Prevalence and Risk Factors of Diabetic Nephropathy in an Urban South Indian Population

Abstract

OBJECTIVE -The aim of this study was to determine the prevalence of diabetic nephropathy among urban Asian-Indian type 2 diabetic subjects.RESEARCH DESIGN AND METHODS -Type 2 diabetic subjects (n ϭ 1,716), inclusive of known diabetic subjects (KD subjects) (1,363 of 1,529; response rate 89.1%) and randomly selected newly diagnosed diabetic subjects (NDD subjects) (n ϭ 353) were selected from the Chennai Urban Rural Epidemiology Study (CURES). Microalbuminuria was estimated by immunoturbidometric assay and diagnosed if albumin excretion was between 30 and 299 g/mg of creatinine, and overt nephropathy was diagnosed if albumin excretion was Ն300 g/mg of creatinine in the presence of diabetic retinopathy, which was assessed by stereoscopic retinal color photography.RESULTS -The prevalence of overt nephropathy was 2.2% (95% CI 1.51-2.91). Microalbuminuria was present in 26. 9% (24.8 -28.9). Compared with the NDD subjects, KD subjects had greater prevalence rates of both microalbuminuria with retinopathy and overt nephropathy (8.4 vs. 1.4%, P Ͻ 0.001; and 2.6 vs. 0.8%, P ϭ 0.043, respectively). Logistic regression analysis showed that A1C (odds ratio 1.325 [95% CI 1.256 -1.399], P Ͻ 0.001), smoking (odds ratio 1.464, P ϭ 0.011), duration of diabetes (1.023, P ϭ 0.046), systolic blood pressure (1.020, P Ͻ 0.001), and diastolic blood pressure (1.016, P ϭ 0.022) were associated with microalbuminuria. A1C (1.483, P Ͻ 0.0001), duration of diabetes (1.073, P ϭ 0.003), and systolic blood pressure (1.031, P ϭ 0.004) were associated with overt nephropathy.CONCLUSIONS -The results of the study suggest that in urban Asian Indians, the prevalence of overt nephropathy and microalbuminuria was 2.2 and 26.9%, respectively. Duration of diabetes, A1C, and systolic blood pressure were the common risk factors for overt nephropathy and microalbuminuria. Diabetes Care 30:2019-2024, 2007D iabetic nephropathy is the leading cause of end-stage renal disease (ESRD) worldwide, and it is estimated that ϳ20% of type 2 diabetic patients reach ESRD during their lifetime (1). Kidney disease in diabetic patients is clinically characterized by increasing rates of urinary albumin excretion, starting from normoalbuminuria, which progresses to microalbuminuria, macroalbuminuria, and eventually to ESRD. Microalbuminuria is the earliest clinically detectable stage of diabetic kidney disease at which appropriate interventions can retard, or reverse, the progress of the disease.According to the most recent estimates published in the Diabetes Atlas 2006 (2), India has the largest number of diabetic patients in the world, estimated to be ϳ40.9 million in the year 2007 and expected to increase to ϳ69.9 million by the year 2025. Type 2 diabetes in Asian Indians differs from that in Europeans in several aspects: the onset is at a younger age, obesity is less common, and genetic factors appear to be more common (3). Some studies (4 -6) conducted in migrant Asian Indians in the U.K. and Europe have reported increased prevalence of diabetic nephropathy compared wit...

Tele-diabetology to Screen for Diabetes and Associated Complications in Rural India

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Type-2 Diabetes Mellitus; Frequency of Microalbuminuria in Patients Having Diabetic Retinopathy in Nishter Hospital Multan

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