Violeta Valentina GHERDAN and Amorin Remus POPA

ABSTRACT

Background: Exploring the risk factors associated with increased albumin excretion is necessary in patients with type 2 diabetes mellitus, due to the fact that such patients are exposed to an increased risk of progression to diabetic kidney disease and that non-traditional newly emerging factors could be corrected in order to reduce the progression rate.
Material and methods: 218 patients with type 2 diabetes mellitus were investigated regarding their urinary albumin/creatinine ratio. Clinical and laboratory data was collected from them, with biochemical investigations including serum uric acid and serum 25-hydroxi-vitamin D (25-OH-vitamin D) measurements. The prevalence of traditional and non-traditional risk factors for increased albumin excretion rate (albumin/creatinine ratio>30 mg/g), hyperuricemia and 25-OH-vitamin D deficiency, was determined after dividing patients into two groups, one with microalbuminuria and the other one with micro- or macroalbuminuria.
Results: Of all patients, 104 (47.93%) had microalbuminuria, while 9.22% (20) presented macroalbuminuria. Poor glucose control (HbA1c ≥7%), female sex, hyperuricemia (uric acid ≥7 mg/dL), vitamin D deficiency (25-OH-vitamin D ≤50 nmol/L), hypertension (systolic hypertension or diastolic hypertension or hypertension treatment) and hypertriglyceridemia (triglycerides ≥150 mg/dL) had a statistically significant higher prevalence (p<0.05) in the 124 patients with microalbuminuria or macroalbuminuria compared to the 94 subjects wit normaoalbuminuria.
Conclusion: Glucose control, hypertension and dyslipidemia are relevant traditional risk factors for an altered kidney function defined as urinary albumin/creatinine ratio >30 mg/g. However, hyperuricemia and 25-OH-vitamin D deficiency are long time ignored factors that could play an important role in the progression towards diabetic kidney disease.
Keywords: albuminuria, diabetic kidney disease, glucose control, hyperuricemia, vitamin D deficiency.

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Andrei Cristian BONDAR and Amorin Remus POPA

ABSTRACT

Background. Diabetic neuropathy has an important impact on the quality of life of affected individuals due to the presence of chronic symptoms like distal neuropathic pain, but it also influences the survival of diabetic patients, given that the clinical forms of diabetic neuropathy produce complications such as diabetic foot syndrome in distal peripheral neuropathy or life threatening arrhythmias in autonomic cardiac neuropathy. The prevalence of diabetic neuropathy in representative cohorts is very discordant in numerous studies, and our purpose was to evaluate the frequency of this microvascular complication in Bihor County and to determine some risk factors for its development in order to perform a more rigorous screening in certain risk groups.
Material and method. We formed two representative cohorts for type 1 and type 2 diabetes mellitus population in our county and applied a questionnaire with three subsets of questions for sensitive, motor and autonomic symptoms. Every patient was evaluated by using semi quantitative tests for distal neuropathy and two tests for determination of cardiac autonomic neuropathy.
Results. The prevalence of diabetic neuropathy was 28.70% in patients with type 1 diabetes mellitus and 50.70% in those with type 2 diabetes mellitus. Distal neuropathy was the most frequent clinical form, autonomic neuropathy having a low prevalence. The same risk factors were associated (p<0.01) with an increased risk of diabetic neuropathy in both type 1 and type 2 diabetes mellitus: age, diabetes duration, HbA₁c, hypertension, dyslipidaemia, and other microvascular complications.
Conclusion. Screening for distal symmetric polyneuropathy can be easily done by using a symptom questionnaire and semi quantitative tests, and it is important to consider the fact that over 50%
of type 2 diabetes patients in the representative cohort were affected by the complication. Control of modifiable risk factors can reduce the risk of neuropathy development considering the lower frequency of neuropathy in the groups with good glycaemic control, normal blood pressure and absence of dyslipidaemia.
Keywords: diabetic neuropathy prevalence, risk factors for diabetes microcomplications.

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