The implications of the detection of proteinuria and microalbuminuria in insulin and non-insulin dependent diabetes

Frequency and pattern of chronic complications of diabetes and their association with glycemic control

BACKGROUND

The study was conducted in diabetes care centers to explore association of chronic complications of diabetes with glycemic status along with their frequency and pattern among adult patients with type 2 diabetes.

METHODS

A cross-sectional study was conducted at outpatient departments of eight diabetes care centers in Dhaka. Data were collected by face to face interview by trained research physicians. Disease related information was recorded in the checklist from diabetes guide books of the patients. Chronic complications of diabetes were recorded from the records of expert consultation.

RESULTS

Records of 5215 patients with type diabetes (59.4% males) were analyzed. Mean age of the male and female subjects was 52.7 and 50.6 years, respectively. Hypertriglyceridemia [OR 1.74, 95% CI (1.18-2.57)], increased LDL [OR 1.27, 95% CI (0.78-2.07)] and decreased HDL [OR 0.81, 95% CI (0.43-1.53)] and diabetic foot ulcers [OR 2.32, 95% CI (1.14-4.01)] were significantly associated with poor glycemic control, whereas hypertriglyceridemia [OR 2.39, 95% CI (1.42-4.03)] diabetic foot ulcer [OR 2.32, 95% CI (1.14-4.01)], hypetension [OR 1.65, 95% CI (1.15-2.43)] and coronary artery diasease [OR 1.23, 95% CI (0.77-2.13) were significantly associated with poor glycemic control according to FPG.

CONCLUSION

The study finds association of chronic complications of diabetes with glycemic control among type 2 diabetes patients in Bangladesh.

Frequency and pattern of chronic complications of diabetes and their association with glycemic control among adults with type 2 diabetes in Bangladesh

BACKGROUND

The study was conducted in diabetes care centers to explore association of chronic complications of diabetes with glycemic status along with their frequency and pattern among adult patients with type 2 diabetes.

METHODS

A cross-sectional study was conducted at outpatient departments of eight diabetes care centers in Dhaka. Data were collected by face to face interview by trained research physicians. Disease related information was recorded in the checklist from diabetes guide books of the patients. Chronic complications of diabetes were recorded from the records of expert consultation.

RESULTS

Records of 5215 patients with type diabetes (59.4% males) were analyzed. Mean age of the male and female subjects was 52.7 and 50.6 years, respectively. Hypertriglyceridemia [OR 1.74, 95% CI (1.18-2.57)], increased LDL [OR 1.27, 95% CI (0.78-2.07)] and decreased HDL [OR 0.81, 95% CI (0.43-1.53)] and diabetic foot ulcers [OR 2.32, 95% CI (1.14-4.01)] were significantly associated with poor glycemic control, whereas hypertriglyceridemia [OR 2.39, 95% CI (1.42-4.03)] diabetic foot ulcer [OR 2.32, 95% CI (1.14-4.01)], hypetension [OR 1.65, 95% CI (1.15-2.43)] and coronary artery diasease [OR 1.23, 95% CI (0.77-2.13) were significantly associated with poor glycemic control according to FPG.

CONCLUSION

The study finds association of chronic complications of diabetes with glycemic control among type 2 diabetes patients in Bangladesh.

Tear glucose dynamics in diabetes mellitus

This study compares tear glucose dynamic differences between 121 diabetic and nondiabetic subjects after the administration of a carbohydrate load. A quantitative chromatographic analysis of tear glucose was used and the values correlated to blood glucose values. Diabetic and nondiabetic tear glucose mean values were 0.35 +/- 0.04 mmol/L and 0.16 +/- 0.03 mmol/L, respectively. Significant differences were observed among the subject groups in both the tear and capillary blood glucose values. A correlation between tear glucose and capillary blood glucose was observed. The concentration of glucose in the tear fluid changes proportionately with respect to capillary blood glucose after a carbohydrate challenge. Although it is possible to determine the diabetic status of a subject using tear glucose values alone, in the clinical setting this may not prove to be practical due to technical limitations.

Diabetes and hypertension: prognostic and therapeutic considerations

Hypertension and diabetes are common disorders which frequently co-exist. Both are risk factors for atherosclerotic vascular disease and their combination is associated with an increased incidence of nephropathy, ischaemic heart disease, peripheral vascular disease, and stroke. Several trials such as the HDFP and SHEP studies that included diabetic patients have demonstrated the beneficial effects of antihypertensive therapy in reducing mortality. In diabetes, studies have focussed predominantly on the efficacy of antihypertensive therapy in reducing the progression of diabetic kidney disease. Such therapy has been shown to decrease albuminuria in the setting of "normal" and elevated blood pressure in both type I and type II diabetic patients. This reduction in albuminuria has been observed in microalbuminuric diabetic patients and also in those with overt renal disease. Recent studies in type I diabetic patients with overt nephropathy indicate that these effects on urinary albumin excretion are associated with reduction in the rate of decline in renal function and development of end-stage renal failure. Indeed, several groups have shown that the initiation of antihypertensive therapy improves the prognosis of type I diabetic patients with nephropathy. While certain classes of drugs may reduce the rate of progression of complications such as nephropathy, others have side effect profiles that are disadvantageous in patients with diabetes.