Appropriateness of Using Tests for Blood Glucose and Diabetic Complications in Clinical Practice: Experiences in a Hospital in Thailand

Abstract

BackgroundThis study aimed to evaluate how the tests for blood glucose (BG) and diabetic complications have been utilized in a hospital in Thailand.Material/MethodsPatient medical records having the results of BG, HbA1c, and/or urine microalbumin presented and the records of DM patients having the results of serum lipids, serum LDL-C, and/or serum creatinine presented were selected. The data of diagnosis, ordered tests, and testing results in these records were extracted for evaluation.ResultsThis study recruited 1066 patients diagnosed with DM and 3081 patients diagnosed with other diseases. Point-of-care testing (POCT) for BG was repeatedly used in 371 non-DM cases; most of its results were normal. The results of BG and HbA1c were often used together. There was a good relationship between them, and these test results indicated poor glycemic control in 58% of DM cases. In non-DM cases, the test results agreed, indicating normoglycemia in 17.32%, pre-diabetes in 20.47%, and diabetes in 21.78%. To prevent diabetic nephropathy, serum creatinine was frequently used, whereas urine microalbumin, the recommended test, was underutilized. The result of LDL-C from both direct measurement and calculation were used; however, based on the same guidelines, the results of measured LDL-C indicated risk of cardiovascular diseases in a higher percentage of DM cases than did the results of calculated LDL-C.ConclusionsThe use of POCT for BG in hospitalized patients may be inappropriate. The utilization of urine microalbumin should be promoted to effectively prevent diabetic nephropathy.

Use of Estimated Glomerular Filtration Rate and Urine Albumin-to-Creatinine Ratio Based on KDIGO 2012 Guideline in a Thai Community Hospital: Prevalence of Chronic Kidney Disease and its Risk Factors

“…As previously reported [ 28 ], the UACR was rarely utilized alone but was frequently used along with SCr due to physicians’ familiarity with SCr. However, the rate of utilizing the UACR along with SCr was not high ( Table 2 ).…”

Albuminuric Status in Patients with Clinical Diabetic Retinopathy in Type II Diabetes Mellitus

“…2 Screening for microalbuminuria with a spot urine albumin/creatinine ratio has been recommended for identifying the early stages of diabetic nephropathy when physicians can manage to prevent the progression to renal failure. 5 Retinopathy is easily recognizable clinical manifestation and precedes the clinically manifest signs of nephropathy in same patient. The association between diabetic retinopathy and nephropathy is weaker in patients with type-2 diabetes mellitus as compared to type 1 diabetes.…”