Effects Of OGTT And HbAlc Diagnostic Criteria On Urinary Microalbumin In Pre-diabetic Patients

Background:Diabetes is a group of metabolic diseases characterized by hyperglycemia.Hyperglycemia due to insufficient insulin secretion,impaired insulin action,or both,is one of the most common epidemics in the world.Impaired glucose regulation(IGR)is a state between normal and diabetic people,also known as pre-diabetes.Microvascular disease is a major complication of diabetes and can affect important organs of the body.Among them,retinopathy and diabetic kidney disease(DKD)are particularly important.Diabetic kidney disease usually does not have any clinical manifestations in the early stage.If there is a persistent increase in urinary protein and renal dysfunction,the course of disease has already entered the late stage.Urinary microalbumin(UMA)can occur in early glomerular injury,so it can be used as an early screening indicator for DKD.Pre-diabetes is an independent risk factor for vascular disease.A large number of studies have found that diabetic microalbumin occurs not only in diabetic patients,but also in the early stages of diabetes.Many studies have already explored that blood glucose and glycated hemoglobin levels are closely related to urinary microalbumin,but there are few studies on the effects of two pre-diabetes diagnostic criteria on urinary microalbumin.Objective:To compare the effects of two diagnostic methods,fasting glucose tolerance test(OGTT)and glycosylated hemoglobin(HbAlc),on microalbuminuria in prediabetes to understand which criteria are more predictive of the development of diabetic kidney disease.Methods:During the period of 2015.05-2017.02,according to the lead report of Jinan Central Hospital and Professor Dong Xiaolin,a project of Shandong Science and Technology Huimin,which is aimed at the cross-sectional study of high-risk populations of diabetes recruited in Jinan,detailed the selected population.Questionnaires,physical examinations and laboratory tests,physical examinations include:height,weight,waist circumference measurements;laboratory tests including blood and urine tests:fasting blood glucose(FPG),HbA1c,blood glucose 2 hours after oral administration(PG2 h),total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),triglyceride(TG),and alanine aminotransferase(ALT),aspartate Acid aminotransferase(AST),serum creatinine(Cr),serum uric acid(sUA)blood biochemical indicators and urine microalbumin(UMA)detection.In the high-risk population for screening,the glucose tolerance test(OGTT)was performed on the population without diabetes.The glucose metabolism status of the subjects was judged as a standard,and the urine microalbumin was compared and analyzed among different glucose tolerance populations.Urinary microalbumin>30mg/L was used to distinguish urinary microalbumin positive group and negative group,and the factors affecting urinary microalbumin were analyzed.The final analysis compares the difference between the two diagnostic methods of OGTT test and HbAlc on pre-diabetes microalbuminuria,and finds which diagnostic method can better predict the occurrence and development of early DKD.Results:A total of 2822 people were completed in the survey.Before the investigation,the diagnosis of diabetes,acute and chronic kidney disease,severe congestive heart failure and other diseases were excluded,and 408 important data were missing.26 cases of urinary microalbumin were kicked out.A population of>346 mg/L in urine,and finally 2048 people were included in the study.Among them,797 were males,accounting for 38.92%of the total sample size,with an average age of 52.79 years;1,251 women,accounting for 61.08%of the total sample size,with an average age of 53.08 years.1.The two diagnostic methods of OGTT and HbAlc result in different glucose metabolism states.The OGTT test was used as the diagnostic criteria:the high-risk population in the screening group had a normal glucose metabolism(NGR)of 1234,accounting for 60.25%of the total sample size;294 patients with newly diagnosed DM,accounting for 14.36%of the total sample;520 people with abnormality(Impaired Glucose Regulation)(IGR),accounting for 25.3%of the total sample size,specifically 520(25.3%of the total screening)were diagnosed as abnormal glucose regulation(IGR)The tester can be further divided into only glucose tolerance reduction(IGT),that is,FPG<6.0mmol/L,7.8mmol/L<2h PG<11.1mmol/L,356 people,accounting for 68.46%,is the main part of the pre-diabetes;Only fasting blood glucose abnormality(IFG),ie 6.1mmol/L<FPG<7.0mmol/L,and 2h PG<7.8mmol/L,only 79 people,accounting for 15.19%of the pre-diabetes population;IGT combined with IFG(IGT/IFG)has a total of 83 people,accounting for 15.96%.Using HbAlc as the diagnostic criteria,NGF was 1439 in the high-risk population,accounting for 70.26%of the total sample size;444 people in the IGR population,accounting for 15.96%of the total sample size;165 patients with newly diagnosed DM,accounting for the total sample size 8.06%.2.Analysis of influencing factors of microalbuminuria in high risk population of diabetesAmong the high-risk groups screened,the number of urinary microalbumin abnormalities(>30mg/L)was 185,accounting for 9.03%of the sample size;the number of normal urine albumin(≤30mg/L)was 1863,accounting for the total sample.The amount is 90.97%.Comparing the two groups of people,the age,TC and LDL-C were compared between the two groups,P>0.05,no statistical significance,that is,no difference between the two groups;and gender,BMI(Kg/m2),waist circumference,contraction There was a difference between the pressure(SBP),diastolic blood pressure(DBP),HbAlc,PG2h,TG,HDL-C,and sUA compared with P<0.05.Further analysis showed that BMI,systolic blood pressure,diastolic blood pressure,2hPGwere independent risk factors for urinary microalbumin.3.Comparison of urinary microalbumin in patients with pre-diabetes and normal glucose metabolism obtained by OGTT and HbA1cOGTT was used as the diagnostic criteria.The high-risk groups were divided into normal glucose group(NGR),pre-diabetes group(IGR)and DM group.The levels of urinary albumin in the three groups were compared.P<0.05 between the three groups.And the level of urinary microalbumin increased with the increase of blood glucose.The abnormal positive rates of urinary microalbumin in the three groups were 6.64%,9.61%,and 18.03%,respectively.The three groups had a statistically significant difference compared with P<0.001,and the regularity was compared with the level of microalbumin.Further IGR components were:only glucose tolerance(I-IGT)group,only fasting blood glucose abnormality(I-IFG)group,IGT combined with IFG(IGT/IFG)group,analysis and comparison of NGT,IGT,IFG,IGT/IFG Group,four groups compared with P less than 0.05,NGT group and I-IGT group,I-IFG group and I-IGT group P<0.05,statistically significant;NGT group and I-IFG group,I-IFG group P>0.05 compared with the IGT/IFG group,no statistical difference.The positive rates of microalbumin in the four groups were 6.64%,9.80%,9.41%,and 8.43%,respectively.There was no statistical difference in the analysis.Using HbAlc as the diagnostic criteria,the high-risk groups for screening were divided into three groups:NGR,IGR,and DM.There were statistically significant differences between the three groups of urine microalbumin compared with P<0.001.There was no statistically significant difference between IGR and DM.There was a statistical difference between NGR and DM and IGR compared with P<0.001.The positive rates of urinary microalbumin in the three groups were 7.44%,10.81%,and 18.18%,respectively,which were statistically significant.4.To compare the effects of two diagnostic methods,OGTT and HbAlc,on microalbuminuria in prediabetesThe high-risk group for screening is divided into the pre-diabetic group(OGTT-IGR)diagnosed only by OGTT,the pre-diabetic group(HbAlc-IGR)diagnosed only by HbA1c,and the true positive group(TRUE-IGR)combined with two diagnostic methods.And both diagnostic methods are in the NGR group.Comparing the four groups,age,gender,BMI(Kg/m2),waist circumference,systolic blood pressure(SBP),diastolic blood pressure(DBP),HbAlc,PG2h,TG,TC,LDL-C,HDL-C,sUA,urine microalbumin were higher than the normal glucose metabolism group(P<0.001),and HDL-C was lower than the normal group.All risk factors except diastolic blood pressure and TC were significantly different between the true positive group and the normal group(P<0.05).HbAlc-IGR was different from the normal group except for diastolic blood pressure(P<0.05);OGTT-Compared with the normal group,all risk factors were different in the IGR group compared with the normal group(P<0.05).There was no statistical difference in the remaining risk factors except the HbAlc in the OGTT-IGR group and the true positive group;OGTT-IGR The age of the group was significantly higher than that of the HbAlc-IGR group,FPG and HbAlc(P<0.05).There was no difference in the remaining risk factors,and there was no difference in urine microalbumin.Conclusion:1.Using OGTT as the diagnostic criteria,the amount of microalbuminuria in the pre-diabetes group was higher than that in the normal group;2.Using HbAlc as the diagnostic criteria,the amount of microalbuminuria in the pre-diabetes group was higher than that in the normal group;3.Pre-diabetes under the two diagnostic methods Urinary microalbumin was higher than normal in the population,and there was no difference between the two groups.The two diagnostic criteria reflected the same cardiovascular risk factor level and the risk of diabetic nephropathy.There was no difference between the two diagnostic methods of OGTT and HbAlc in the pre-diabetes urinary microalbumin.There was no difference in the predictive efficacy of the two diagnostic methods for early diabetic kidney damage.