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(searched for: Microalbuminuria in Type 2 Diabetes Mellitus and Glycemic Control)
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Swathi Kulkarni, Anurag Yadav
International Journal of Research in Medical Sciences, Volume 9, pp 144-147; doi:10.18203/2320-6012.ijrms20205833

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Sruthi Kare, Vishwanath N. Reddy, Thejdeep Mahamkali
International Journal of Advances in Medicine; doi:10.18203/2349-3933.ijam20205454

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Hana Ahmed , Tayseer Elshaikh, Mohamed Abdullah
Published: 24 November 2020
Journal of Diabetes Research, Volume 2020, pp 1-8; doi:10.1155/2020/7181383

Abstract:
Objective. Data on microvascular complications in children and adolescents with type 1 diabetes mellitus (T1DM) in Sudan are scarce. This study was aimed at determining the prevalence of diabetic nephropathy (DN) and retinopathy (DR) and their relationship to certain risk factors in children with T1DM attending the Sudan Childhood Diabetes Centre. Design and Methods. A clinic-based cross-sectional study of 100 patients with T1DM aged 10-18 years. Patients with disease duration exceeding 5 years if the onset of diabetes was prepubertal and 2 years if it was postpubertal were included. Relevant sociodemographic, clinical, and biochemical information was obtained. Blood pressure was measured. The patients were screened for DN and DR using urinary microalbumin estimation and fundus photography, respectively. Results. The frequency of microalbuminuria and diabetic retinopathy was 36% and 33%, respectively. Eleven percent had both retinopathy and microalbuminuria. Seven percent of the patients were found to be hypertensive. Patients with diabetic retinopathy had significantly higher HbA1c levels ( p = 0.009 ) and longer diabetes duration ( p = 0.02 ) than patients without retinopathy. Logistic regression showed that high HbA1c (odds ratio (OR) 0.83, confidence interval (CI) 0.68-1.00, p = 0.04 ), but not age, duration, ethnic group, BMI, blood pressure, and presence of nephropathy, was an independent risk factor for retinopathy. Likewise, high blood pressure (OR 6.89, CI 1.17-40.52, p = 0.03 ), but not age, duration, ethnic group, BMI, HbA1c, and presence of retinopathy, was a predictor for nephropathy. Conclusion. High prevalence of incipient DN and early stages of DR were observed in this study. Longer diabetes duration and higher HbA1c were associated with the presence of diabetic retinopathy. High blood pressure was a risk factor for DN. So regular screening for these complications and optimization of glycemic control are needed.
Krishkumar A. Jivani
PARIPEX INDIAN JOURNAL OF RESEARCH pp 4-5; doi:10.36106/paripex/2902916

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Michel P. Hermans , Sylvie A. Ahn, Shaukat Sadikot, Michel F. Rousseau
Diabetes & Metabolic Syndrome: Clinical Research & Reviews, Volume 14, pp 1503-1509; doi:10.1016/j.dsx.2020.07.027

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M.D.; Mohamed Halawa Salah Shelbaya, M.D. Merhan Nasr
The Medical Journal of Cairo University, Volume 88, pp 1413-1421; doi:10.21608/mjcu.2020.110954

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Nikoletta Proudan, Murray B Gordon
Journal of the Endocrine Society, Volume 4; doi:10.1210/jendso/bvaa046.1550

Abstract:
Myotonic dystrophy (MD) is a multisystemic, autosomal dominant disorder associated with progressive muscle weakness, premature cataracts, frontal baldness, and cardiac disturbances. MD has been associated with several endocrinopathies including primary testicular failure, autoimmune endocrinopathies (hypothyroidism, hyperthyroidism, multinodular goiter, and Addison’s disease), thyroid carcinoma (primarily papillary), insulin resistance, and type 2 DM. Development of diabetes is thought to be related to formation of an insulin-resistant receptor because of aberrant regulation of mRNA. We describe the first reported case of a patient with MD associated with type I diabetes mellitus, Hashimoto’s thyroiditis with hypothyroidism, and follicular variant of papillary thyroid cancer. A 49-year-old female presented with acute congestive heart failure. The patient had history of type I DM diagnosed at the age of 26, complicated by mild background retinopathy, peripheral neuropathy, and nephropathy with microalbuminuria. The patient first noticed proximal muscle weakness 1 year ago that gradually progressed resulting in multiple falls. She had history of bilateral cataracts status post cataract extraction at age 26. She also had progressive dysphagia requiring PEG placement, and cognitive dysfunction with mood disorder and depression. Family history was significant for myotonic dystrophy in both maternal aunt and uncle as well as 2 cousins. EMG confirmed myotonia however genetic testing was not obtained due to cost. Due to her cognitive dysfunction and depression, she had difficult to control diabetes with HbA1c of 9.9%, and multiple previous admissions for DKA. She was status post total thyroidectomy in 2008 for follicular variant of papillary carcinoma and Hashimoto’s thyroiditis followed by I-131 therapy in 2009 and maintained on levothyroxine suppression therapy. Most recent Tg and Tg Ab were undetectable. On physical exam, the patient had a narrow, sallow face with temporal muscle atrophy, percussion myoclonus involving the thenar eminence of the hands, but no frontal balding. Work up showed LVEF of 20-24% with regional hypokinesis that led to catherization and PCI to LAD. The patient had recurrent NSTEMI which eventually resulted in CABG 1 year after presentation. The association of autoimmune endocrinopathies, thyroid carcinoma and MD suggests a possible cause and effect relationship between these disorders. In patients with diabetes and MD, previously described insulin resistance as well as cognitive dysfunction can hinder good glycemic control increasing risk for complications. Although patients with MD are typically treated by neurologists, evaluation and therapy of endocrine dysfunctions are also necessary.
X Y Zheng, S H Luo, X Y Wei, P Ling, H Y Ai, Z Y Liu, Q Y Lin, J Lü, B Yao, J H Yan, et al.
Published: 18 February 2020
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Wen-Chan Chiu, Yun-Ru Lai, Ben-Chung Cheng, Chih-Cheng Huang, Jung-Fu Chen, Cheng-Hsien Lu
Published: 25 January 2020
BioMed Research International, Volume 2020, pp 1-8; doi:10.1155/2020/7462158

Abstract:
Background. Glycemic variability is associated with higher risk of microvascular complications in patients with type 2 diabetes. Aim. To test the hypothesis that glycemic variability can contribute to progression to macroalbuminuria in normal or microalbuminuria in patients with type 2 diabetes. Design. This prospective study enrolled 193 patients with type 2 diabetes at a tertiary medical center. Methods. For each patient, the intrapersonal glycemic variability (mean, SD, and coefficient of variation of HbA1c) was calculated using all measurements obtained three years before the study. Patients were divided into four groups stratified by both urine albumin/creatinine ratio and HbA1c-SD. The presence of macroalbuminuria was assessed with Kaplan–Meier plots and compared by log-rank test. Results. Of the 193 patients, 83 patients were in the macroalbuminuria state. Patients in the initial macroalbuminuria group after enrollment had the highest diabetes duration, mean, CV-HbA1c and HbA1c-SD, and uric acid level, and the lowest estimate glomerular filtration rate, followed by subsequent macroalbuminuria and without macroalbuminuria groups. Patients with microalbuminuria and high HbA1c-SD showed the highest progression rate to macroalbuminuria, after a six-year follow-up study by Kaplan–Meier Plots and compared by log-rank test. Conclusions. Higher HbA1C variability is more likely to progress to macroalbuminuria in those patients who are already in a microalbuminuria state. We recommend that clinicians should aggressively control blood glucose to an acceptable range and avoid blood glucose fluctuations by individualized treatment to prevent renal status progression.
Asad Ullah, Rozi Khan, Jaffar Khan, Muhammad Saleem Panezai, Asad Khan Kakar, Muhammad Samsoor Zarak
Archives of Nephrology and Urology, Volume 3, pp 5-16; doi:10.26502/anu.2644-2833015

Abstract:
Objective: To determine the frequency of microalbuminuria in Type 2 Diabetes Mellitus with good glycemic control. Introduction: Diabetes Mellitus is a chronic illness, frequently not diagnosed until complications appear. Microalbuminuria is a renal marker of generalized vascular endothelial damage and early atherosclerosis. Patients with microalbuminuria are at increased risk of microvascular and macrovascular complications of Diabetes Mellitus like myocardial infarction, stroke, and nephropathy. Poor glycemic control increases the risk of microalbuminuria. Methodology: A cross-sectional study is conducted at the Department of Medicine, Bolan Medical College/ Sandeman Provincial Hospital Quetta, Pakistan. The duration of the study is six months from September 2016 to March 2017. A total of 140 Type 2 DM patients with good glycemic control is included in this study. 63 (45%) were female, and 77 (55%) were male with a mean age of 44.47 ± 4.99 years. The mean duration of DM is found to be 4.21 ± 0.94 years. The mean HbA1c level was found to be 6.74 ± 0.17. 21 patients (15%) were found to have microalbuminuria. Conclusion: There is an association of microalbuminuria in diabetic patients with good glycemic control; however, the prevalence is low, but it is still positive. Uncontrolled DM is strongly associated with the prevalence of microalbuminuria. Screening for microalbuminuria and HbA1c test should be done both in new and already diagnosed type 2 diabetic patients as an early marker of renal dysfunction and glycemic control.
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