Progression of diabetic nephropathy in patients with uncontrolled type 2 diabetes mellitus: a cross-sectional study
DOI:
https://doi.org/10.18203/2349-3933.ijam20251932Keywords:
Chronic kidney disease, Diabetic nephropathy, Hemoglobin A1c, Hypertension, Estimated glomerular filtration rate, Type 2 diabetes mellitus, ProteinuriaAbstract
Background: Diabetic nephropathy (DN) is a major complication of uncontrolled type 2 diabetes mellitus (T2DM), leading to chronic kidney disease (CKD) and end-stage renal disease (ESRD). This study aimed to assess the progression of DN in patients with uncontrolled T2DM and its association with clinical and biochemical parameters.
Methods: A cross-sectional study was conducted on 147 T2DM patients aged 45-60 years at Enam medical college, Sir Salimullah medical college, and Dhaka medical college from March 2024 to December 2024. Purposive sampling technique was applied in sample selection Patients were categorized into two groups: poorly controlled diabetes (HbA1c≥7%) and controlled diabetes (HbA1c<7%). Data were analyzed by using SPSS version 23.0 program.
Results: This study of 147 T2DM patients found 53.1% had poorly controlled diabetes (HbA1c≥7%), associated with higher urinary ACR, reduced eGFR, and elevated serum creatinine. Advanced CKD (eGFR<60 mL/min/1.73 m2) was present in 67.3%, with 33.3% microalbuminuria and 19.7% macroalbuminuria. Grade 2 hypertension (HTN) (43.5%) was significantly linked to renal impairment, highlighting the need for better glycemic and blood pressure (BP) control.
Conclusions: Poor glycemic control and HTN significantly accelerate DN progression in T2DM patients. Early intervention targeting glycemic control, BP management, and regular renal screening is essential to mitigate renal complications and improve outcomes.
Metrics
References
Johansen KL, Chertow GM, Foley RN, Gilbertson DT, Herzog CA, Ishani A, et al. US renal data system 2020 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis. 2021;77(4):7-8. DOI: https://doi.org/10.1053/j.ajkd.2021.01.002
Alicic, Radica Z, Rooney MT, Tuttle KR. Diabetic kidney disease: challenges, progress, and possibilities. Clin J Am Society Nephrol. 2017;12(12):2032-45. DOI: https://doi.org/10.2215/CJN.11491116
Thomas MC, Brownlee M, Susztak K, Sharma K, Jandeleit-Dahm KA, Zoungas S, et al. Diabetic kidney disease. Nature reviews Disease primers. 2015;1(1):1-20. DOI: https://doi.org/10.1038/nrdp.2015.70
Afkarian M, Sachs MC, Kestenbaum B, Hirsch IB, Tuttle KR, Himmelfarb J, et al. Kidneydisease and increased mortality risk in type 2 diabetes. J Am Society Nephrol. 2013;24(2):302-8. DOI: https://doi.org/10.1681/ASN.2012070718
Luigi G, Coward RJM, Long DA. Diabetic nephropathy: perspective on novel molecular mechanisms. Trends Endocrinol Metabol. 2016;27(11):820-30. DOI: https://doi.org/10.1016/j.tem.2016.07.002
George BL. The importance of blood pressure control in the patient with diabetes. Am J Med. 2004;116(5):30-8. DOI: https://doi.org/10.1016/j.amjmed.2003.10.018
Bjornstad P, Snell-Bergeon JK, Rewers M, Jalal D, Chonchol MB, Johnson RJ, et al. Early diabetic nephropathy: a complication of reduced insulin sensitivity in type 1 diabetes. Diabetes care. 2013;36(11):3678-83. DOI: https://doi.org/10.2337/dc13-0631
Prospective, Diabetes UK. Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352(9131):837.
Gavin C. The Effects of Dietary Protein on Postprandial Essential Amino Acids Bioavailability as a Substrate for Protein Anabolism in Young and Older Adults and on Cardiometabolic Health-Related Outcomes. Diss. Purdue University. 2023.
Adler AI, Stevens RJ, Manley SE, Bilous RW, Cull CA, Holman RR, et al. Development and progression of nephropathy in type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS 64). Kidney Int. 2003;63(1):225-32. DOI: https://doi.org/10.1046/j.1523-1755.2003.00712.x
Fontela PC, Winkelmann ER, Ott JN, Uggeri DP. Estimated glomerular filtration rate in patients with type 2 diabetes mellitus. Revista da Associação Médica Brasileira. 2014;60(6):531-7. DOI: https://doi.org/10.1590/1806-9282.60.06.010
Dianna JM, Boyko EJ. IDF diabetes atlas. 2022.
Duggal V, Thomas IC, Montez-Rath ME, Chertow GM, Tamura MK. National estimates of CKD prevalence and potential impact of estimating glomerular filtration rate without race. J Am Society Nephrol. 2021;32(6):1454-63. DOI: https://doi.org/10.1681/ASN.2020121780
Merlin CT, Cooper ME, Zimmet P. Changing epidemiology of type 2 diabetes mellitus and associated chronic kidney disease. Nature Rev Nephrol. 2016;12(2):73-81. DOI: https://doi.org/10.1038/nrneph.2015.173
Bhalla V, Zhao B, Azar KM, Wang EJ, Choi S, Wong EC, et al. Racial/ethnic differences in the prevalence of proteinuric and nonproteinuric diabetic kidney disease. Diabetes Care. 2013;36(5):1215-21. DOI: https://doi.org/10.2337/dc12-0951
Andrew SL, Eckfeldt JH. Using glomerular filtration rate estimating equations: clinical and laboratory considerations. Clin Chem. 2015;61(10):1226-9. DOI: https://doi.org/10.1373/clinchem.2015.245282
Klaudia I, Sekula J, Lawrence R. Adherence to Dietary and Lifestyle Guidelines Among Women With a History of Gestational Diabetes Mellitus and the Influence of a Student‐Led Dietetic Clinics. Food Sci Nutrit. 2025;13(3):70076. DOI: https://doi.org/10.1002/fsn3.70076
UK Prospective Diabetes Study (UKPDS) Group. Intensive Blood-Glucose Control with Sulphonylureas or Insulin Compared with Conventional Treatment and Risk of Complications in Patients with Type 2 Diabetes (UKPDS 33). Lancet. 1998;352(9131):837-53. DOI: https://doi.org/10.1016/S0140-6736(98)07019-6
Ogurtsova K, Guariguata L, Barengo NC, Ruiz PL, Sacre JW, Karuranga S, et al. IDF diabetes Atlas: Global estimates of undiagnosed diabetes in adults for 2021. Diabetes Res Clin Pract. 2022;183:109118. DOI: https://doi.org/10.1016/j.diabres.2021.109118