Evaluation of Microalbuminuria and Glycosylated Hemoglobin in the Assessment of Diabetic Control in Type 1 Diabetes Mellitus Hospitalized Children with Diabetic Ketoacidosis

Microalbuminuria is thought to be an early predictor of impending diabetic nephropathy while glycosylated Hemoglobin (HbA1c) is a biochemical marker of long term glycemic control in Type 1 Diabetes Mellitus (T1DM) children. The study aimed to evaluate the prevalence of microalbuminuria and its association with HbA1c on admission and duration of diabetes. Also, the change in HbA1c level on admission and post 3 months of admission were studied to assess diabetic control in T1DM children.

The prospective study was conducted on 38 children (<18 years) diagnosed with TIDM presenting with clinical signs, symptoms, and biochemical parameters of DKA. Presence of microalbuminuria, HbA1c levels and number of past episodes of DKA were recorded. HbA1c levels were again estimated after 3 months. The resultant data was tabulated and analyzed statistically (p<0.05).

Microalbuminuria and poor HbA1c control was observed in 18 % and 60% of the sample population respectively. A significant association was found between HbA1c >9% (P=0.032) and duration of diabetes >4 years (P=0.032) with microalbuminuria. Significant improvement in glycemic control was noted from the time of admission (9.76± 2.77) to 3 months (7.75± 1.28) (P= 0.00012). A significant proportion difference was observed between past DKA episodes according to HbA1c control (P<0.001).

Assessment of microalbuminuria is needed in T1DM children especially with HbA1c >9% and duration of diabetes >4 years to evaluate diabetic nephropathy. Good glycemic control can be brought up with effective insulin therapy accompanied with appropriate counseling and regular follow-up.