Frequency of nephropathy and its relation to metabolic control in patients with dia-betes mellitus

Diabetic nephropathy is a serious complication of both type 1 and type 2 diabetes, and unless arrested, leads to end-stage renal disease. The aim of this study was to find the prevalence of kidney dysfunction in patients with diabetes mellitus and to determine its correlation with metabolic control. We randomly selected 1203 cases with diabetes mellitus presenting to the Institute of Endocrinology and Metabolism. Urinary protein and creatinine were determined in a sample of 24-hour urine collection by the enzymatic methods and spot urine dipstick blood urea nitrogen, serum creatinine, HbA1c and fasting blood glucose were assessed. In this study, 1203 patients (438 patients with type 1 diabetes mellitus [T1DM] and 777 with type 2 diabetes mellitus [T2DM]) were randomly selected. They consisted of 512 females and 721 males. Mean ± SD (standard deviation) of HbA1c was 7.9±3.4 in T1DM and 7.4±3.5 in T2DM. Based on HbA1c levels, good control was detected in 50.2% of patients, fair control in 20.4% and bad control in 29.4%. Of 1022 patients who were evaluated for proteinuria, 201 (19.7%) had albuminuria or clinical proteinuria. Of 931 patients, 19% had high levels of blood urea nitrogen and serum creatinine. End-stage renal disease (ESRD) was seen in 10 (0.8%) of all the cases. A statistically significant positive correlation was found between duration of DM, serum creatinine and 24-hour urinary protein (P< 0.001). We found a high prevalence of clinical proteinuria in diabetic patients. Duration of diabetes and poor metabolic control were identified as a strong predictors of kidney damage in patients with diabetes.