The prevalence of renal dysfunction in insulin requiring type 2 diabetic patients being followed up at a specialist diabetic clinic at a tertiary academic hospital
Date
2018-10-04
Authors
Angamia, Zareena
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Abstract
Diabetes Mellitus (DM), particularly Type 2 DM, with its high prevalence, continuous growth and numerous complications, places a significant burden on health care systems. Much of the morbidity and mortality is due to Diabetic Nephropathy (DN); a frequent cause of chronic kidney disease (CKD) and a leading cause of end stage renal disease. As such, early diagnosis and appropriate management is essential in alleviating the strain of DN on health care.
Limited information about the prevalence of DN and the evaluation of screening and treatment protocols in our, South African, healthcare facilities is available. This study aims to assess the prevalence and stage of renal dysfunction in type 2 diabetic patients, measured as chronic kidney disease, attending a specialist diabetic clinic at a tertiary academic hospital. Furthermore, the study attempts to review the association of certain parameters (such as demographics, co-morbidities, HbA1c, BMI and proteinuria) with DN.
Patients and Methods:
This study is a retrospective clinical audit and descriptive study of patients attending the Helen Joseph Academic Hospital (HJAH) Diabetic Clinic. The files of 321 insulin-requiring type 2 diabetic patents, who had been diagnosed more than five years previously, were reviewed between the 01/03/2015 and 21/04/2015. In order to determine the prevalence of renal dysfunction, the patient profile and associated factors the following parameters were assessed: demographics, co-morbidities, HbA1c, BMI, renal function, urine dipstick and urine PCR.
Results and Discussion:
The study population of 321 patients yielded a mean age of 59.4 years, a female predominance of 62% and comprised 44.6% black and 34% coloured patients. Hypertension and dyslipidaemia were the most common co-morbid diseases (89.1% and 82.2% respectively); while 54% of the sample were classified as obese. Over half of the sample population (56.3%) did not engage in exercise and almost a third (29.2%) had tobacco exposure. The mean HBA1c was 9.5%.
66.8% of the study group showed evidence of CKD, a large proportion of which were classified as Stage 2 CKD. It was demonstrated that Glomerular Filtration Rates (GFRs) did not worsen in general with time, but rather tended to oscillate between the defined CKD stages and there were no significant differences in the time between the transitions between the stages. Urine dipstick results noted proteinuria in 16.8% and glycosuria in 37.7%. The association of time period from diagnosis, co-morbid disease, HbA1c and BMI yielded no significant difference between the groups with normal renal function and renal dysfunction. Limited information regarding urine PCR was available.
Conclusion:
The prevalence of DN, as defined by CKD, is significant in this study population. Glycaemic control is considerably poorer than target levels; there are high levels of comorbid diseases and poor lifestyle choices. The screening for DN (micro-albuminuria measurement) is under-utilised, possibly contributing to delay in diagnosis, treatment and poor outcome. Appropriate amendments in screening and management is essential to improve DN-associated morbidity.
Description
A dissertation submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg, in fulfillment for the requirements of the degree of Master of Medicine, Johannesburg 2018