| Diabetes is one of the most common epidemics in the world,and it has been the third non-infectious disease that threatens human health following cardiovascular diseases and tumor.The major complication of diabetes is microvascular disease,in which the most common and difficult to treat is renal microangiopathy.Usually,there is no clinical indication in early diabetic nephropathy(DN).The progress of DN is slowly and easily overlooked.Once the course in advanced,the major characteristics of DN may appear in the later stage of the course,such as persistent proteinuria and progressive kidney function loss.And DN is also an important factor for end-stage renal disease(ESRD).Therefore,early detections and active interventions of DN are significant to control and delay the development of renal damage.The study is to explore the relationship between the control level of HbA1c and renal damage in diabetic patients,and the value of mAlb for early diabetic renal damage,through detecting the levels of glycosylated hemoglobin(HbA1c),microalbuminuria(mAlb),and glomerular filtration rate(GFR).Accordingly,it provides recommendations for early screening and treatment of DN.Objective:To explore the relationship between the control levels of Hb A1c in diabetic patients and the degree of renal damage by analyzing the positive status of microalbuminuria and the abnorma l conditions of e GFR in different control levels of HbA1c in diabetic patients.To investigate the value of detecting mAlb for DN patients through analyzing the relationship between mAlb and eGFR in different control levels of HbA1c.Method:We collected the clinical data and information of the type 2 diabetes mellitus(T2DM)patients who were diagnosed by the Traditional C hinese Medicine Hospital of Kunshan according with the standard of T2DM of WHO in 1999,and accepted hospitalization from January 1,2013 to April 30,2016 in the department of endocrine.1376 cases were finally included in the study by excluding patients suffering from thyroid dysfunction,severe liver diseases,acute or chronic kidney diseases of other causes,and mAlb>200mg/L.All participants were collected demographic characteristics,and were measured heigt,weight and blood pressure.Further,fasting plasma glucose,glycosylatedhemoglobin,triglyceride,total cholesterol,high density lipoprotein cholesterol,low density lipoprotein cholesterol,serum creatinine,uric acid,urea nitrogen andmicroalbuminuria were detected.The eGFR was assessed using simplified MDRDformula.According to different levels of mAlb,participants were divided into two groups:mAlb?20.00mg/L,20.00mg/L<mAlb?200.00mg/L.And according to different levels of eGFR,patients were divided into three groups:e GFR<90.00ml/(min·1.73m~2),90.00ml/(min·1.73m~2)?e GFR?140.00ml/(min·1.73m~2),e GFR>140.00ml/(min·1.73m~2).Rand sum tests were used to compare the difference for continuous variables among groupsand C hi-square tests were used to test the difference for categorical variables.Association of poorly-controlled HbA1c and other factors with abnormal mAlb and eGFR were calculated by non-conditional Logistic regressio n analysis.Results:1.Among 1376 T2DM patients,757 were men and 619 were women aged from 25 to 92 years old.The average level of HbA1c was 8.90%,and participants whose HbA1c lower than 6.50%accounted for 15.10%(208/1376).The median level of mAlb was 17.25 mg/L(8.00-38.80mg/L),and 609 people had an elevated mAlb(>20.00mg/L)with they accounted for 44.03%of total patients.The median level of eGFR was 104.16 ml/(min·1.73m~2),and 482 people had a lower level of eGFR(<90.00ml/(min·1.73m~2)),they accounts for 35.00%,and 193 people had a higher level of eGFR(>140 ml/(min·1.73m~2)),they accounts for 14.00%.2.Patients with the elevated Hb A1c levels had a higher concentration(18.25mg/L vs.12.15mg/L,P<0.001)and an abnormal proportion(45.89%vs.35.10%,P=0.004)of mAlb than individuals whose Hb A1c were well controlled.In the univariate logistic analysis,participants with Hb A1c?6.50%had a higher risk of the elevated mAlb than those whose HbA1c<6.50%,and OR was 1.568(95%CI=1.154-2.132).In the multivariate logistic regression analysis,after adjustment of covariate factors,HbA1c?6.50%still increased the risk of the elevated mAlb(OR=1.600,95%CI=1.616-2.206).3.PatientswiththeelevatedHbA1clevelshadahigher concentration(105.01ml/(min·1.73m~2)vs.97.25 ml/(min·1.73m~2),P=0.004)and an abnormal proportion(33.90%vs.41.35%,P=0.012)of eGFR than individuals whose HbA1c were well controlled,and the differences were found statistically significant between the two groups.In the univariate logistic analysis,participants with HbA1c?6.50%had a higher risk of the elevated e GFR than those whose Hb A1c<6.50%,and OR was 1.824(95%CI=1.064-3.128).The multivariate logistic regression analysis demonstrated Hb A1c?6.50%still increased the risk of the elevated e GFR(OR=1.856,95%CI=1.062-3.244)after adjustment of covariate factors,.4.Participants were stratified into two groups:the normal HbA1c group and the elevated HbA1c group,and relationship between mAlb and eGFR in different HbA1c groups.In the normal Hb A1c group,mAlb was not found correlating with eGFR(r=-0.092,P=0.187).Further,the differences were not found statistically significant between the patients with mAlb<20.00mg/L and those with mAlb?20.00mg/L(98.66 ml/(min·1.73m~2)vs.94.21 ml/(min·1.73m~2),P=0.878).However patients with the elevated mAlb levels had abnormal proportions of elevation(13.77%vs.5.19%)and reduction(49.32%vs.37.04%)of eGFR than individuals whose mAlb were normal.The univariate logistic analysis shown that participants with elevated mAlb levels had higher risks of the reduced e GFR and the elevated e GFR,and ORs were 2.080(95%CI=1.127-3.837)and 4.127(95%CI=1.429-11.917),respectivley.The multivariate logistic regression analysis demonstrated that after adjustment of covariate factors,mAlb was still correlated with the reduced and the elevated e GFR.In the elevated HbA1c group,mAlb was negatively correlated with eGFR(r=-0.189,P<0.001).The median concentration of mAlb<20.00mg/L was 107.78ml/(min·1.73m2)and the median concentration of mAlb?20.00mg/L was 99.43ml/(min·1.73m2)and the differences were found statistically significant between the two groups(P<0.001).And patients with the elevated mAlb levels had an abnormal proportion of reduction(39.18%vs.29.43%)of eGFR than individuals whose mAlb were normal.Compared to participants with normal mAlb,individuals with the elevated mAlb level had a higher risk of the reduced eGFR,and OR was 1.489(95%CI=1.154-1.923).After adjustment of covariate factors,the elevated mAlb level still had a higher risk of the reduced eGFR(OR=1.500,95%CI=1.151-1.957),however no correlations were found between mAlb and the elevated eGFR.Conclusion:1.The poor control of glycosylated hemoglobin may increase the risk of renal damage in diabetic patients.2.To reduce the degree of renal damage in diabetic patients,the monitoring and control of abnormal mAlb should be strengthened in patients with the well-controlled of HbA1c.And for those with the poorly-controlled of Hb A1c,it's important to reinforce the control of blood glucose concentration to decrease the damage of renal function. |
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