Dipstick proteinuria and risk of type 2 diabetes mellitus: a nationwide population-based cohort study

Diabetes health care specific services readiness and availability in Kenya: Implications for Universal Health Coverage

Diabetes is a major cause of morbidity and mortality worldwide yet preventable. Complications of undetected and untreated diabetes result in serious human suffering and disability. It negatively impacts on individual's social economic status threatening economic prosperity. There is a scarcity of data on health system diabetes service readiness and availability in Kenya which necessitated an investigation into the specific availability and readiness of diabetes services. A cross sectional descriptive study was carried out using the Kenya service availability and readiness mapping tool in 598 randomly selected public health facilities in 12 purposively selected counties. Ethical standards outlined in the 1964 Declaration of Helsinki and its later amendments were upheld throughout the study. Health facilities were classified into primary and secondary level facilities prior to statistical analysis using IBM SPSS version 25. Exploratory data analysis techniques were employed to uncover the distribution structure of continuous study variables. For categorical variables, descriptive statistics in terms of proportions, frequency distributions and percentages were used. Of the 598 facilities visited, 83.3% were classified as primary while 16.6% as secondary. A variation in specific diabetes service availability and readiness was depicted in the 12 counties and between primary and secondary level facilities. Human resource for health reported a low mean availability (46%; 95% CI 44%-48%) with any NCDs specialist and nutritionist the least carder available. Basic equipment and diagnostic capacity reported a fairly high mean readiness (73%; 95% CI 71%-75%) and (64%; 95%CI 60%-68%) respectively. Generally, primary health facilities had low diabetic specific service availability and readiness compared to secondary facilities: capacity to cope with diabetes increased as the level of care ascended to higher levels. Significant gaps were identified in overall availability and readiness in both primary and secondary levels facilities particularly in terms of human resource for health specifically nutrition and laboratory profession.

Proteinuria and its associated factors in patients attending family medicine clinics in Dammam, Saudi Arabia

BACKGROUND

Urinalysis is a simple, valuable, and low-cost tool for the detection of proteinuria, a significant risk factor for renal and cardiovascular diseases. The purpose of this study was to determine the rate of proteinuria and its associated risk factors in patients attending Family Medicine Clinics in Dammam, Saudi Arabia, as no study of that nature had previously been conducted.

MATERIALS AND METHODS

In this register-based cross-sectional study, data including urinary protein and other urinalysis components ordered between January 2018 and January 2020 were collected from electronic medical records. In addition, data regarding nationality, gender, age, blood pressure, body mass index, serum human chorionic gonadotropin, fasting glucose, hemoglobin A1c (HbA1c), 25-hydroxy Vitamin D level, blood urea nitrogen (BUN), uric acid, creatinine, estimated glomerular filtration rate (eGFR), and lipid profile was also obtained. Proteinuria was classified as negative if no or trace protein was present, and positive if protein was ≥1+, and was considered overt proteinuria.

RESULTS

In total, results of 2942 urinalysis tests were included. The mean age of the patients was 42.4 ± 14.5 years; majority of the patients were females (62.3%) and were Saudis (68.8%). The rate of proteinuria was 4.2%. Saudi nationality, female gender, age ≥ 40 years, high systolic blood pressure, high diastolic blood pressure, fasting glucose ≥126, HbA1c ≥6.5%, BUN >20 mg/dl, creatinine >1.3 mg/dl, low eGFR <60, and high low-density lipoproteins cholesterol were significantly associated with proteinuria based on bivariate analysis. Using a logistic regression model, a statistically significant association was observed between proteinuria and advancing age, the presence of urinary casts, elevated serum creatinine level, and Saudi nationality.

CONCLUSION

The only variables that were independently associated with proteinuria using the logistic regression were the presence of casts in the urine, Saudi nationality, high creatinine level, and older age. These variables should be borne in mind by treating physicians.

The risk of Parkinson's disease according to diabetic kidney disease status in a Korean population

INTRODUCTION

Type 2 diabetes is a risk factor for Parkinson's disease (PD). Recently, it has been reported that proteinuria without reduced estimated glomerular filtration rate (eGFR) can increase the risk of PD development. The objective of this study was to evaluate the risk of PD among Korean adults with type 2 diabetes stratified by proteinuria (PU) and eGFR levels.

METHODS

Using the Korean National Health Insurance Service database, a total of 2,217,326 patients with type 2 diabetes who underwent regular health check-ups from 2009 to 2012 were included. These patients were classified into four groups (no-diabetic kidney disease (DKD) (PU^-GFR^-), proteinuric DKD with normal eGFR (PU⁺GFR^-), nonproteinuric DKD (PU^-GFR⁺), and proteinuric DKD with reduced eGFR (PU⁺GFR⁺) and followed up until 2018. PD was defined using International Classification of Diseases, 10th revision.

RESULTS

The prevalence of PU^-GFR^-, PU⁺GFR^-, PU^-GFR⁺, or PU⁺GFR⁺ phenotype was 83.3%, 5.0%, 10.1%, or 1.6%, respectively. During a median follow-up of 7.2 years, 16,079 participants developed PD. Hazard ratios for PD were 1.10 (95% confidence interval [CI]: 1.01-1.21, p = 0.0091), 1.15 (95% CI: 1.09-1.21, p < 0.0001), and 1.23 (95% CI: 1.09-1.39, p < 0.0001) for participants in PU⁺GFR^-, PU^-GFR⁺, and PU⁺GFR⁺ groups relative to those in the PU^-GFR^- group, respectively. Effects of DKD on PD were more pronounced in those aged less than 65 years.

CONCLUSION

Reduced eGFR and/or proteinuria might be independent risk factors for boosting PD development among patients with type 2 diabetes. More attention should be paid to PD in patients with DKD, even in a younger aged population.