Microalbuminuria among Type 2 Diabetic Patients in the Gaza Strip

Abstract

Diabetic nephropathy is defined as the appearance of persistent proteinuria in an individual with diabetes. The present study was carried out to assess microalbuminuria among type 2 diabetic patients in the Gaze strip. The target population was type 2 diabetic patients from Al Remal diabetic clinic. The sample size was 99 type 2 diabetic patients (44 males and 55 females) and 95 healthy individuals (52 males and 43 females) aged 30-60 years. Data were collected from a questionnaire interview and biochemical analysis of blood and urine samples of the diabetics and controls. Random spot urine and fasting blood samples were collected. Microalbuminuria was determined by immunoturbodimetric technique to calculate albumin/creatinine ratio. Serum glucose, urea, creatinine, uric acid, iron, sodium, potassium, magnesium, calcium, phosphorus, alkaline phosphatase (ALP), amylase, cholesterol, triglycerides, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), HbA1c and C-reactive protein were determined. Urine components including urea, creatinine and phosphorus were measured. Dipstick was used to exclude macroalbuminuria and microalbuminuria was confirmed by 24 hours collection. Results showed that 22.2% were microalbuminuric diabetic patients, 22.2% were macroalbuminuric diabetic patients and 55.5% normoalbuminuric diabetic patients. Microalbuminuria was found to be related to diabetes mellitus (X2=10.0 and P=0.002). There were significant differences in age and body mass index between controls and diabetic patients (t=8.8, p=0.000 and X2=27.87, P=0.000). Smoking was significantly associated with macroalbuminuria (X2=8.33, P=0.004). About half of patients were found to be diabetics since 5 years or less and they can develop microalbuminuria and macroalbuminuria within this period. Serum urea, creatinine and uric acid concentrations were significantly decreased in diabetic patients compared to controls 23.89±6.80, 0.49±0.15 and 3.05±0.98 respectively versus 26.65±6.98, 0.57±0.11 and 3.79±0.85, respectively with t=2.8, p=0.006,t=4.12, p=0.000 and t=5.6, p=0.000 respectively. In microalbuminuric and macroalbuminuric diabetic patients, only urea concentrations were significantly increased 26.00±9.29 and 25.59±8.35 mg/dl compared to that of normoalbuminurics 22.38±4.24 mg/dl, (t=2.35, p=0.021 and t = 2.2, p = 0.030). In urine, urea and creatinine showed significant decreases among diabetics compared to controls (1426.97+542.43, 105.94+59.50, respectively) compared to controls (1627.16+552.71, 132.55+63.23 respectively) with t=2.55, p=0.012 and t=3.02, p=0.003 respectively. In microalbuminuric diabetic patients urine, urea, creatinine and phosphorus showed significant decreases compared to normoalbuminurics (1153.64±434.22, 72.32±42.39 and 32.14±15.44, respectively) compared to normoalbuminurics (1454.±509.24, 110.21±54.23 and 51.78±32.86, respectively) with t=2.34, p=0.022, t=2.84, p=0.006 and t=2.66, p=0.010, respectively. Iron and magnesium levels were significantly decreased in diabetics 78.31±29.29 and 2.04±0.21 compared to controls 92.05±30.51, 2.15±0.16 with (t=3.5, p=0.001 and t=4.26, p=0.000). In contrast potassium levels were increased 4.74±0.37 compared to controls 4.61±0.36 (t=2.31, p=0.022). Calcium levels were increased in microalbuminuric diabetic patients 9.81±0.31 and normoalbuminurics 9.57±0.49 in relation to serum levels of calcium with t=2.03, p=0.046 and iron levels were increased in macroalbuminuric79.18±30.37 and normoalbuminurics 77.00±28.71 with (t=2.41, p=0.018). ALP was significantly increased in diabetics 131.91+38.73 compared to controls 117.40+23.06 with (t=3.15, p=0.002). Lipid profile including, total cholesterol, triglyceride and LDL-C were higher among diabetics (198.90+ 30.50, 227.27 + 116.59 and 128.27+ 40.38, respectively ) compared with those of controls (186.22+ 33.43, 128.98 + 53.01 and 109.04+ 29.42 respectively ) with t=2.76, p=0.006, t=7.51, p=0.000 and t=2.60, p=0.010. In contrast, the average of HDL-C of diabetics (44.30+7.60) was lower than that of controls (47.14+5.83) with t=2.90, p=0.004. However, these parameters were not affected by the presence of macroalbuminuria and microalbuminuria. HbA1c was significantly increased in diabetic patients versus controls 6.73+1.22 versus 5.26+0.57 with t=23.22, p=0.000 and microalbuminuric diabetic patients have significantly higher HbA1c than normoalbuminurics 7.27±1.65 and 6.55±1.09 with (X2=7.75, p=0.021).