diabetes follow-up guidelines, were less likely to develop retinopathy. Also, those who performed regular kidney function testing were less likely to have nephropathy, and those who performed a regular foot exam were less likely to develop diabetic foot.

CONCLUSIONS

Diabetes-related microvascular complications were associated with patient age, low education level, residency location, and adherence to diabetes follow-up guidelines of diabetes management; i.e., having been tested for HbA1c, consulting with specialists, regular kidney function, and foot examination. These factors can be utilized in setting up proper management protocols to prevent or delay microvascular complications in many patients.

Systolic inter-arm blood pressure difference and estimated glomerular filtration rate in type 2 diabetic patients in Palestine: a cross-sectional study

OBJECTIVES

This study aimed to investigate the association between systolic inter-arm blood pressure difference (IABPD) and the estimated glomerular filtration rate (eGFR), as well as chronic kidney disease (CKD), in patients with type 2 diabetes mellitus (T2DM).

PATIENTS AND METHODS

This cross-sectional study included 189 Palestinians diagnosed with T2DM. Data were collected through personal interviews, medical records and three separate blood pressure measurements from both arms. Patients were stratified in two ways: based on systolic IABPD ≥15 mmHg and the presence of CKD, indicated by an eGFR of <60 mL/min/1.73 m2 over a three months period. We used simple and multiple linear regression analyses to clarify the association between systolic IABPD (mmHg) and eGFR and to identify independent predictors for eGFR.

RESULTS

The mean age was 61.3 years, with a female percentage of 57.7%. The prevalence of systolic IABPD ≥15 mmHg and CKD was 27.5% and 30.2%, respectively. Among patients with eGFR <60 mL/min/1.73 m2, the median systolic IABPD was 12.5 mmHg (interquartile range (IQR), 13.5 mmHg), whereas in patients with eGFR ≥60 mL/min/1.73 m2, it was 7.5 mmHg (IQR, 9.8 mmHg) with a significant difference (p = .021). The results of the multiple linear regression model did not reveal an independent association between systolic IABPD and eGFR, with an unstandardized coefficient (B) of -0.257 (95% confidence interval (CI), -0.623 to 0.109; p = .167). However, older age (B, -0.886; 95% CI, -1.281 to -0.49; p < .001), hypertension (B, -12.715; 95% CI, -22.553 to -2.878; p = .012) and a longer duration of DM (B, -0.642; 95% CI, -1.10 to -0.174; p = .007) were significantly and negatively associated with eGFR.

CONCLUSIONS

Systolic IABPD did not exhibit an independent association with eGFR in T2DM patients. However, older age, a previous history of hypertension, and a longer duration of DM were all significantly associated with lower eGFR.

Dyslipidemia and serum cystatin C levels as biomarker of diabetic nephropathy in patients with type 2 diabetes mellitus

Background

Diabetic nephropathy is a leading cause of end-stage renal disease. The diagnostic markers of nephropathy, including the presence of albuminuria and/or a reduced estimated glomerular filtration rate, are not clinically ideal, and most of them are raised after a significant reduction in renal function. Therefore, it is crucial to seek more sensitive and non-invasive biomarkers for the diagnosis of diabetic nephropathy.

Objective of the study

This study aimed to investigate the serum cystatin C levels and dyslipidemia for the detection of diabetic nephropathy in patients with type 2 diabetes mellitus.

Methodology

A hospital-based comparative cross-sectional study was conducted from December 2021 to August 2022 in Tikur, Anbessa specialized teaching hospital with a sample size of 140 patients with type2 diabetes mellitus. Socio-demographic data was collected using a structured questionnaire, and 5 mL of blood was collected from each participant following overnight fasting for biochemical analyses.

Results

In type 2 diabetes patients with nephropathy, we found significant lipoprotein abnormalities and an increase in serum cystatin C (P &lt; 0.001) compared to those without nephropathy. Serum cystatin C, systolic blood pressure, fasting blood glucose, total cholesterol, triglyceride, low density lipoprotein, very low-density lipoprotein, high density lipoprotein, and duration of diabetes were identified as being significantly associated with diabetic nephropathy (P &lt; 0.05) in multivariable logistic regression analysis. The mean values of total cholesterol levels, triglyceride levels, and high-density lipoprotein cholesterol levels were also found to be significantly higher (P &lt; 0.05) in females as compared to male type-2 diabetic patients. The fasting blood glucose levels and lipid profiles of the participants were found to be significantly associated with serum cystatin C levels.

Conclusion

The present study found significant serum cystatin C and lipoprotein abnormalities in T2DM patients with diabetic nephropathy when compared with those without diabetic nephropathy, and these lipoprotein abnormalities were significantly associated with serum cystatin C levels.

Epidemiology of type 2 diabetes in the Middle East and North Africa: Challenges and call for action

Type 2 diabetes continues to be a serious and highly prevalent public health problem worldwide. In 2019, the highest prevalence of diabetes in the world at 12.2%, with its associated morbidity and mortality, was found in the Middle East and North Africa region. In addition to a genetic predisposition in its population, evidence suggests that obesity, physical inactivity, urbanization, and poor nutritional habits have contributed to the high prevalence of diabetes and prediabetes in the region. These risk factors have also led to an earlier onset of type 2 diabetes among children and adolescents, negatively affecting the productive years of the youth and their quality of life. Furthermore, efforts to control the rising prevalence of diabetes and its complications have been challenged and complicated by the political instability and armed conflict in some countries of the region and the recent coronavirus disease 2019. Broad strategies, coupled with targeted interventions at the regional, national, and community levels are needed to address and curb the spread of this public health crisis.

Prevalence of Vitamin D Deficiency among Hemodialysis Patients in Palestine: A Cross-Sectional Study

INTRODUCTION

The level of vitamin D status and its relationship to kidney function and liver function among patients with and without type 2 diabetes were not studied among Palestinian hemodialysis patients before. The aim of this study was to assess the status of vitamin D in hemodialysis patients with and without type 2 diabetes and its determinants.

METHODS

Data were collected on 163 patients on hemodialysis therapy in the Nephrology Department at Najah National University Hospital. Information on age, sex, plasma 25 (OH)D, serum calcium, serum phosphate, parathyroid hormone, dialysis period, hypertension, diabetes, ALT, AST, albumin, alkaline phosphates, and BMI was obtained from the medical records. Data were analyzed using SPSS. Findings. The mean level of 25 (OH)D was 17.3 ± 10.5 ng/ml. Only 12.9% of subjects had 25 (OH)D levels >30 ng/ml, whereas 65% had levels between 10 and 30 ng/ml; the remaining 22.1% were severely vitamin D deficient (<10 ng/ml). Vitamin D deficiency was more prevalent among females. It was not related to PTH, calcium, kidney, or liver function tests.

CONCLUSION

Vitamin D deficiency is highly prevalent among patients on hemodialysis with or without DM2.

Diabetes Mellitus and Renal Function: Current Medical Research and Opinion

Diabetes mellitus (DM), which is defined as high blood glucose level, is a major public health issue worldwide. An enormous amount of data has been gathered regarding DM as populations have been living with it for more than a decade; however, continually updating our knowledge of DM remains important. Comorbidities are among the major challenges associated with DM. Poorly controlled DM, especially type 2 DM (T2DM), is considered a risk factor for many diseases, including but not limited to chronic kidney disease (CKD). Complications might appear over time as the aging process changes body functions; moreover, a significant number of antidiabetic medications are eventually cleared by the kidneys, thereby increasing the burden on kidney function and placing diabetic patients at risk. The significantly high number of patients with uncontrolled diabetes resulting from kidney disease shows the impact of this condition on the quality of life of patients. This review presents an overview of the pathophysiology, etiology, and prevalence of CKD and abnormal renal parameters correlated with poorly controlled T2DM, with an emphasis on clinical studies involving the association between vitamin D insufficiency/deficiency and CKD among patients with T2DM.

Chronic Kidney Disease among Diabetes Patients in Ethiopia: A Systematic Review and Meta-Analysis

Background

Though different primary studies have reported the burden of chronic kidney disease among diabetes patients, their results have demonstrated substantial variation regarding its prevalence in Ethiopia. Therefore, this study aimed to estimate the pooled prevalence of chronic kidney disease and its associated factors among diabetes patients in Ethiopia.

Method

PubMed, African Journals Online, Google Scholar, Scopus, and Wiley Online Library were searched to identify relevant studies. The I² statistic was used to check heterogeneity across the included studies. A random-effects model was applied to estimate the pooled effect size across studies. A funnel plot and Egger's regression test were used to determine the presence of publication bias. All statistical analyses were performed using STATA™ version 14 software.

Result

In this meta-analysis, a total of 12 studies with 4,075 study participants were included. The estimated prevalence of CKD among diabetes patients was found to be 35.52% (95% CI: 25.9–45.45, I² = 96.3%) for CKD stages 1 to 5 and 14.5% (95% CI: 10.5–18.49, I² = 91.1%) for CKD stages 3 to 5. Age greater than 60 years (OR = 2.99; 95% CI: 1.56–5.73), female sex (OR = 1.68; 95% CI: 1.04–2.69), duration of diabetes >10 years (OR = 2.76; 95% CI: 1.38–5.51), body mass index >30 kg/m² (OR = 2.06; 95% CI: 1.41–3.00), type 2 diabetes (OR = 2.54; 95% CI: 1.73–3.73), poor glycemic control (OR = 2.01; 95% CI: 1.34–3.02), fasting blood glucose >150 mg/dl (OR = 2.58; 95% CI: 1.79–3.72), high density lipoprotein >40 mg/dl (OR = 0.48; 95% CI: 0.30–0.85–25), systolic blood pressure>140 mmHg (OR = 3.26; 95% CI: 2.24–4.74), and diabetic retinopathy (OR = 4.54; CI: 1.08–25) were significantly associated with CKD.

Conclusion

This study revealed that the prevalence of chronic kidney disease remains high among diabetes patients in Ethiopia. This study found that a long duration of diabetes, age>60 years, diabetic retinopathy, female sex, family history of kidney disease, poor glycemic control, systolic blood pressure, overweight, and high level of high-density lipoprotein were associated with chronic kidney disease among diabetic patients. Therefore, situation-based interventions and context-specific preventive strategies should be developed to reduce the prevalence and risk factors of chronic kidney disease among diabetes patients.

Burden of diabetic kidney disease among persons with type 2 diabetes mellitus registered in a tertiary care center, Puducherry

BACKGROUND & AIMS

To determine burden of diabetic kidney disease (DKD) and estimate yield and number needed to screen (NNS) in a tertiary diabetes care center.

METHODS

DKD was diagnosed if estimated Glomerular Filtration Rate (eGFR) < 60 ml/min/1.73 m² or Urinary Albumin Creatinine Ratio (UACR) ≥30 mg/g in two urine samples.

RESULTS

Of 511 participants, 206 (40%) had DKD. Using both UACR and eGFR, yield and NNS were 39% and three, respectively.

CONCLUSION

Using eGFR alone, yield and NNS to find a case of DKD among consecutive adult (≥18 years age) patients with type 2 diabetes mellitus were 26.4% and 4, respectively.

Incidence of diabetic nephropathy in patients with type 2 diabetes mellitus at a tertiary healthcare setting in Ethiopia

BACKGROUND AND AIMS

Diabetic nephropathy (DN) is a leading cause of morbidity and mortality in diabetic patients representing a huge health and economic burden. Despite the increasing number of patients with Diabetes Mellitus in Ethiopia, the incidence of diabetic nephropathy in patients with DM has not been well established. Therefore, this study aimed to estimate the incidence and predictors of DN in patients with T2DM at tertiary healthcare setting, Ethiopia.

METHODS

An institution based retrospective follow study was conducted from March 1 to April 28, 2019. Kaplan-meier survival curve together with log rank test were used. Cox proportional hazard model was used at 5% level of significance to determine the net effect of each explanatory variable on diabetic nephropathy. An assumption was check by schoenfeld residual test.

RESULTS

The incidence rate of diabetic nephropathy was 3.6% per 100 person-years (95% CI = 2.49-11.47). The median time to develop nephropathy was 100(95% CI, 96.7-107) months. Predictors of diabetic nephropathy were males (AHR: 2.7, 95%CI: 1.39, 5.23), long duration of diabetes (AHR: 1.03, 95%CI: 1.01, 1.06), HbA1c> 7% (AHR: 1.74, 95% CI: 1.67, 3.12), high density lipoprotein (AHR: 0.37, 95% CI: 0.16, 0.83), and mixed anti-diabetic therapy (AHR: 0.07, 95% CI: 0.01, 0.59).

CONCLUSION

The incidence of diabetic nephropathy among T2DM patients was relatively high. Males, longer duration of diabetes, HbA1c, and fasting blood glucose were increase the risk of diabetic nephropathy.

Type 2 Diabetes, Atrial Fibrillation, and Direct Oral Anticoagulation

Type 2 diabetes (T2D) is an independent risk factor of stroke and systemic embolism in patients with atrial fibrillation (AF), and T2D patients with AF-associated stroke seem to have worse clinical outcome and higher risk of unfavorable clinical course compared to individuals without this metabolic disorder. Long-term anticoagulation is indicated in majority of T2D patients with AF to prevent adverse AF-associated embolic events. Direct oral anticoagulants (DOACs), direct oral thrombin inhibitor dabigatran, and direct oral factor Xa inhibitors, rivaroxaban, apixaban, and edoxaban, have emerged as a preferred choice for long-term prevention of stroke in AF patients offering potent and predictable anticoagulation and a favorable pharmacology with low risk of interactions. This article reviews the current data regarding the use of DOACs in individuals with T2D and AF.

Association of Serum Calcium Level with Waist Circumference and Other Biochemical Health-care Predictors among Patients with Type 2 Diabetes

INTRODUCTION

This study aimed to find the association of serum calcium level with abdominal obesity according to the waist circumference (WC) and the associated factors.

MATERIALS AND METHODS

A cross-sectional study was carried out at private health-care center. A total of 291 patients, aged 18 years and above, with type 2 diabetes mellitus who attended the clinic from May 2017 through March 2018 were included. Sociodemographic, clinical, and laboratory data were obtained from the medical records of patients. Statistical analysis was carried out using the Statistical Package for the Social Sciences software (SPSS, version 23). Abdominal obesity was defined by WC ≥ 80cm in women and ≥94cm in men.

RESULTS

A total number of 291 participants participated in the study. Among these participants, 42.6% (n = 124) were male and 57.4% (n = 167) were female. The average age of respondents was 55.99 ± 9.81 years. Among the male participants, 90 (72.6%) (95% confidence interval [CI]: 64.6%-80.5%) were abdominally obese as were 154 participants (92.2%) (95% CI: 88.1%-96.3%) among females. Overall, 244 participants (83.8%) (95% CI: 79.6%-88.1%) were abdominally obese. The results of statistical modeling showed that gender, smoking status, physical activity, and serum calcium are strong determinants of abdominal obesity.

CONCLUSION

This study revealed a significant association of abdominal obesity and serum calcium level among patients with diabetes.